Module 1 4

Maternal and Child Care Nursing
(NUR1204) BATCH 2025

INSTITUTE OF HEALTH SCIENCES AND NURSING – FAR EASTERN UNIVERSITY MANILA
TRANSCRIBED BY: Johana Chariz B. Ramos
LECTURER/S: Ms. Annaliza Alfonso, Ms. Cristina Tianela, Dr. Wilfredo Quijencio
TOPIC OUTLINE CENTERING/  see only one of the object’s

1 Growth and Development EGOCENTRISM characteristics
2 Principles of Growth and Development
3 Factors affecting Growth and Development DEVELOPMENT  increase in skill or ability to
4 Structures of Personality function
5 Theories of Development GROWTH  increase in no. and size of
6 Nursing Process (ADPIE) cells, measured in terms of
quantity; orderly and predictable
but not even
OVERVIEW
DEVELOPMENTAL  skill or growth responsibility
NEWBORN After birth until 1 mo
TASK arising at a particular time in an
INFANCY 1 mo - 12 mos individual’s life, the achievement
TOODLER 12 mos – 3 years of which will provide a
PRESCHOOL 3 – 6 years old foundation for the
SCHOOL AGE 6-12 years old accomplishment of future tasks
ADOLESCENCE 12 or 13 until beginning of adulthood REVERSIBILITY  ability to retrace steps
THEORY  systematic statement of
UMBILICAL CORD (AVA) principles that provides a
 two arteries and one vein framework for explaining some
phenomenon
VERNIX CASEOSA MATURATION  development of cells until
 white, creamy substance covering the skin of fetus they are ready to function
 provide warm to the baby / prevent hypothermia SCHEMAS  they are the finer units of
 until 24 hours newborn must not receive a bath each stage of cognitive
development according to Piaget
COLOSTRUM ROLE FANTASY  how preschoolers would like
 first milk in body produces during pregnancy something to turn out
 after 3 days the milk will be released PERMANENCE  infants learn objects in the
NOTE: environment - their bottles,
Breastfeeding: 6 mos – 2 years and beyond blocks, bed, or even a parent –
Bottlefeeding: up to 3 years old (not encourage in are permanent and continue to
hospitals by WHO) exist even though they are out
of sight or changed in some way.
GROWTH AND DEVELOPMENT SENSIMOTOR  practical intelligence during
INTELLIGENCE infancy, because words and
DEFINITION OF TERMS symbols for thinking and
 capable of thinking in terms problem solving are not yet
ABSTRACT of possibility rather than limited available at this early age.
THOUGHT to thinking about what already is TEMPERAMENT  usual reaction pattern of an
 changing ideas to fit reality individual or an individual’s
ACCOMMODATION characteristic manner of
 animals and inanimate thinking. Behaving or reacting to
ANIMISM objects as being capable of stimuli in the environment. It is
thought and feelings also known an inborn characteristic.
as magical thinking
ASSIMILATION  taking in info and changing it PARAMETERS OF GROWTH
to fix their existing ideas WEIGHT  measured in grams,
kilograms or pounds solving are
CONSERVATION  ability to discern truth, even HEIGHT  measured in inches, feet or
though physical properties centimeters
change
J.C.RAMOS 1
8. Early foundations are critical

DEVELOPMENT 9. Each phase of development has hazards
Direct observation of child’s performance 10. Each phase of development has characteristic
Note parents’ description of child’s progress behavior
Use of DDST (Denver Developmental Screening Test), 11. There is an optimum time for initiation of
modified as MMDST (Metro Manila Denver developmental experiences or learning
Developmental Screening Test) in the Philippines 12. Most developmental skills and behaviors are
learned by practice
13. Neonatal reflexes must be lost before motor
FIVE MAIN AREAS OF DEVELOPMENT
development can proceed
PHYSICAL Height, strength, etc.
14. Development is affected by cultural changes
EMOTIONAL Trusting relationships, attitudes,
15. There are social expectations for every stage
sense of self as an individual, feelings
of development
INTELLECTUAL Thinking and understanding
16. Development is a product of heredity and
SOCIAL 3interactions
environment
SPIRITUAL Search for transcendental meaning
MAJOR FACTORS INFLUENCING GROWTH AND

HAVIGHURST’S DEVELOPMENTAL TASKS
DEVELOPMENT
GENETICS Physical characteristics, learning

style and temperament, genetic
abnormality
GENDER (e.g. girls born 1 oz lighter than boys
)
HEALTH
INTELLIGENCE (e.g. children w/ high intelligence
tend to grow and develop late)
ENVIRONMENT a. Socioeconomic level
b. Parent-child relationship
c. Ordinal position in the
family
d. Heallth
TEMPERAMENT Inborn characteristic which is the
response pattern of an individual or
an individual’s characteristic manner
PRINCIPLES GROWTH AND DEVELOPMENT of thinking. Behaving or reacting to
1. Growth and development are continuous stimuli in the environment. It is an
processes from conception until death inborn characteristic
2. All aspects of development are interrelated
3. Growth is continuous and gradual
4. Growth is not uniform REACTION PATTERNS THAT DETERMINE
5. Growth and development follows an orderly TEMPERAMENT
pattern ACTIVITY LEVEL Differs widely
a. Cephalocaudal RHYTHMICITY With set patterns (e.g. Highly
b. Proximo-distal – motor development rhythmic babies fall into a
c. General to specific (Gross refined) – fine routine naturally, waking and
movement development sleeping at the same times every
6. There are periods of accelerated and day, being hungry at predictable
decelerated growth rate times and eliminating on
7. All individuals are different schedule.
J.C.RAMOS 2
Babies with low rhythmicity are SUPEREGO  Developed during preschool

unpredictable - they may sleep  Conscience – morality principle
for hours one day and skip nap Emerges around at the age of 5
altogether the next day
APPROACH Response on initial contact with
a new stimulus FACTORS AFFECTING PERSONALITY DEVELOPMENT
ADAPATABILITY Change one’s reaction to stimuli HEREDITY Characteristics present at birthy: body
over time build, eye color, skin, hair type, certain
INTENSITY OF aptitudes
REACTION BIRTH First born, middle child, later born
DISTRACTIBILITY Shift easily to a new situation ORDER
ATTENTION SPAN Remain interested to a project PARENTS Age of parents, occupation, economic
AND PERSISTENCE or activity status, religious orientation, level of
THRESHOLD Intensity level of stimulation education, and cultural heritage
RESPONSE necessary to evoke reaction CULTURE
MOOD QUALITY Negative or positive condition
THEORIES OF CHILD DEVELOPMENT

CATEGORIES OF TEMPERAMENT  Developmental theories provide road maps for
explaining human development
EASY CHILD Easy to care for; 40% to 50% of
 Achievement of developmental task or growth task
children
which will provide for the accomplishment of future
DIFFICULT CHILD Withdraw rather than approach
tasks.
new situations, 10% of children
 Chronologic age
INTERMEDIATE Combination of the easy and the
 It is not so much chronologic age as the completion
CHILD difficult child
of developmental tasks that defines whether a child has
SLOW-TO-WARM- Adapts slowly to new situations;
passed from one developmental stage of childhood to
UP CHILD 15% of children another
STRUCTURES OF PERSONALITY
PSYCHOANALYTIC THEORY BY SIGMUND FREUD
 adult behavior is a result of instinctual drives that
DEVELOPMENT OF MENTAL FUNCTION AND have a primary sexual nature (libido)
PERSONALITY DEVELOPMENT  child development is a series of Psychosexual stages
Individual adjustment to his environment in which a child’s sexual gratification becomes focused
Covers appearances, abilities, motives, emotional on a particular body part at each stage
reactivity and experiences that have shaped him to his
present person
Early experiences influence behavior later in life INFANT “Oral phase”; infants are so
Mostly established by the age of 5 interested in oral stimulation or
pleasure during this time
TODDLER “Anal phase”; children focused
STRUCTURE OF PERSONALITY on anal region as they begin
ID  Developed during infancy toilet training
 Operates on pleasure principle Pleasure in both retention of
to reduce feces and defecation
EGO  Developed during toddler PRESCHOOLER “Phallic phase”; masturbation
period and exhibitionism (expose
genitals)
 Reality principle
SCHOOL AGE “Latent phase” (exist but not
 Promotes satisfactory
fully developed); children libido
adjustment in relation to the
diverted into concrete thinking
environment
J.C.RAMOS 3
ADOLESCENT “genital phase”; establishment Tertiary Circular 12 – 18 Explore properties of

of new sexual aims and finding Reactions mos objects through
new love objects novel actions
Mental 18 mos – Internal depictions
Representations 2 years of objects or events,
PSYCHOSOCIAL DEVELOPMENT BY ERIK ERIKSON
deferred imitation
 8 Developmental stages
 each stage there is a conflict bet. 2 opposing forces
 resolution of each conflict, allows individual to go on
Stage 2:PREOPERATIONAL
next phase of development
 2 – 7 yo
 Concept formation, symbolic reasoning
Stage 3:OPERATIONAL
 7 – 11 yo
 Logical operations on concrete objects and
events
Stage 4:FORMAL OPERATION

 Beginning at 12 years and beyond
 Abstract, analogies, metaphors, hypothetical
reasoning
COGNITIVE DEVELOPMENT BY JEAN PIAGET

 4 stages
INFANT  Sensorimotor stage
 each stage there is finer units or schemas  Sensorimotor intelligence is
 each period is an advance over the previous one practical intelligence
 to progress, child must reorganize their thinking  Gain concept of
processes to bring them closer to adult thinking permanence
TOODLER  Complete final stages of
sensorimotor period
Stage 1: SENSORIMOTOR  Begin to develop some
cognitive skills of
 Birth – 18 months or 2 years
preoperative period
 Knowing by sensing and acting
(symbolic thought and
SENSORIMOTOR STAGES
egocentrism thinking)
Reflective Birth – 1 Newborn reflexes PRESCHOOL  Moving on to a substage of
Schemes mo
preoperational thought,
Primary Circular 1 - 4 mos Simple motor habits intuitive thought
Reactions centered around
 Preschoolers believe in:
own body
 Centering
Secondary 4 - 8 mos Repeat interesting
 Lack of conservation
Circular effects in sounding
 Animism and magical
Reactions
thinking
Coordination of 8 – 12 Intentional, goal-
 Role fantasy
Secondary mos directed behavior,
 Assimilation
Circular object permanence
Reactions  Accommodation
J.C.RAMOS 4
SCHOOL AGE  Beginning of concrete

operational thought PRESCHOOL  Individualism and exchange
 Recognize cause and effects  “lie still now for me while I
relationships change dressing and I will
 Conservation read you a story when I am
 Inductive reasoning (specific through”
to general) SCHOOL AGE  Conventional development:
 Reversibility (water has the nice girl, nice boy”
same amount even when  Engage in actions that are
poured to a container) “nice” or “fair” rather than
ADOLESCENT  Formal operational thought necessarily right
 Capable of:  “when people see what
a. Abstract thinking have done, they will think I
b. Deductive reasoning am a good person”
(general to specific) ADOLESCENT  Postconventional
development: Law and
Social order
 “but there is no rule that
MORAL DEVELOPMENT BY LAWRENCE KOHLBERG says that I can’t do it
 children gain knowledge of right and wrong or
moral reasoning
NURSING PROCESS
ASSESSMENT FOR PROMOTION OF NORMAL GROWTH

