GROWTH AND DEVELOPMENT

Prepared by: Dr. Julius M. Mirafuentes, R.N.

 GROWTH and DEVELOPMENT

Growth Development
 Increase in physical size of the  Maturation of physiological
whole body or any of its parts and psychosocial skill to a
 Measured by inches or more complex function

centimeters and in pound or

kilograms
Principles of Growth and Development
 G&D proceeds in an orderly
sequence – ex: the majority of
children sit before they creep,
creep before the stand, stand