AND DEVELOPMENT
 Measure and plot height and weight in a
standard growth chart for children at all
health care visits to document growth is
occurring and the child’s growth remains
within a constant percentile.
 Take a health history from both parents and
the child and observe what specific activities
the child can accomplish to establish whether
developmental milestones (major markers of
INFANT  Pre-religious stage normal development) are being met.
 Little concept of any  Document a 24 hour recall history for
motivating force beyond nutritional intake, sleep, and a description of
their parents school and play behaviors
 To support this stage,
caregivers must praise
infants for doing what they
NURSING DIAGNOSIS
have been asked to do
When assessment is completed, a child profile can be
TOODLER  Preconventional stage:
devised and needs and problems identified. Examples
punishment obedience
of nursing diagnoses applicable to this area included:
orientation
 Risk delayed growth and development related
 “I help take care of my
to lack of age appropriate toys and activities
brother because if I don’t,
 Delayed growth and development related to
my mother will punish me”
prolonged illness
J.C.RAMOS 5
 Readiness for enhanced family coping related MODULE 2: THE INFANT

to parent’s seeking information about child’s
growth and development TOPIC OUTLINE
 Health-seeking behaviors related to 1 Definition of Terms
appropriate stimulation for infants 2 Physiologic Development
 Imbalanced nutrition, less than body 3 The Infant’s Body Systems
requirements, related to parental knowledge 4 The Infant’s Senses
deficit regarding child’s protein need 5 Motor Development
 Deficient knowledge related to potential long- 6 Freud’s Theory of Psychosexual Development
term effects of obesity in school-age child 7 Social and Emotional Development
8 Language Development
9 Erikson’s Theory of Psychosocial Development
OUTCOME IDENTIFICATION AND PLANNING 10 Piaget’s Theory of Cognitive Development
1. To provide holistic nursing care, consider all 11 Feeding and Nutrition
aspects of a child’s health (physical, 12 Nursing Process (ADPIE)
emotional, cultural, cognitive, spiritual,
nutritional, and social), remembering that
each child’s developmental progress is
DEFINITION OF TERMS
unique.
 ability to fuse two images as
2. Children cannot be forced to achieve
BINOCULAR one at 2 months
milestones faster than their own timetable
VISION
will allow.
 also known as infant caries.
3. Interventions to foster growth and
BABY-BOTTLE Tooth decay that occurs while an
development include encouraging age-
SYNDROME infant sleeps liquid from the
appropriate self-care in a child and suggesting
propped bottle continuously soaks
age-appropriate toys or activities to parents.
the upper front teeth and lower
4. Role modeling is an important ongoing
back teeth
intervention with both children and families
 paroxysmal abdominal that
COLIC (KABAG) generally occurs in infants under 3
months of age and is marked by
OUTCOME EVALUATION
loud, intense crying
If a child has difficulty achieving one developmental
DIAPER  also known as diaper rash, when
task, for example, the next one may be difficult to
DERMATITIS child’s diaper is not frequently
achieve as well. Evaluation must also be
changed, feces is left in contact with
comprehensive. If a developmental task involves only
skin, and irritation may result in the
gross motor function, it may not be apparent that
perianal area
something is wrong with a child’s fine motor function
MILIARIA  or prickly heat rash. Clusters of
until the child is asked to perform fine motor tasks in
pinpoints, reddened papules with
school.
occasional vesicles (tubig) and
Examples of expected outcomes are:
pustules surrounded by erythema
 Child, 5 years of age, expresses less
MILK TEETH  it is the first baby tooth (typically
negativism at next clinic visit.
a central incisor) usually erupts at
 At 9-month checkup, parents describe how
age 6 months
they have made a safe space in their home
PARACHUTE  when infants are suddenly
for their infant to crawl so that he is not
REACTION lowered toward an examining table
confined to a playpen.
from ventral suspension, the arms
extend as if to protect themselves
from falling
PHYSIOLOGIC  – condition present at 2 to 3
ANEMIA months of age. This occurs because
the life of a red cell is 4 months so
the cells the child had at birth are
J.C.RAMOS 6
disintegrating, but new cells are not HEAD CIRCUMFERENCE

yet being produced in adequate  End of first year, brain is two thirds of its
replacement numbers adult size
SOLITARY PLAY  independent play, when infants  Head circumference increases rapidly
play alone  Some infants’ heads appear asymmetric until
VENTRAL  the position of an infant when the second half of the first year
SUSPENSION held in midair on a horizontal plane,  Place infant on his back to sleep and prone
supported by a hand under the when playing
abdomen. It is used to test gross  Persistence of asymmetry may suggest an
motor ability infant lacks stimulation or most of the time
PHYSIOLOGIC DEVELOPMENT BODY PROPORTION

Physiologic development proceeds in a continuous  Body proportion changes from that of a
fashion after birth although some of the body systems newborn to a more typical infant appearance
remain immature during infancy. The immaturity of the  The mandible becomes more prominent
systems accounts for the infantile patterns of behavior  End of infant period, lower jaw is prominent
and of physical and mental abilities characteristics of  Chest circumference is less than that of the
this stage head at birth by about 2 cm
 6 to 12 months, CC = HC
 Abdomen remains protuberant
PHYSICAL GROWTH  Cervical, thoracic, and lumbar vertebral
The physiologic changes that occur in the infant year curves develop
reflect both the increasing maturity and growth of body  7 months lower extremities lengthen
organs. The following sections will discuss the changes  Changes appearance from “baby-like” to
that are typically seen in the first year of life “toddler-like”
WEIGHT THE INFANT’S BODY SYSTEMS

 During the first 6 months, infants typically
average a weight gain of 2 lbs per month
6 months = Birth weight X2
CARDIOVASCULAR SYSTEM
 During the second 6 months, weight gain is
 Heart rate slows from 120 to 160 bpm to 100
approximately 1 lb per month.
to 120 bpm
1 year = Birth weight X3
 Slightly elevated blood pressure (from an
average of 80/40 to 100/60 mmHg)
 Physiologic anemia at 2 to 3 months of age
HEIGHT
 5 to 6 months, Hemoglobin converted from
 Increase in height during first year by 50%, or fetal to adult hemoglobin
from average birth length of 20 inches to
 6 to 9 months, second decrease in serum iron
about 30 inches (50.8 to 76.2 cm)
levels
 During the early months growth most
apparent in the trunk
 During the second half of the first year,
RESPIRATORY SYSTEM
growth more apparent as lengthening of the
 Respiratory rate slows from 30 to 60 breaths
legs
per minute to 20 to 30 breaths per minute
 At end of first year, child’s legs may still
appear disproportionately short and bowed
GASTROINTESTINAL SYSTEM
 Gastrointestinal tract mature gradually
 Amylase deficient until 3rd month
J.C.RAMOS 7
 Lipase is decreased can follow an object across their

 Liver remains immature 3 MONTHS midline, Has hand regard
 Extrusion reflex fades at 3 to 4 months 4 MONTHS recognizes familiar objects, follow
 6 months, eruption of first baby tooth or milk parents’ movements with their eyes
teeth (central incisor) 6 MONTHS begin to perceive distances
accurately.
7 MONTHS depth perception has matured
RENAL SYSTEM 10 MONTHS beginning of object permanence
 Kidneys remain immature
 Prone to dehydration because of fluid shifting
in body fluid compartments HEARING
quiets momentarily at a distinctive
1 MONTH sound
ENDOCRINE SYSTEM hearing awareness becomes so
 Unable to respond to stress effectively due to 2 MONTHS acute
immature endocrine system in response to
pituitary stimulation turns heads to attempt to locate a
3 MONTHS sound
4 MONTHS turns and looks in the direction of a
IMMUNE SYSTEM distinctive sound
 2 months, immune system becomes 5 MONTHS can localize sounds downward and
functional to the side
 At 1 year, can actively produce both IgG and 6 MONTHS able to locate sounds made above
IgM antibodies them
 Levels of other immunoglobulins (IgA, IgE, 10 MONTHS perception has matured
and IgD) are not plentiful until preschool age 12 MONTHS can easily locate sound in any
 6 months, can shiver if cold and has direction and turn toward it. A
developed additional adipose tissue for vocabulary of two words plus
insulation “mama” and “da-da” also
demonstrates an infant can hear
INTEGUMENTARY SYSTEM
 Skin is more permeable so insensible water TOUCH
loss and penetration of invasive materials are  An infant need to be touched to experience
increased skin-to- skin contact.
 Milia and cradle cap develop due to increased  Clothes should feel comfortable and soft;
sebum production diapers should be dry rather than wet.
 Sweat glands do not actively form  Teach parents to handle infants with
perspiration assurance and gentleness.
THE INFANT’S SENSES TASTE

 Infants demonstrate that they have an acute
sense of taste by turning away from or
VISION spitting out a taste they do not enjoy.
regards an object in the midline of  Urge parents to make mealtime a time for
1 MONTH their vision as close as about 18 fostering trust as well as supplying nutrition
inches away.  Feedings done at an infant’s pace
has achieved binocular vision, or the  Amount of feeding offered fits the child’s
2 MONTHS ability to fuse two images into one. needs
J.C.RAMOS 8
SMELL 6 MONTHS  Demonstrates parachute

 Infants can smell accurately within 1 or 2 reaction from a ventral suspension
hours after birth position
 Respond to an irritating smell by drawing  Rests weight on hands with
back from it extended arms
 Enjoy pleasant odors and learn early in life to  Raises chest and the upper part
identify the familiar smell of breast milk of their abdomen off the table
 Sits momentarily without
support
MOTOR DEVELOPMENT  Supports nearly full weight when
Gross motor development - ability to accomplish large in a standing position
body movements 7 MONTHS  Reaches out to be picked up
Fine motor development - ability to coordinate hand  Sits alone, but only when hands
movements are held forward for balance
 Bounces with enjoyment in a
standing position.
GROSS MOTOR DEVELOPMENT 8 MONTHS  Sits securely without support
9 MONTHS  Creeps or crawls (abdomen off
 Lifts head momentarily, then
floor)
1 MONTH drops it again
 Sits so steadily, can lean forward
 Turns head to the side
and regain balance
 Gross head lag as in the first days
of life 10 MONTHS  Pulls self to standing
 Raise their heads and maintain 11 MONTHS  Cruises (walks with support)
2 MONTHS the position, but they cannot raise 12 MONTHS  Stands alone
their chests high enough to look  Some infants take first step
around yet
 Lifts and maintains the head well
3 MONTHS above the plane of the rest of the FINE MOTOR DEVELOPMENT
body in ventral suspension  Keeps hands fisted
Slight head lag when pulled to a 1 MONTH  Able to follow object to midline
sitting position with eyes
Begins to try to support part of their 2 MONTHS  demonstrate social smile
weight when held in standing 3 MONTHS  follows object past midline with
position. eyes
4 MONTHS  Lifts chest off the bed and look 6 MONTHS  uses palmar grasp
around actively, turns head from 7-8 MONTHS  transfers objects to hand
side to side, turns from back to 9-10 MONTHS uses pincer grasp (thumb and
front; finger) to pick up small things
 No head lag when pulled to a 12 MONTHS  Holds cup and spoon well
sitting position Helps dress (pushes arm into
 Stepping reflex has faded, begins sleeve)
to support weight on legs
5 MONTHS  Rests weight on their forearms
when prone FREUD’S THEORY OF PSYCHOSEXUAL DEVELOPMENT
 Turns over, front to back and vice  Oral stage of development
versa  The site of gratification is the mouth and
 Continues to sustain a portion of receives gratification through sucking
weight  Sucking, biting, and crying are for enjoyment;
 Tonic neck reflex should be release of tension and for nourishment
extinguished
 Moro Reflex is fading
J.C.RAMOS 9
SOCIAL AND EMOTIONAL DEVELOPMENT 12 MONTHS say two words besides “mama” and
1 MONTH Differentiate between faces and “da-da”; they use those two words
other objects with meaning; “Baby sleep””
2 MONTHS Social smile
3 MONTHS Demonstrates increased social
awareness: 1. WHOLE SENTENCES STAGE
 readily smiling at the “Doggie is big”
sight of a parent’s face
 laugh out loud at the ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
sight of a funny face.
4 MONTHS recognizes primary caregiver
5 MONTHS shows displeasure when an object is TRUST VS MISTRUST
taken away  Child begins to separate himself from
6 MONTHS aware of the difference between environment and becomes aware that his
people who regularly care for them actions can influence others around him.
and strangers.  Infants first learn to trust others in the
7 MONTHS shows obvious fear of strangers; environment to meet their needs.
cries when taken from parents  Social smile on the third month
8 MONTHS eighth month anxiety, or stranger
anxiety
9 MONTHS very aware of changes in tone of PLAY
voice; cries when scolded  Solitary play or independent play
12 MONTHS has overcome fear of strangers and  Use their bodies as the primary avenue to
is alert and responsive again when explore the world.
approached; likes to play interactive  Learn to participate in and control simple
nursery rhymes and rhythm games social interactions with caregivers.
and “dance” with others  Learn to recognize, explore, and control
objects, sights, sounds, textures, and tastes.
 Explore, master, and learn to use their body
LANGUAGE DEVELOPMENT
parts.
 Learn how to get desired reactions from
1. PRE-VERBAL STAGE
people and objects
2 MONTHS makes cooing sound; differentiates
a cry
3 MONTHS laughs out loud PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
4 MONTHS cooing, babbling, and gurgling when  Piaget identifies four stages of cognitive
spoken to development during infancy. He calls it the
5 MONTHS says some simple vowel sounds sensorimotor period.
“goo-goo” and “gah-gah”) REFLEXIVE  birth to 1 month
6 MONTHS imitates sounds like a parent’s SCHEMA  Infant’s innate reflex
cough to attract attention
responses, such as
7 MONTHS imitates vowel sounds well “oh-oh,” sucking, are organized
“ah-ah,” and “oo-oo” into functioning patterns
PRIMARY  1-4 months
CIRCULAR  Infant actions lead to
2. HOLOPHRASTIC STAGE (ONE-WORD SPEECH) REACTION chance events that have
9 MONTHS speaks a first word: “da-da” or “ba- positive value, and he
ba” gradually learns how to
make the event happen
3. TELEGRAPHIC STAGE again and again.
J.C.RAMOS 10
SECONDARY  4-8 months  Introduce small amounts

CIRCULAR  Learns to make events of new food (1- 2 tsp at a
REACTION happen with objects time)
separate from his own  Use teaspoon only -
body. Through repeated Respect infant food
activity, the infant preferences
develops awareness of the  Use only minimal to no
outcome of his actions. salt and sugar on solid
 He keeps repeating the foods to minimize the
same acts with different number of additives
objects, learning about  To prevent aspiration., do
their properties in the not place food in bottles
process with – formula
COORDINATION  8-12 months 7-9 MONTHS  Introduce finger foods &
OF SECONDARY  The child becomes more cup when infant is able to
CIRCULAR coordinated in his sit up
REACTION movements, more aware  Have infant join family at
of objects about him and mealtimes
makes interesting  Allow self-feeding with
innovations in using and observation to prevent
exploring them. choking; offer small piece
 He recognizes that objects of fruits or grapes, not
and persons as separate large chunks - Offer fluids
from himself. Thus, he after solids.
searches for the lost  Introduce limited amounts
objects outside his visual of diluted juice in a cup. -
field. Avoid sugary deserts and
soda.
10-12 MONTHS  Offer 3 meals and healthy
NUTRITION AND FEEDING OF AN INFANT
snacks.
 Begin to wean from bottle
and beginning table foods
0-3 MONTHS  Feed only on breast milk  Avoid fruit drinks and
or formula flavored milk.
 Limit water intake to 1⁄2  Avoid infant to feed self
oz at a time for bottle with spoon. By 1 year,
feeding; no water for stomach can hold no more
breast feeding infants than approximately 1 cup
 Avoid use of honey or (240 ml)
corn syrup - Allow non-
nutritive sucking
4-6 MONTHS  Introduce solid foods GUIDELINES FOR INTRODUCING SOLID FOOD
without added salt or
sugar and iron-fortified
cereal. 5-6 MONTHS Iron-fortified cereal mixed with
 Introduce one food at a breast milk, orange juice or formula.
time, waiting 5 to 7 days - Cereal is the least allergenic type
between new items. of food and is easily digested.
 Introduce food before 7 MONTHS Vegetables like boiled and mashed
formula or breast feeding carrots, potatoes, broccoli can be
when an infant is hungry introduced.
J.C.RAMOS 11
8 MONTHS fruits like banana, apple, and peach EVALUATION

are introduced. Evaluate expected outcomes at each visit to detect
9 MONTHS Boiled meat is added changes in parents’ understanding of caring for their
10 MONTHS Egg yolk is introduced infant. Help parents understand all aspects of infant
care, not just a single element
NURSING PROCESS
EXAMPLES OF EXPECTED OUTCOMES INCLUDE:
ASSSESSMENT OF AN INFANT 1. Mother states she feels fatigued but able to
1. Begins with an interview with the primary cope with sleep disturbance from night
caregiver waking.
2. Important areas to discuss include nutrition, 2. Parents state five actions they are taking daily
growth patterns, and development to encourage bonding.
3. Infant’s height, weight, and head 3. Father states both he and spouse are adjusting
circumference are important indicators of to new roles as parents.
growth → anthropometric measurements 4. Parents verbalize appropriate techniques they
4. Physical assessment must be done quickly use to stimulate infant.
5. Primary caregiver should be present to make 5. Infant demonstrates age-appropriate growth
child feel comfortable and development.
6. Use calm approach so infant remain calm as 6. Infant exhibits weight, height, and head and
well chest circumference within acceptable norms
NURSING DIAGNOSIS FOR INFANTS

1. Delayed growth and development related to
lack of stimulating environment
2. Risk for impaired parenting related to long
hospitalization of infant
3. Readiness for enhanced family coping related
to increased financial support
4. Social isolation (maternal) related to lack of
adequate social support
5. Ineffective role performance related to new
responsibilities within the family
IMPLEMENTATION OF SAFE & QUALITY NURSING

INTERVENTIONS
1. Outcomes established for infant care need to
be realistic based on the family’s new
circumstances.
2. Parents of infants must do a lot of adjusting,
and this takes time.
3. Suggest activities that can be easily
incorporated into the family’s lifestyle.
4. Suggest that caretaker talk to the infant more.
5. Spend additional time each evening reading or
reciting nursery rhymes to the baby. 6. Teach
new parents on how to care for their infant
and keep the infant safe.
J.C.RAMOS 12
MODULE 3: THE TODDLER with it, she may shake it to see if it

rattles)
TOPIC OUTLINE  the tendency to focus on only
1 Toddler’s Creed CENTRATION one aspect of a situation at one
2 Definition of Terms time
3 Assessing Average Toddler DEFERRED  able to remember an action
4 Physiologic Development IMITATION and imitate it later
5 Motor Development DISCIPLINE  is setting rules and road signs
6 Developmental Milestones so children know what is expected
7 Freud’s Theory of Psychosexual Development of them
8 Psychosocial Development EGOCENTRISM  child's inability to see a
9 Social and Emotional Development situation from another person's
10 Language Development point of view.
11 Toddler Play LORDOSIS  It is the forward curve of the
12 Piaget’s Theory of Cognitive Development spine at the sacral area seen in
13 Moral Development toddlers
14 Nutrition PARALLEL PLAY  When children play beside
15 Nursing Process other children, not with them or
side-by-side play.
OVERVIEW PUNISHMENT  consequence that results from
a breakdown in discipline, from
 Time of dramatic change, both physical and
child’s disregard of the rules that
psychosocial that form the basis for care and
we learned
health teaching
SEPARATION  A child becomes fearful and
 Covers from 1-3 years
ANXIETY nervous when away from home or
 Accomplish a wide array of developmental
separated from a loved one,
tasks like walking, talking, a growing sense of
usually a parent or other
autonomy
caregiver, to whom the child is
 To match this growth, parents must also
attached
change during this period
SIBLING RIVALRY  feeling of jealousy of a toddler
every new baby enters into his
domain
TODDLER’S CREED
SYMBOLIC  ability to make one thing – a
"If I want it, it's mine. REPRESENTATION word on an object – stand for
If I give it to you and change my mind later, it's mine. something other than itself
If I can take it away from you, it's mine.
If I had it a little while ago, it's mine.
If it's mine it will never belong to anyone else, no
ASSESING AVERAGE TODDLER
matter what.
If we are building something together, all the pieces are
mine.
If it looks like mine, it's mine."
DEFINITION OF TERMS
 the belief that inanimate
ANIMISM objects (such as toys and teddy
bears) have human feelings and
intentions.
ASSIMILATION  uses toys in the wrong way (toy
hammer = instead of pounding
J.C.RAMOS 13
PHYSIOLOGIC DEVELOPMENT E. DENTITION

 2 yrs old 8 new teeth erupt (canines and first
A. WEIGHT AND HEIGHT
molars)
 Gains about 5 to 6 lb (2.5 kg) and 5 in. (12
 2.5 to 3 yrs. old all 20 deciduous teeth
cm)/yr.
present
 Subcutaneous, or baby fat, begins to
disappear toward the end of the second year
 Changes from a plump baby into a leaner,
MOTOR DEVELOPMENT
more muscular little girl or boy.
This is a period of slow and steady, but not sudden,
 Appetite decreases accordingly, adequate
intake of all nutrients is still essential to meet growth, thus, developmental milestones are less
energy needs.
Toddler development is influenced by:
a. amount of social contact
B. HEAD CIRUMFERENCE b. number of opportunities for exploring
 HC increases 2 cm during the second year c. experience new degrees of independence d.
 compared to about 12 cm during the first individual readiness for a new skill
year.
 HC = CC at 6 months to 1 year of age
 By 2 years, CC is greater than the head DEVELOPMENTAL MILESTONES
GROSS MOTOR DEVELOPMENT

12 MONTHS  picks things up while standing
C. BODY PROPORTION  walks even when only one
 Has prominent abdomen because, although hand is held
they are walking well, their abdominal  Move and sway to music
muscles are not yet strong enough to support 15 MONTHS (1  walks alone
abdominal contents year and 3 mos)  can seat self in chair
 They also have a forward curve of the spine at  can creep upstairs
the sacral area (lordosis) 18 MONTHS  can push a chair around, climb
 May waddle or walk with a wide stance which and get down from it
keeps them on their feet.  walk up and down the stairs
holding on to rails
 can run and jump in place
D. BODY SYSTEMS places both feet on one step
 Body systems continue to mature before advancing
 RR slightly slow and mainly abdominal 2 YEARS(24 mos)  walks up the stairs alone, still
using both feet on same step at
 HR slows from 110 to 90 beats/min
same time
 BP increases to 99/64 mmHg
2 ½ YEARS  jumps from step or chair
 Brain is about 90 % of its adult size
 balances one foot momentarily
 Stomach secretions is more acidic
3 YEARS  walks backwards
 Stomach capacity increases: can eat 3 meals a
 pedals a tricycle
day
 jump down from chairs
 Complete myelination of the spinal cord so
toilet training is possible.
 Immune globulin IgG and IgM antibody
production becomes mature at 2 years of age. FINE MOTOR DEVELOPMENT
 The passive immunity obtained during 12 MONTHS  pick up objects bet. thumb and
intrauterine life is no longer operative one finger
J.C.RAMOS 14
15 MONTHS (1  holds a spoon well but still  Temper Tantrums decrease by 2 ½ years
year and 3 mos) turns upside down on the way to  Vocabulary increases from about 10-20 words
the mouth to over 900 words by 3 years
scribble with markers or  Has beginning awareness of ownership at 18
crayons mos
 drop a pellet into a narrow-  Shows proper uses of pronouns by 3 years
necked bottle  Moves from hoarding and possessiveness at
18 MONTHS  color or paint by moving the 18 mos to sharing with peers by 3 years
entire arm  Beginning of problem solving
 holds a spoon well and no
longer rotates
2 YEARS (24 mos)  turn knobs and handles AUTONOMY VS DOUBT AND SHAME
30 MONTHS  make simple lines or strokes for  Autonomy develops when child is permitted
crosses with a pencil to assert himself. They feel secure and
3 YEARS (36 mos)  copies circle, uses scissors, confident
button and unbuttons  Shame and doubt develop if child does not
develop a sense of trust/or learns his
FREUD’S THEORY OF DEVELOPMENT: ANAL STAGE assertiveness as “is not acceptable”
 There is sense of inadequacy and self-doubt
 Toilet training
 Child finds pleasure in both retention of feces
(holding it) and in defecation (letting it go). HOW TO DEVELOP AUTONOMY
 This anal interest is part of child's discovery of 1. Give an opportunity for decision making such
self and a way of exerting his independence. as offering choices
 Toilet training usually completed by 3 years 2. Encourage the child to make decisions rather
than judge
CUES FOR TOILET TRAINING READINESS 3. Toddlers begin to develop their sense of
a. Can stand, squat and walk alone. autonomy by asserting themselves with the
b. Can communicate toilet needs. frequent use of the word “no”
c. Can maintain himself or herself dry at an  Although they like to explore the
interval of 2 hours. environment, they always have a
significant person nearby.
 Receptive & expressive language skills
ADULT CHARACTER
are developing quickly.
ANAL  a.k.a. anal aggressive 4. One of the most admirable and frustrating
EXPLUSIVE  little self-control, sloppy, things about two and three-year-olds is their
PERSONALITY disorganized, generous to a fault. determination
maybe cruel, destructive, hostile 5. “Can do” is their motto
and given to vandalism and graffiti.  If we can preserve that "can do" attitude
ANAL  tend to be overly clean, (with appropriate modesty to balance it)
RETENTIVE perfectionist, dictatorial, very we are much better off as adults.
PERSONALITY stubborn, and stingy, or is tight in all
ways.
BEHAVIORS TO OBSERVE
 Shows a sense of "me"
ERIKSON’S PSYCHOSOCIAL DEVELOPMENT:
 Negativism
AUTONOMY VS DOUBT AND SHAME
 Ritualistic and stereotyped behavior
 Increased independence
 Temper tantrums
 Better able to tolerate separation from
primary caregiver
 Less likely to fear strangers
 Able to help with dressing/undressing at 18
months
 Has sustained attention span
J.C.RAMOS 15
NURSING IMPLICATIONS:
 Provide opportunities for decision making ·
such as offering choices of clothes to wear or 5. Point to pictures and describe what the
toys to play with. picture shows
 Praise ability to make decisions rather than 6. Enunciation should be good; children imitate
judging correctness of any decision. what they hear
EMOTIONAL DEVELOPMENT PRONOUNS ARE DIFFICULT TO USE CORRECTLY (I, ME,

Toddlers who have learned to trust themselves HIM, HER)
and others during the infant year are better prepared  15 months - 4 to 6 words
to do this than those who have not learned to trust  18 months - 7 to 20 words; uses
themselves or others. jargoning; names one body part
 24 months — 50 words; two-word
sentences (noun or pronoun and verb)
like “Daddy go” or “dog talks”
SOCIAL DEVELOPMENT  30 months - verbal language increasing
 Once walking well, they resist sitting in laps steadily; knows full name; can name one
and color and holds up finger to show age
 At 15 months - enthusiastic in interacting with
people, provided they are willing to follow
them where they want to go. TODDLER PLAY
 At 18 months - imitate things they see PARALLEL PLAY
 2 or more years — aware of gender  Children play beside other children, not with
differences them or side-by-side play; evident at 24 mos
1. They should have similar toys
2. They enjoy toys:
a. they can play with by themselves
LANGUAGE DEVELOPMENT b. that require actions
To master language, children need: c. that they can control and manipulate
(autonomy)
1. Practice time 15 MONTHS  can stack 2 blocks
2. Exposure to words through conversation and  enjoys being read to
books read to them  drops toys for adult to recover
 Watching television promotes little learning (exploring sense of permanence)
in toddlers because the activity is passive  put in, take out stage
limiting television viewing until at least 2
years of age 18 MONTHS  imitates household chores
 begins parallel play
walks securely enough to enjoy
HOW TO ENCOURAGE LANGUAGE DEVELOPMENT pull toys
1. Naming objects as they play with their child 30 MONTHS spends time playing house
or when they give the toddler something  imitating parents’ actions
 words are not meaningless sounds; they  play is “rough-housing” or active
apply to people and objects and have
uses. EXAMPLES OF APPROPRIATE TODDLER TOYS
2. Always answer a child’s questions 1. Pull -push toys
 Answers are simple and brief, they have 2. Blocks
short attention span. 3. Assortment of balls
3. Call on them to use language (It is readily 4. Picture books
given to them) 5. Play Doh with simple tools (craft sticks and
4. Allow reading to strengthen vocabulary wooden rollers
6. Containers
J.C.RAMOS 16
7. Toys and props or dramatic play like scarves, Ex: For example, a child might say that it is windy
hats, a toy telephone, stuffed animals, and outside because someone is blowing very hard, or the
generic baby dolls Clouds are white because someone painted them that
8. Large pegged-top puzzles color.
9. small climbing structure NURSING IMPLICATIONS:
1. Transitional phase to the next period.
2. Uses memory and imitation to act.
3. Can solve basic problems, foresee maneuvers
PIAGET’S COGNITIVE DEVELOPMENT that will succeed or fail.
4. Good toy: Those with several uses: blocks,
colored plastic rings
SENSORIMOTOR STAGE: TERTIARY CIRCULAR
REACTION (12 – 18 MONTHS)
 Uses active experimentation to achieve PREOPERATIONAL THOUGHT (2-3 YEARS)
unattainable goals
 Uses newly acquired skills through
experimentation A. SYMBOLIC FUNCTION (2-4 YEARS)
 beginning of RATIONAL JUDGEMENT and  Egocentric (unable to see the viewpoint of
INTELLECTUAL THINKING another
 The "Young Scientist"  Use of symbols - a thing that represents
something else
NURSING IMPLICATIONS:  Language developed
1. Child is able to experiment (trial and error) to  Displays static thinking (inability to remember
discover new characteristics of objects and what
events.  he/she staked to talk about so that at the
 Ex. Dropping objects end of a sentence, the child is talking
2. Capable of space perception and time about another topic).
perception as well as permanence.  Concept of time is now, and concept of
3. Good game: Throw and retrieve. distance is only as far as he/she can see.
 Centering or focusing on a single aspect of an
object causes distorted reasoning.
SENSORIMOTOR STAGE: INVENTION OF NEW MEANS
(18 –24 MONTHS)
 Child is in final sensorimotor stage. KEY FEATURES OF PREOPERATIONAL STAGE
 Most dramatic change is object permanence. 1. Centration - the tendency to focus on only one
 Can infer a cause when they are experiencing aspect of a situation at one time
2. Egocentrism - child's inability to see a situation
 the effect. ("Candy is missing, sister is smiling")
from another person's point of view.
 Uses mental imagery to understand the
3. Svmbolic Representation - the ability to make
environment
one thing - word or an object - stand for
 Uses fantasy or "make-believe"
something other than itself
 Deferred imitation — able to remember an
4. Pretend (or symbolic) play - common in
action and imitate it later
toddlers (e.g. superheroes, policeman).
5. Imaginary playmate
6. Animism - the belief that inanimate objects
A shift to symbolic thinking (such as toys and teddy bears) have human
1. Animism - inanimate objects are capable of actions feelings and intentions.
and have lifelike qualities
2. Artificialism - the belief that environmental
characteristics can be attributed to human actions or
Interventions
J.C.RAMOS 17
NURSING DIAGNOSIS
KOHLBERG’S MORAL DEVELOPMENT  Nursing diagnosis focuses on the parents'
eagerness to learn more about the
LEVEL 1: PRE-CONVENTIONAL MORALITY (4-10 YEARS parameters of normal growth and
OLD) development or issues of safety or care.
People at this stage do not really understand the  Examples of nursing diagnoses are:
conventions / rules of a society. 1. Health-seeking behaviors related to
normal toddler development
2. Deficient knowledge related to the best
method of toilet training
STAGE 1: PUNISHMENT-OBEDIENCE ORIENTATION
3. Risk for injury related to impulsiveness of
(2-3 YEARS)
the toddler
Consequences of acts determine whether they're good
4. Interrupted family process related to
or bad.
need for close supervision of a 2-year old
 Child does right because parents tell him 5. Readiness for enhanced family coping
to avoid punishment. related to the parents' ability to adjust to
 Child is good because parent said child the new needs of the child
must be, not that is right to be good. 6. Risk for imbalanced nutrition, more than
 Children see morality as something body requirements, related to fast food
external to themselves, as that which the choices
big people say they must do 7. Disturbed sleep pattern related to lack of
NURSING IMPLICATION: bedtime routine
 Child needs help to determine what are
right actions
 Give clear instructions to avoid confusion. IMPLEMENTATION OF SAFE AND QUALITY NURSING
“"l help take care of my brother because if/ don't, my INTERVENTIIONS
mother will punish me" 5. Health visits provide opportunities to help
parents learn healthier coping techniques as
well as a time to demonstrate effective
NUTRITION OF A TODDLER communication skills so parents can improve
Toddlers may sit and play with their food their interactions with their child
1. Put small amount of food on a plate and allow 6. Focus largely on family education and
child to eat it and ask for more rather than anticipatory guidance.
serve a large portion that the child cannot 7. Establish realistic goals and outcomes to meet
finish. the rapidly changing needs of their toddler
2. Allow self-feeding 8. Learn to cope with typical toddler behaviors
3. Offer finger foods and a choice between two 9. Parents can expect too much of a toddler and
types of food (promote independence) grow frustrated instead of enjoying being a
4. Children prefer to eat the same type of food parent of a child this age.
over and over [sense of security) 10. Good rule is to think of a toddler as a visitor
from a foreign land who wants to participate
in everything the family is doing but doesn't
know the customs or the language.
NURSING PROCESS
ASSESSMENT OF A TODDLER
 Assessment begins with a careful health EVALUATION
history Expected outcomes must be evaluated frequently
 Ask parents about toddler's ability to carry during the toddler period because children change so
out activities of daily living much and learn so many new skills during this time that
 Child-parent relationship their abilities and associated parental concerns can
 Careful observation change from day to day.
 Parents state the child maintains a consistent
bedtime routine within the next 2 weeks
J.C.RAMOS 18
ECTOMORPHIC  a slim body built

MODULE 4: THE PRE-SCHOOLER BODY BUILT
EGOCENTRISM  thinking for a young child to
TOPIC OUTLINE see everything that happens as it
relates to him- or herself
1 Definition of Terms
ELECTRA strong attachment of a preschool
2 Physiologic Development
COMPLEX girl to her father.
3 Motor Development
ENDOMORPHIC  large body built
4 Freud’s Theory of Psychosexual Development
BODY BUILT
5 Erikson’s Theory of Psychosocial Development
HANDEDNESS  as children grow older, they tend
6 Social and Emotional Development
to favor one hand over the other for
7 Language Development
certain tasks, particularly for writing
8 Pre Schooler Play or drawing.
9 Piaget’s Theory of Cognitive Development INTUITIONAL  they understand what they are
10 Kohlberg’s Moral Development THOUGHT feeling but they do not know how to
11 Nutritional Health explain it
12 Nursing Process MAGICAL  child's belief that what he or she
THINKING wishes or expects can affect what
really happens.
OEDIPUS  strong emotional attachment of
OVERVIEW COMPLEX a preschool boy to his mother
 The preschool period includes the years 3, 4,
and 5.
 Physical growth slows considerably during this PHYSIOLOGIC DEVELOPMENT
period, personality and cognitive growth A. PHYSICAL
continue at a rapid rate.
 Change in body contour: Slimmer, taller, more
 An important period of growth for parents
of child-like proportions.
because they may be unsure how much
 Future body type: ectomorphic (slim body
independence & responsibility for self-care
build) and endomorphic (large body build)
they should allow their rapidly maturing child
apparent.
 Most children of this age want to do things for
 More childlike than baby like
themselves.
 Handedness is manifested at 4 yrs. old
 Parents need reassurance that this behavior is
 Weight gain is only about 4.5 lb. (2 kg) a year.
typical because it is the way children explore
 Appetite same as during toddler
and learn about new experiences
 Height gain is minimal: increases only 2 to
 3.5 inches (6 - 8 cm) a year on average.
 Birth length is doubled by 4 years.
DEFINITION OF TERMS
 Head circumference increase by 1 inch per year
 these are words or phrases of
 Vital signs decrease slightly:
BATHROOM parents or older children in the
 Pulse 85 /min;
LANGUAGE family that a pre-schooler imitates
that they incorporate swear words  respirations 24-25;
in their vocabularies whenever they  BP 85-100 / 60-
hear them.
BROKEN  also known as stuttering. It is the
FLUENCY repetition of words or syllables
B. TEETH
BRUXISM  teeth grinding
Preschoolers have all 20 deciduous teeth by the end of
CENTRATION  preschoolers cannot mental three years; it is rarely new teeth erupt during the
substitutions and often feel they are preschool period.
always right. They cannot see your
side of the situation.
J.C.RAMOS 19
C. BODY SYSTEMS DEFINITION OF TERMS IN PHALLIC STAGE

 Lymphatic tissue begins to increase in size BOOKWORM  is harshly rejected by his mother
particularly tonsils. PERSONALITY and threatened by his father
 Levels of IgG and IgA antibodies increase HYPERFEMINE  girl rejected by father and
making preschool illnesses more localized. BELLE OR threatened by mother
 Physiologic splitting of heart sounds and WALL-FLOWER
innocent heart murmurs are heard for the first EFFEMINATE  if boy is favored by mother over
time. his milquetoast (timid or
submissive) father
MASCULINE  girl is daddy’s little princess and
MOTOR DEVELOPMENT AND SELF- best buddy, and mommy is
CENTERED relegated to a servant role
AGE FINE MOTOR GROSS PLAY

SKILLS MOTOR SKILLS ADULT CHARACTER
3 Undress self Runs Able to
PROMISCUOS unselected
YEARS Stack tower Alternates feet take turns
AMORAL Unconcerned with the rightness or
of blocks on stairs Very
wrongness of something
Draws a cross Rides tricycle imaginative
PURATANICAL Practicing strict religious or moral
Stands on one
behavior
foot
4 Can do Constantly in Pretending
YEARS simple motion is major
buttons Jumps and activity NURSING SIGNIFICANCE
skips a. Accept the child fondling his or her genitalia
5 Draw a six- Throws Likes as a normal area of exploration.
YEARS part figure overhand games with b. In case of masturbation, explain to the child
Lace shoes numbers or that things like this must be done in a private
letters place or divert the attention.
c. Answer the child’s question directly and
honestly as this is the right time to
FREUD’S THEORY OF PSYCHOSEXUAL DEVELOPMENT: d. Introduce sexuality.
PHALLIC STAGE
Child may show exhibitionism, masturbation, and
increased knowledge on both SEXUALITY Sum of total of one’s feelings and
behavior as male or female
GENDER ROLES begin to be aware of the difference
OEDIPUS COMPLEX between sexes and so need to be
The Oedipus complex describes these feelings of introduced to both gender roles.
wanting to possess the mother and the desire to GENDER sense of self as male, female,
replace the father. However, the child also fears that he AWARENESS/ bisexual (feeling comfortable with
will be punished by the father for these feelings, a fear GENDER both sexes), homosexual or
Freud termed as Castration Anxiety IDENTITY ambivalent (transexual).
ELECTRA COMPLEX
Electra complex has been used to describe a similar set BEHAVIORS TO OBSERVE:
of feelings experienced by young girls. However, girls a. Exhibits interest in sex differences.
instead experience Penis Envy b. Exhibits preoccupation with loss of body parts
and bodily injury.
c. Asks many questions related to sexuality.
J.C.RAMOS 20
ERIKSON’S PSYCHOSOCIAL DEVELOPMENT: INITIATIVE INHIBITION person will not try things because
VS GUILT "nothing ventured, nothing lost"
 The developmental task: Initiative versus and, particularly to feel guilty about.
Guilt COURAGE the capacity for action despite
 Children with sense of initiative like to clear understanding of your
explore because they have discovered that limitations and past failings.
learning new things is fun.
 If criticized or punished for attempts at BEHAVIORS TO OBSERVE:
initiative, they can develop a sense of guilt for a. Starts many task; completes few
wanting to try new activities, or to have new b. Very imaginative
experiences. c. Engages in fantasy play
 Those who leave the preschool period with a d. Very curious, asks many questions
sense of guilt can carry it with them into e. Boastful
school situations. They may even have
difficulty later in life making decisions about
everything NURSING IMPLICATIONS
 Provide opportunities for exploring new places
or activities.
DEVELOPMENTAL TASK: INITIATIVE VS GUILT (4-6
 Allow play to include
YEARS OLD)
 activities including water, clay (modeling) or
 The child learns to do basic things alone and finger paint (enhances imagination, creativity,
no longer imitate the action of others. and fine motor development)
 Same is true for language and fantasy
activities.
SOCIAL AND EMOTIONAL DEVELOPMENT
 sensitive and critical time for socialization
HOW TO DEVELOP INITIATIVE  3-year-olds are capable of sharing they play
 Allow freedom to initiate small activities and with other children their age much more than
to ask questions. do toddlers
 Encourage parents to answer child's question  Children at age 4 continue to enjoy play
(intellectual initiative) and do not inhibit groups become Involved in arguments more
fantasy or play activity. than they did at age 3 (more certain of their
 Encourage creative play: clay, finger pants, role in the group)
soapy water, sand, mud, homemade dough.  five-year-olds begin to develop "best"
 Give opportunity to explore new places, and friendships
events such bringing the child to an  The elementary rule:
amusement park (exploration, adventure and  two or four will play, but three or five
discovery). will quarrel.
 Guilt develops if the child is made to feel that
his activity is bad or wrong.
FANTASY
 begin to differentiate cartoon characters from
Motor activity Bad
real.
Questioning Nuisance
Play stupid and silly  fond of imitating and pretending to be
something or someone else fantasy role: like
Sense of Guilt rabbit, batman, superman.
 Parents should be encouraged to support the
Persist in life fantasy still reassuring the child that she/he is
still herself himself, the difference between
Limited brainstorming and problem-solving the child and the role
J.C.RAMOS 21
LANGUAGE DEVELOPMENT INTUITIVE STAGE (4-7 YEARS OLD)

 The 3-year old child has a vocabulary of 900 CENTERING children tend to look at an object’s
words one characteristic.
 The extent of a 3-year old vocabulary varies. LACK OF Inability to discern truth, although
 The 4-vear old has a vocabulary of 1,500 CONSERVATION physical properties change
words. LACK OF Inability to retrace steps
 • The 5-year old has a vocabulary of 2,100 REVERSBILITY
words. ROLE FANTASY How children would like something
 Words that sound alike but mean different to turn out
things can be confounding to children of this ASSIMILATION Taking info and changing it to fit
age. their existing ideas
 They need simple answers, so vocabulary LEARNING Changing ideas to fit reality rather
building and questioning are encouraged ACCOMODATION than the reverse
 They would just follow what has been told to EGOCENTRISM Can’t understand viewpoint of
them but then return and ask why it was so. others
 Child has increased cognitive ability thus has MAGICAL Believing that one event happens
an ability to learn extended language. THINKING as a result of another without a
plausible link of causation
Ex: “I got up on the left side of the
THE PRE SCHOOLER: PLAY bed today; therefore it will rain”
1. IMAGINATIVE PLAY ANIMISM Perceive animals and objects as
 Do not need so many toys having feelings and thoughts
 Imaginations are keener
 Enjoy games that use imitation like KOHLBERG’S MORAL DEVELOPMENT
playing.
 Pre-Conventional level (Individualism and
 They imitate what parents are doing: Exchange)
eating meals, mowing the lawn, cleaning
 Children at this stage do the right thing in
the house, washing, ironing arguing, etc.
exchange for something.
 Imaginary friends exist until they
 Rules are obeyed for personal gain with the
formally begin schooling
ethics of "What's in it for me?"
2. PRETEND PLAY
 Preschoolers carry out actions to satisfy their
 Teachers, firefighters, cowboys,
own needs rather than society's.
store clerks
3. ROUGH HOUSING
 Four and five-year-olds divide their
time between rough-housing and STAGE 2: INSTRUMENTAL RELATIVIST ORIENTATION
 imaginative/imitative/ associative  The ethics of "What's in it for me?"
play.  Obeying rules and exchanging favors are
 Five-year- olds become interested judged in terms of the benefit to the
in group games or reciting songs individual
they have learned in STAGE 2: INDIVIDUALISM AND EXCHANGE (4-7 Y/O)
 Children recognizes that there is not just one
right view that is handed down by authorities.
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT:  Different individuals have different viewpoint.
INTUITIVE THOUGHT  Since everything is relative, each person is
 Preoperational: Second phase called Intuitive free to pursue his/her own interest.
thought.  Carries out actions to satisfy his own needs
 Children learn by asking questions such as rather societv's
 "How come?" and "Why?"  Will do something for another if that person
does something for the child (Egocentrism)
J.C.RAMOS 22
CONVENTIONAL LEVEL II: STAGE 2: INDIVIDUALISM NURSING DIAGNOSIS

AND EXCHANGE 1. Center on health promotion or unintentional
NURSING IMPLICATION injury prevention
 Child is unable to recognize that like Examples:
situations require like actions.  Health seeking behaviors related to
 Unable to take responsibility for self-care developmental expectations
because meeting own needs interferes with  Risk for injury related to increased
“What is in it for me?" independence outside the home
"Lie still now for me while I change your dressing and I  Delayed growth and development related to
will read you a story when I am through. " frequent illness
 Risk for nutrition more than body
requirements, related to fast food choices
NUTRITIONAL HEALTH  Risk for poisoning related to maturational age
 A sense of initiative, or learning how to do of the child
things, can strengthened by allowing a child  Parental anxiety related to lack of
to prepare simple foods understanding of childhood development
 Urge parents to offer snacks after school,
such as fruit, cheese, or milk rather than
cookies and a soft drink or juice IMPLEMENTATION OF SAFE AND QUALITY NURISNG
 Food to serve should have variety and INTERVENTIONS
consider My Plate recommendations Planning and establishing expected outcomes for care
 Preschoolers do not eat meat so much of Pre-schoolers often:
because it can be hard to chew 1. Begin with establishing a schedule for
 Vitamins may be viewed as candy discussing normal preschool development
 Fruits, vegetables, and grains are healthy with the parents.
food snacks 2. Plan opportunities for adventurous activities
 Calcium very important for bone growth and interaction with other children.
 Vitamin D is found in fortified cereals and 3. Parents find it helpful to be referred to online
milk resources for further information
 Vitamin B12 is found almost exclusively in 4. Important nursing Intervention, maybe role-
animal products playing mood attitude you would like a child
to learn.
NURSING PROCESS
EVALUATION
Examples of expected outcomes might include.'
ASSESSMENT 1. Child states importance of holding parent's
1. Obtain a health history which details their hand while crossing streets
usual performance level 2. Parents states realistic expectations of 3-year
2. Perform both a physical and developmental old child's motor ability by next visit
evaluation healthcare visits 3. Mother reports she has prepared her 4 year-
3. Pre-schoolers may speak very little during a old for new baby by next visit
health assessment; they may even revert to
baby talk or infantile actions when stressed
4. Assessment should be based on standards
and racial backgrounds
J.C.RAMOS 23
MODULE 5: THE SCHOOL AGE
TOPIC OUTLINE CONSERVATION  ability to appreciate that a

change in shape does not
necessarily mean a change in size.
DECENTERING  ability to project one's self into
3 Sexual Maturation
other people's situations and see
4 Teeth
the world from their viewpoint
5 Motor Development
rather than focusing only on their
6 Freud’s Theory of Psychosexual Development own view.
7 Social and Emotional Development MALOCCLUSION  deviation of tooth position from
8 Erikson’s Theory of Psychosocial Development the normal
9 School Age Child Play NOCTURAL  increased seminal fluid begins
10 Piaget’s Theory of Cognitive Development EMISSIONS (WET to be produced, boys begin to
11 Kohlberg’s Moral Development DREAMS) notice ejaculation during sleep
12 Nutrition
13 Nursing Process
PHYSIOLOGIC DEVELOPMENT
A relatively long time span, grow and develop
OVERVIEW extensively during this time period.
 Refers to children between the ages of 6 and
12 years.
A. PHYSICAL GROWTH
 A time of slow physical growth, the school age
child’s cognitive growth and development  Average annual weight gain is approximately
continue to proceed at rapid rates. 3 -5 lb. (1.3 kg)
 Child may demonstrate contradictory  Increase in height is I to 2 inches (2.5 to 5 cm).
responses.  Lordosis and knock-kneed appearance is lost
 What the child enjoys on one occasion may now
change over time.  Girls are usually taller by about 2 inches (5 cm)
or more than preadolescent boys because
their typical growth spurt begins earlier.
 Hips among girls become broader.
DEFINITION OF TERMS
 At 10 years of age:
 period between ages 13 up to
a. Brain growth complete, thus fine
ADOLESCENCE 20 years, a time that serves as a
motor coordination is refined.
transition between childhood and
b. Eye globe reaches its final shape and
becoming a late adolescent
adult vision level is achieved.
COMEDONES  blocked hair follicle
 Immune globulins IgG and IgA each reach
FORMAL  ability to think in abstract terms
adult levels and lymphatic tissue continues to
OPERATIONAL and use the scientific method
grow in size until about age 9 years.
THOUGHT (deductive reasoning) to arrive at
 Tonsils seem to fill the entire back of the
conclusions
throat using Eustachian tube obstruction
ACCOMODATION  ability to adapt thought
resulting in temporary conduction deafness
processes to fit what is perceived
until the tissue recedes normally.
such as understanding that there
can be more than one reason for
other people's actions.
CARIES  also known as dental cavity
CLASS  ability to understand that
INCLUSION objects can belong to more than
one classification such as by
different materials, by sizes, by
shapes, etc.
J.C.RAMOS 24
Rinne’s Test results b. follicle-stimulating hormote (FSH) which then

 Normal hearing will show an air conduction activate changes in the testes and ovaries to
time that is twice as long as the bone cause puberty.
conduction time. In other words, you will hear  Timing of the onset of puberty varies widely
the sound next to your ear twice as long as you between 8 and 14 years of age, partly due to
will hear the sound behind your ear. a. genetic
 If you have conductive hearing loss, the bone b. cultural differences and is rated according to
conduction is heard longer than the air Tanner stages.
conduction sound.  Length of time from puberty until sexual
 If you have sensorineural hearing loss, air maturity is complete also varies.
conduction is heard longer than bone  Sexual maturation in girls occurs between 12 -
conduction, but may not be twice as long. 18 yrs.
 Sexual maturation in boys, between 14 and 20
Weber’s Test results
years.
 Normal hearing will produce equal sound in
 In boys, as increased seminal fluid begins to be
both ears.
produced, boys begin to notice ejaculation
 Conductive loss will cause the sound to be during sleep, termed nocturnal ejaculation.
heard best in the abnormal ear.
 Sensorineural loss will cause the sound to be
heard best in the normal ear.
CHRONOLOGIC DEVELOPMENT OF SECONDARY SEX
CHARACTERISTICS
A. PHYSICAL GROWTH AGE BOYS GIRLS

 The appendix being lined with lymphatic 9-11 Prepubertal weight Breasts: elevation
tissue, so swelling of this tissue in the narrow gain occurs papilla Birth breast
tube can lead to trapped fecal material and formation; diameter
inflammation enlarges
 Frontal sinuses develop at about 6 years so 11-12 - Sparse grow -Straight hair along
sinus headaches become a possibility. straight, downy, the labia;
 The left ventricle of the heart enlarges to be slightly pigmented -Vaginal epithelium
strong enough to pump to the growing body. hair at base of penis cornified
 Innocent heart murmurs become apparent -Scrotum becomes -pH of vaginal
due to the extra blood crossing heart valves. textured secretions become
a. Pulse rate decreases to 70 to 80 beats/min -Growth of penis & acidic
b. BP rises to about 112/60 mm Hg. testes begin -Slight mucous
 Exertion ability and stamina increases due to -Sebaceous gland vaginal discharge is
maturation of the respiratory system which secretion increases -Sebaceous gland
leads to increased oxygen-carbon dioxide -Perspiration secretion increases
exchange increases -Perspiration
 Scoliosis may become apparent for the first increases
time in late childhood -Dramatic growth
spurt
12-13 -Pubic hair present -Pubic hair grows
SEXUAL MATURATION across pubis darker; spreads over
As brain matures, the hypothalamus transmits an -Penis lengthens entire pubis
enzyme to the anterior pituitary gland to begin -Dramatic linear -Breasts enlarge still
production of gonadotropic hormones growth spurt no protrusion of
a. luteinizing hormone (LH) -Breast enlargement nipples
may occur -Axillary hair present
-Menarche occurs
J.C.RAMOS 25
BREAST DEVELOPMENT
STAGE 1 No breast development, only the nipple
is raised
STAGE 2 Breast bud stage. There is a elevation
of the breast as a small mound and
enlargement of the areola diameter
STAGE 3 Further enlargement of the breast and
areola, with no separation in the
contour of the breast and the
nipple/areola
STAGE 4 The nipple and areola project to form a
second mound above the level of the
MALE GENITALIA breast
STAGE 5 Mature stage. Projection of the nipple
only – the areola now shares the
general contour of the breast and no
longer a second mound in stage 4
PUBIC HAIR GROWTH

STAGE 1 The velus (ie fine, very light hair) in the
pubic area is no more develop than that
on the abdomen – i.e. no pubic hair
STAGE 2 Sparse growth of longer, slightly
pigmented but downy hair straight or
slightly curled appearing mostly along
the labia
STAGE 3 Considerably darker, coarser and more
curled hair. It is just beginning to spread
across the pubic area, but there is still
FEMALE BREAST no hair on nearby thigh area
STAGE 4 the hair is now more like adult pubic
hair, but the area it covers is still smaller
than that in adults thing areas
STAGE 5 the hair is now like adult pubic hair in
both type and quantity. It is distributed
in the classic triangle pattern and has
spread to nearby thigh areas
TEETH
 Deciduous teeth are loss and permanent teeth
erupt during the school-age period.
 The average child gains 28 teeth between 6-
12 yrs old
 The central & lateral incisors First, second &
third cuspids
 First and second molars
J.C.RAMOS 26
MOTOR DEVELOPMENT - Enjoy showing off this new skill in cards,

letters, or projects
9 YEARS -Writing begins to look mature and less
GROSS MOTOR OLD awkward.
-Older school age children begin to evaluate
6 YEARS - Endlessly jump, tumble, skip, & hop. their teachers' ability & perform at varying
OLD -Have enough coordination to walk a straight levels depending on teacher's expectations
line, ride a bicycle, and learn to skip rope
with practice
7 YEARS -Quiet compared with the 6 years old. FREUD’S PSYCHOSEXUAL STAGE: LATENCY STAGE
OLD -Girls do more traditional female roles and  “Age of Suppression
activities while boys may gravitate to more  Sexual drive (libido) is repressed and energy is
traditional male roles and activities used to gain new skills and social relationship
8 YEARS -Movements are more graceful than younger and knowledge
OLD children, although, as their arms and legs  Achievement oriented years.
grow, they may appear awkward in their play  Emphasis is development of skills and talents.
and eating habits.
-Ride a bicycle well and enjoy sports like
gymnastics, etc. GENITAL STAGE
9 YEARS -Constantly on the go BEHAVIORS TO OBSERVE:
OLD - Have enough eye-hand coordination to - Separates from parents
enjoy baseball, basketball, and volleyball - Responsible for self
10 -More interested perfecting their athletic - Develops sexual identity
YEARS skills - Relationship with the opposite sex
OLD
11 -Feel awkward due to growth spurt and drop
YEARS out of sports activities LATENT STAGE
OLD -May channel energy to constant motion like
 Normally homosexual (interest on same sex
drumming fingers, tapping pencils or feet.
only)
12 -Plunge into activities with intensity and
 Major conflict the child has to overcome is to
YEARS concentration like participating in sports
establish relationship with same sex peers.
OLD events as walkathon.
NURSING SIGNIFICANCE:
-Able to handle a great deal of
 Help the Child achieve positive experiences so
responsibility and complete given tasks
that he/she will be ready to face the conflict of
adolescence.
FINE MOTOR
EVELOPMENT OF SECONTERISTICS EMOTIONAL DEVELOPMENT
Children enter this period with:
6 YEARS - Can easily tie shoe laces, cut and paste well a. ability to trust others
OLD and draw a person with good detail. b. sense of respect for their own worth
- Can paint although they may routinely c. ability to accomplish small tasks
7 YEARS -Called the "eraser year” because children independently (autonomy)
OLD are never quite content with what they d. Ability to practice or mimic adult roles
have done. e. Ability to share
8 YEARS - Eyes developed enough so can read regular- f. Children discovered that learning is an
OLD size type which make reading a greater adventure, and grasped the idea that doing
pleasure & school more enjoyable. things is more important and more rewarding
- Able to write script and to print. than watching things being done (a sense of
initiative).
J.C.RAMOS 27
g. They usually explore the social environment. 9 YEARS - When they discover dirty jokes, they like to
OLD tell them to friends and try to understand
those told by adults.
SOCIAL AND EMOTIONAL DEVELOPMENT -Use swear words to express anger or
6 YEARS play in groups, but when they are tired or just to show to other children they are
OLD under stress, they usually prefer one-to-one rowing-up.
contact -Have short period of fascination with
7 YEARS - Increasingly aware of family roles and bathroom language," as they did during
OLD responsibility. preschool years.
- Promises must be kept because 7-year 12 - Sense of humor is apparent.
olds view them as definite, firm YEARS -Can carry on an adult conversation,
commitments. OLD although stories are limited because of their
- They tattle because they have such a lack of experience.
strong sense of justice
8 YEARS - Actively seek company of other children.
OLD - Most 8-yr. old girls have a close girlfriend; ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT:
boys have a close boyfriend INDUSTRY VS INFERIORITY
- Whisper among themselves as they have Developmental Task: Industry vs Inferiority
secrets with close friends
9 YEARS - Take the values of their peer group very HOW TO DEVELOP INDUSTRY
OLD seriously.  Give short assignments and projects.
- Club age because they form groups, usually  Give them small chores that can be finished
"spite clubs." quickly and the difference is visible from the
a. Group is divided previous one
b. Have a secret password and secret
meeting place
c. Membership is generally all boys INDUSTRY VS INFERIORITY
or all girls.  Develops sense of competency vs sense of
- Parents should not intervene because inadequacy
loyalties shift quickly  Industry develops when a child is permitted to
- They are ready for social interaction. Thus do things by himself and praised for the
are ready for results.
- Activities away from home (campout)  Interested in learning how to do things well.
 Inferiority develops if the child's activities are
seen as a nuisance.
LANGUAGE DEVELOPMENT  They begin to create and develop a sense of
6 YEARS - Talk in full sentences, using language easily competence & perseverance and master skill
OLD and with meaning; that will help them function in the adult world.
- define objects by their use.  They are motivated by activities that provide a
7 YEARS - Can tell time in hours, but have trouble sense of worth.
OLD with concepts such as "half past" and  These children compare themselves with
"quarter to" especially with digital clocks and others and obtain feedback from teachers &
watches. peers.
- Know months of year and can name months
in which holidays fall.
-Know simple arithmetic. SETTINGS WHERE TO LEARN INDUSTRY VS
-Can add and subtract and make simple INFERIORITY
change, so they can go to the store and make  Home, structured activities, school, problem
simple purchases solving
J.C.RAMOS 28
BEHAVIORS TO OBSERVE 10 - Spend most of their time playing screen

 Wants to learn to do things well and YEARS games.
completely OLD -Boys and girls play separately although
 Participates in variety of activities especially in interest in the opposite sex is apparent.
school -Boys show off as girls pass their group;
 Takes pride in accomplishments -Girls talk loudly or giggle at the sight of a
NURSING IMPLICATIONS: familiar boy.
 Provide opportunities such as allowing child to -Slumber parties and campouts become
assemble and complete a short project so that increasingly popular.
child feels rewarded for accomplishment. -Very interested in rules and fairnees.
-Club activities become structured.
11 AND - Enjoy dancing and playing table games
THE SCHOOL AGE CHILD PLAY 12 -Time with friends is often spent just talking
6 YEARS - Play is active however, when they discover YEARS -Like to do jobs around the house or baby-
OLD reading as an enjoyable activity that opens OLD sitting for money
doors to other worlds, they can begin to
spend quiet time with books.
-Many spend hours playing increasingly PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
challenging video games, which can either  The school age child is in the Concrete
foster a healthy sense of competition or operational stage or the ability to reason
create isolation from others through any problem they can actually
7 YEARS - Require more props for play than when visualize.
OLD they were younger.
-Start of decline in imaginative play which
will continue unless adequate CONCRETE OPERATIONS (7-12 YEARS OLD)
encouragement to use imagination is done.  Children can use logic, but tend to be
- Prefer teenage dolls if they play with doll literalistic.
-Also develop interest in collecting items  Abstract concepts (including many spiritual
which structured as a child reaches 8 years of truths) are not easily understood.
age.  Concrete problem solving, some reversibility,
8 YEARS - When they collect items, they begin sorting categorical labels (number or animal)
OLD and cataloging.  Includes systematic reasoning and recognize
-Most of them enjoy helping in the kitchen cause-and-effect relationship.
such as making cookies and salads or frosting - Ex. Beads
cakes.  Uses broad concepts and subgroups concepts.
-Start to be more involved in simple science Knows how to classify.
projects and experiments. - Ex. Sorting objects by color, seriation
-Like table games but hate to lose, so they  Child is aware of reversibility.
tend to avoid competitive games. - Activity: Sorting, classifying
-May also change rules in the middle of a
game to keep from losing.
9 YEARS - They play hard. They squeeze in some 1. Includes systematic reasoning and recognize
OLD activity so that he or she will have more time cause-and-effect relationship.
to play. - Ex. Beads
-Play is rough; 2. Uses broad concepts and subgroups concepts.
-Not as interested in perfecting their skill. Knows how to classify.
-May be introduced to music lessons and Ex. Sorting objects by color, seriation
arts 3. Child is aware of reversibility.
• Use the social media. - Activity: Sorting, classifying
4. Understands conservation, sees constancy
despite
J.C.RAMOS 29
transformation (mass or quantity remains the same  Lying is common to disguise that they have
even if changes in shape or position) been involved in an action that is not "nice".
5. Uses memory to learn broad concepts (Fruits) NURSING IMPLICATIONS:
and subgroups of concepts (apple, orange,  Child enjoys helping others because this is a
grapes). nice behavior.
6. Classification involves sorting objects  Allow child to help 4th bedmaking and other
accordingly. like activities.
ACTIVITY: Collecting and natural objects such  Praise for desired behavior such as sharing.
as plants, sea shells, etc.
”When people see what I have done, they will think I am
a good person."
KOHLBERG’S THEORY OF MORAL DEVELOPMENT
 School age children begin to mature in terms
of moral development as they enter a stage of NUTRITION
Conventional reasoning, as early as 5 years of  They have good appetites, although meals
age. They concentrate on "niceness" or may be influenced by the day's activity.
"fairness" and cannot see yet that stealing  Boys need more calories than girls though
hurts their neighbor the highest level of moral both need
reasoning. Because they are still limited in a. Iron
their ability to understand others' views. they b. Adequate calcium
may interpret something as being right c. Fluoride
because it is good for them, not because it is  A major deficit may be fiber because school
right for humanity as a whole. age children typically dislike vegetables.
 Encourage outside activities for sun exposure
to increase Vitamin D.
LEVEL II: CONVENTIONAL MORALITY
 People at this stage conform to the
conventions/rules of a society NURSING PROCESS
STAGE 3: GOOD BOY – NICE GIRL ORIENTATION ASSESSMENT

 Ethical decisions are based on concern for or  History and physical examination are basis for
the opinions of others assessment.
 They are interested and able to contribute to
their own health history.
CONVENTIONAL LEVEL II  During a physical examination, be attentive to
STAGE 3: GOOD BOY – NICE GIRL RELATIONSHIP child's need for privacy when undressed.
(7-10 Y/0)  Parents of school age children often mention
 children--who are by now usually entering behavioral issues/conflicts during yearly
their teens—see morality as more than simple health visits.
deals.  Children begin to express their own opinions
 They believe that people should live up to the & beliefs.
expectations of the family and community and
behave in "good" ways.
 Good behavior means having good motives NURSING DIAGNOSIS
and interpersonal feelings such as love, 1. Health-seeking behaviors related to normal
empathy, trust, and concern for others. school age growth and development
 Child follows rules because of a need to be a 2. Readiness for enhanced parenting related to
"good" person in own eyes and eyes of others. improved family living conditions
J.C.RAMOS 30
3. Anxiety related to slow growth pattern of OVERVIEW

child  Period between ages 13 up to 20 years, a time
4. Risk for injury related to deficient parental that serves as a transition between childhood
knowledge about safety precautions for a and becoming a late adolescent.
school age child  It can be divided into
a. Early period (13 to 14 years)
b. Middle period (15 to 16 years)
IMPLEMENTATION OF SAFE AND QUALITY NURSING c. Late period (17 to 20 years).
INTERVENTIONS  Adolescents invariably feel a sense of pressure
1. School age child is interested in learning throughout this period because they are
about adult roles, which means they will note mature in some respects but still young in
adult attitude as well as actions in a given others
situation.
2. When giving care, keep in mind that these
children feel more comfortable if they know DEFINITION OF TERMS
the "hows" and "whys" of actions. \  period between ages 13 up to
3. They may not cooperate with a procedure 20 years, a time that serves as a
until they are given a satisfactory explanation transition between childhood and
of why it must be done. becoming a late adolescent
COMEDONES  blocked hair follicle
FORMAL  ability to think in abstract terms
EVALUATION OPERATIONAL and use the scientific method
Yearly health visits for both physical and psychosocial THOUGHT (deductive reasoning) to arrive at
development are important at this age. conclusions
Examples of expected outcomes include: IDENTITY task of forming a sense of
1. Parent states that he permits the child to identity is for the adolescent to
make his own age-related decisions. decide who they are and what kind
2. Child identifies books he has read together of person they will be
with parents in the past 2 weeks HAZING  form of organized bullying which
3. Child states he understands the variation of refers to demeaning or humiliating
growth as related to the growth chartChild rituals that prospective members
does not sustain injuries from sports activities have to undergo to join sororities,
fraternities, adolescent gangs or
sports teams
MODULE 6: THE ADOLESCENT PUBERTY  the time at which an individual
first becomes capable of sexual
TOPIC OUTLINE
reproduction.
STALKING refers to repetitive, intrusive,
and unwanted actions such as
3 Sexual Maturation
constant and threatening
4 Teeth pursuit directed at an individual to
5 Motor Development gain individual's attention or to
6 Freud’s Theory of Psychosexual Development evoke fear
7 Social and Emotional Development SUBSTANCE USE  refers to the use of chemicals to
8 Erikson’s Theory of Psychosocial Development DISORDER improve a mental state or induce
9 School Age Child Play euphoria.
10 Piaget’s Theory of Cognitive Development
11 Kohlberg’s Moral Development
12 Nutrition PHYSIOLOGIC DEVELOPMENT
13 Nursing Process  Major milestones of physical development in
this period
J.C.RAMOS 31
a. the onset of puberty at 8 to 12 years of age

b. Cessation of body growth around 16 to 20
years. SEXUAL DEVELOPMENT (GIRLS)
 At first, the gain in physical growth is mostly in  Development of secondary sex characteristics,
weight, leading to the stocky, slightly obese traits that differ between the sexes that are
appearance of prepubescence; later comes neither required for reproduction nor related
the thin, gangly appearance of late to sex differences which include pubic hair,
adolescence. enlarged breasts and widened hips of females,
and facial hair and Adam's apples on males.
 Menarche
PHYSICAL GROWTH  Breast development is first sign of puberty
 Most girls are 1-2 Inches (2.4—5 cm) taller
than boys coming into adolescence and
generally stop growing within 3 years from SEXUAL DEVELOPMENT (BOYS)
menarche. Thus, those girls menstruating at  Enlargement of testes is first sign of sexual
10 years of age may reach their adult height maturation; occurs at age 13, about I year
by age 13. before growth spurt
 Boys grow about 4-12 in. (10-30 cm) in height  Scrotum and penis increase in size until age 18
and gain about 15-65 lb (7-30 kg) during teen  Reaches reproductive maturity at age 17, w/
yrs. viable sperm
 Girls grow 2-8 inches (5-20 cm) in height and  Nocturnal emission
gain 15-55 lb. (7-25 kg).  Masturbation increases
 Growth stops with closure of the epiphyseal  Pubic hair continues to grow and spread until
lines of long bones, which occurs at about 16 mid 20’s
to 17 years of age in females and about 18 to  Facial hair appears
20 years of age in males.  Voice changes due to growth of laryngeal
 Apocrine glands (scent glands) cause cartilage
increased body odor E
 Increased production of sebum, and plugging
of sebaceous ducts causes acne. THE PUBERTY
 Blood flow an oxygen availability reduced  The time at which an individual first becomes
 because the lungs and heart increase more capable of sexual reproduction.
slowly than the rest of the body.  girl has entered puberty when she begins to
 Pulse rate and respiratory rate decrease menstruate (between ages 11-14 yrs)
slightly (to 70 bpm and 20 breaths / min.)  boy enters puberty when he begins to produce
 BP increases slightly to 120/70 mmHg spermatozoa.
reaching adult levels by late adolescence.
CHRONOLOGIC DEVELOPMENT OF SECONDARY SEX

CHARACTERISTICS
B. TEETH
 Gain second molars at about 13 yrs. of age
 Third molars (wisdom teeth) bet. 18 and 21 yrs AGE BOYS GIRLS
 Third molars may erupt at 14 to 15 years 9-11 Prepubertal weight Breasts: elevation
 The jaw reaches adult size toward the end of gain occurs papilla Birth breast
adolescence, however, adolescents whose formation; diameter
third molars erupt before the lengthening of enlarges
the jaw is complete may experience pain and 11-12 - Sparse grow -Straight hair along
may need these molars extracted because straight, downy, the labia;
they do not fit their jawline. slightly pigmented -Vaginal epithelium
hair at base of penis cornified
J.C.RAMOS 32
-Scrotum becomes -pH of vaginal -May have some

textured secretions become degree of facial acne
-Growth of penis & acidic -Gynecomastia
testes begin -Slight mucous (enlarged breast
-Sebaceous gland vaginal discharge is tissue),
secretion increases -Sebaceous gland if resent fades
-Perspiration secretion increases 17-18 -end of skeletal
increases -Perspiration growth
increases
-Dramatic growth
spurt
TANNER’S STAGES OF PUBERTY
12-13 -Pubic hair present -Pubic hair grows
across pubis darker; spreads over
-Penis lengthens entire pubis
-Dramatic linear -Breasts enlarge still
growth spurt no protrusion of
-Breast enlargement nipples
may occur -Axillary hair present
-Menarche occurs
13-15 - Growth spurt - Pubic hair thick and
continuing curly, triangular in
-Pubic hair distribution
abundant and curly -Breast areola and
-Testes, scrotum, papilla form
and penis enlarging secondary mound
further -Menstruation is
-Axillary hair ovulatory, making GENITALIA’S DEVELOPMENT
present; facial hair pregnancy possible
fine and downy
Voice changes
happen with
anno annoying
frequency
15-16 -Genitalia adult - Pubic hair curly and
-Scrotum dark and abundant may
heavily rugated extend onto medial
-Facial and body hair aspect of thighs;
present -Breast tissue
-Sperm production appears adult;
mature nipples protrude;
areolas no longer
project as separate
ridges from breast FREUD’S PSYCHOSEXUAL STAGE: GENITAL STAGE
-May have some  Site of gratification: Genitalia
facial acne  Activity: Learns to establish satisfactory
16-17 - Pubic hair may -end of skeletal relationship to the opposite sex.
extend along medial growth NURSING SIGNIFICANCE
aspect of thighs  Give an opportunity to relate to the opposite
-Testes, scrotum, sex.
and penis adult size
J.C.RAMOS 33
GENITAL STAGE cliques may develop less favorable self-image

 Resurgence of sexual drives and low self esteem
 Sexual pleasure through genitals - Role Confusion develops when the adolescent
 Sexual identification is not sure who he is or what he can do.
 Heterosexual is normal
 Maturation of the reproductive system
 Mastery of this period results in the TO ACHIEVE IDENTITY
development of ability to love and to work  Adolescents must bring together everything
 Psychological theme: that they have learned about themselves as
- Maturity, creation and enhancement of life son or daughter, as a friend, student and so on
 (intellectual and artistic creativity). and integrate this different images of
 Task: Learn how to add something to life and themselves as a whole that make sense hence
society. develop sense of self.
 How to achieve this state  The four main areas in which they must make
- Balance both love and work. gains to achieve a sense of identity include:
1. Accepting their changed body image
2. Establishing a value system or what kind
GENITAL STAGE of person they want to be
BEHAVIORS TO OBSERVE 3. Making a career decision
- Separates from parents 4. Becoming emancipated from parents
- Responsible for self
- Develops sexual identity
- Relationship with the opposite sex TO ACHIEVE IDENTITY
 Adolescents must bring together everything
that they have learned about themselves as
ERIKSON’S PSYCHOSOCIAL STAGE: IDENTITY VS ROLE son or daughter, as a friend, student and so on
CONFUSION and integrate this different images of
 The developmental task in early and mid- themselves as a whole that make sense hence
adolescence is to form a sense of identity develop sense of self.
versus role confusion.
 In late adolescence, it is to form a sense of
intimacy versus isolation. LATE ADOLESCENT: INTIMACY VS ISOLATION
 Developing a sense of intimacy means a ate
adolescent is able to form long-term,
ADOLESCENCE meaningful relationships with persons of the
IDENTITY VS ROLE CONFUSION opposite as well as their same sex.
- The adolescent adjusts to changes in his or her  Those who do not develop a sense of intimacy
body and seeks freedom from parents to learn are left feeling isolated; in a crisis situation,
who he/she is or what kind of person he/she they have no one to whom they feel they can
will be. turn to for help or support.
- Identity develops when there is a feeling of  A sense of intimacy is closely related to the
belongingness and being accepted by himself sense of trust learned in the first year of life
and others. because, without the feeling that one can trust
- Those who are accepted, loved & valued by others, building a sense of intimacy is difficult.
family and peers generally tend to gain NURSING IMPLICATIONS:
confidence feel good about themselves.  Provide opportunities for the adolescent to
- Those who have difficulty forming discuss feelings about events important to
relationships or who are perceived by peers as him or her.
too different and not included in adolescent  Offer support and praise for decision making.
J.C.RAMOS 34
THE ADOLESCENT: SOCIALIZATION THE ADOLESCENT: PLAY OR RECREATION

 Early teenagers may feel more self-doubt than  Thirteen-year-old children's activities change
self-confidence when they meet new to more adult forms of recreation such as
adolescent with whom they would like to listening to music, texting or chatting, or
begin a lasting relationship. following a sports teams wins and losses.
 The voices of most boys have not yet  Team loyalty becomes intense and follow
dependably deepened and most girls' bodies coach's instructions mandatorily.
have not yet fully developed. These make  Overuse injuries from athletics occur
them unable to trust themselves to carry out  Most adolescents spend a great deal of time
what they wish to convey. just talking with peers as social interaction.
 Both male and female early adolescents tend  For an adolescent, talking is a major way they
to loud and boisterous, particularly when learn about values and responsibilities.
someone whose attention they would like to  Beginning age 16 years, most adolescents
attract is nearby. want part-time jobs to earn money. Such jobs
 They are also impulsive in that they want what can teach them how to work with others,
they want immediately, not when it is accept responsibility and how to save and
convenient for others. spend money wisely.
 Many 13 year-olds begin to experience  Many of them also engage in charitable
"crushes", or infatuations with schoolmates. endeavors during middle to late adolescence
They may spend more time longing for as a form of recreation. These activities fulfill
someone than they do instituting an in-depth an adolescent's need for satisfying interaction
and rewarding relationship. with others as well as indicators of maturity
 By age 14 years, teenagers have become and willingness to accept adult roles.
quieter and more introspective. They are
becoming used to their changing bodies, have
more confidence in themselves, and feel more PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
self-esteem.  The final stage of cognitive development, the
 Adolescents watch adults carefully, searching formal operational thought, begins at age 12
for good role models with whom they can or 13 years and grows in depth over the
identify. adolescent years, although it may not be
 They usually have a hero whom they want to complete until about age 25 years. This step
grow up to be like. Idolization of famous involves the ability to think in abstract terms
people or older adolescents of this nature and use the scientific method (deductive
fades as adolescents become more interested reasoning) to arrive at conclusions.
in forming reciprocal friendships.  Problem solving in any situation depends on
 Most 15-year-olds fall "in love" five or six times the ability to think abstractly and logically.
a year and are based on attraction or of  Develops abstract thinking abilities
physical appearance.  Is capable of scientific reasoning and formal
 Because infatuation is fleeting, it can lead to logic
extremely intense but brief attachments that  Enjoys intellectual abilities
fade once the two young people discover they  Is able to view problems comprehensively
have little in common.
 By age 16 years, boys are becoming sexually
mature. Both sexes are better able to trust FORMAL OPERATIONS
their bodies than the year before.
 Condition where cognition achieves it's final
 By age 17 years, they tend to have adult values
form.
and responses to events. They have left behind
 Can solve hypothetical problems with
the childish behaviors they used in early
scientific reasoning.
adolescence to get the attention of others.
 Understands causality and can deal with past
J.C.RAMOS 35
 present and future. They are capable of  They recognize that different social groups
abstract and formal thought. within a society will have different values, but
ACTIVITY: Talk time that will sort through attitudes and they believe that all rational people would
opinions agree on two points.
 Abstract concept can be understood and  Involves consideration of the formal rules and
reasoned with. guidelines of the entire society and of
 Multiple hypotheses and outcomes can handle personal values and opinions.
proposition.
 hypothetical thinking NURSING IMPLICATIONS:
- using logical operations, and  An adolescent can be responsible for self-care
- using them in the abstract, rather than the because he/she views this as a standard of
concrete adult behavior.
COGNITIVE DEVELOPMENT FEEDING AND NUTRITION

Adolescent egocentrism can be dissected into two types  Adolescent needs an increased number of
of social thinking: calories to support the rapid body growth that
1. Imaginary audience - believes and imagines that occurs.
people are enthusiastically watching her  Iron to meet expanding blood volume
2. Personal fable - involves a sense of personal requirements.
uniqueness and invincibility  Calcium and Vitamin D plus physical exercise
for rapid skeletal growth as well as to
"stockpile" calcium to prevent osteoporosis
KOHLBERG’S THEORY OF MORAL DEVELOPMENT later in life.
 Zinc for sexual maturation and final body
growth.
LEVEL III: POST CONVENTIONAL MORALITY  For high school athletes, they need more
- The moral principles that underline the carbohydrate for energy. A source of
conventions of a society understood. carbohydrate that best sustains them comes
from the breakdown of glycogen because this
supplies a slow and steady release of glucose.
STAGE 5: SOCIAL CONTRACT ORIENTATION  Glycogen loading is a procedure used to
- Rules and laws represent agreements among ensure there is adequate glycogen to sustain
people about behavior that benefits society. energy through an athletic event.
Rules can be changed when they no longer
meet society's needs.
NURSING PROCESS
Social contract, utilitarian law making perspectives.
 Follows standards of the society for the good
of all people. ASSESSMENT OF AN ADOLESCENT
 Those which do not promote the general  Health maintenance visits during adolescence
welfare should be changed when necessary to may become more irregular because
meet "the greatest good for the greatest adolescents may not seek care from health
number of people". care facilities on their own unless they are ill.
 This is achieved through majority decision,  Until adolescents need a physical examination
and inevitable compromise. for athletic or some other clearance, they are
 Children basically believe that a good society often not seen for assessments.
best conceived as a social contract into which  When adolescents are accompanied by their
people freely enter to work toward the parents at health visits, it is best to obtain a
benefit of all health history separately from the adolescent
J.C.RAMOS 36
to promote independence and responsibility EVALUATION

for self- care. An evaluation of expected outcomes should include
 When performing physical examinations, be whether adolescents are pleased with the outcome.
aware they may be very self-conscious of Examples of outcome criteria include:
their body. 1. Patient states she feels good about herself
 They need health assurance and appreciative even though she is the shortest girl in her class
comments. 2. Patient states he has not consumed alcohol in
2 weeks
3. Parents state they feel more confident about
NURSING DIAGNOSIS their ability to parent an adolescent
Frequently used diagnoses related to adolescent and 4. Patient states she feels high self-esteem
their families include: despite persistent facial acne.
1. Health-seeking behaviors related to normal
growth and development MODULE 7: HEALTH PROMOTION
2. Low self-esteem related to facial acne
3. Anxiety related to concerns about normal TOPIC OUTLINE
growth and development
4. Risk for injury related to peer pressure to use
alcohol and drugs
3 Sexual Maturation
5. Risk for disease related to sexual activity
4 Teeth
6. Readiness for enhanced parenting related to
increased knowledge of teenage years 5 Motor Development
6 Freud’s Theory of Psychosexual Development
7 Social and Emotional Development
IMPLEMENTATION OF SAFE AND QUALITY NURSING 8 Erikson’s Theory of Psychosocial Development
INTERVENTIONS 9 School Age Child Play
 Including the adolescent in planning is 10 Piaget’s Theory of Cognitive Development
essential so the plan will be agreeable and 11 Kohlberg’s Moral Development
accepted. They are not likely to adhere to a 12 Nutrition
plan of care that disrupts their lifestyle or 13 Nursing Process
makes them appear different from others their
age.
 Establishing a contract may be the most
effective means to reach a mutual
understanding.
 Adolescents are very oriented to the present,
so a program that provides immediate results
will usually be carried out well. Those with
long-term goals may not be as successful.
 Adolescents tend to do poorly with tasks
someone tells they must do. Integrating the
adolescent in their plan of care typically helps
them be successful.
 They have little patience with adults who do
not demonstrate the behavior they are being
asked to achieve.
 For best results, evaluate how an intervention
appears from an adolescent's standpoint
before beginning teaching.
J.C.RAMOS 37

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Maternal and Child Care Nursing

(NUR1204) BATCH 2025

TOPIC OUTLINE CENTERING/  see only one of the object’s

8. Early foundations are critical

MAJOR FACTORS INFLUENCING GROWTH AND

GENETICS Physical characteristics, learning

Babies with low rhythmicity are SUPEREGO  Developed during preschool

THEORIES OF CHILD DEVELOPMENT

ADOLESCENT “genital phase”; establishment Tertiary Circular 12 – 18 Explore properties of

Stage 4:FORMAL OPERATION

COGNITIVE DEVELOPMENT BY JEAN PIAGET

SCHOOL AGE  Beginning of concrete

ASSESSMENT FOR PROMOTION OF NORMAL GROWTH

 Readiness for enhanced family coping related MODULE 2: THE INFANT

disintegrating, but new cells are not HEAD CIRCUMFERENCE

PHYSIOLOGIC DEVELOPMENT BODY PROPORTION

WEIGHT THE INFANT’S BODY SYSTEMS

 Lipase is decreased can follow an object across their

THE INFANT’S SENSES TASTE

SMELL 6 MONTHS  Demonstrates parachute

SECONDARY  4-8 months  Introduce small amounts

8 MONTHS fruits like banana, apple, and peach EVALUATION

NURSING DIAGNOSIS FOR INFANTS

IMPLEMENTATION OF SAFE & QUALITY NURSING

MODULE 3: THE TODDLER with it, she may shake it to see if it

PHYSIOLOGIC DEVELOPMENT E. DENTITION

GROSS MOTOR DEVELOPMENT

EMOTIONAL DEVELOPMENT PRONOUNS ARE DIFFICULT TO USE CORRECTLY (I, ME,

ECTOMORPHIC  a slim body built

C. BODY SYSTEMS DEFINITION OF TERMS IN PHALLIC STAGE

AGE FINE MOTOR GROSS PLAY

LANGUAGE DEVELOPMENT INTUITIVE STAGE (4-7 YEARS OLD)

CONVENTIONAL LEVEL II: STAGE 2: INDIVIDUALISM NURSING DIAGNOSIS

MODULE 5: THE SCHOOL AGE

TOPIC OUTLINE CONSERVATION  ability to appreciate that a

Rinne’s Test results b. follicle-stimulating hormote (FSH) which then

A. PHYSICAL GROWTH AGE BOYS GIRLS

PUBIC HAIR GROWTH

MOTOR DEVELOPMENT - Enjoy showing off this new skill in cards,

BEHAVIORS TO OBSERVE 10 - Spend most of their time playing screen

STAGE 3: GOOD BOY – NICE GIRL ORIENTATION ASSESSMENT

3. Anxiety related to slow growth pattern of OVERVIEW

a. the onset of puberty at 8 to 12 years of age

CHRONOLOGIC DEVELOPMENT OF SECONDARY SEX

-Scrotum becomes -pH of vaginal -May have some

GENITAL STAGE cliques may develop less favorable self-image

THE ADOLESCENT: SOCIALIZATION THE ADOLESCENT: PLAY OR RECREATION

COGNITIVE DEVELOPMENT FEEDING AND NUTRITION

to promote independence and responsibility EVALUATION

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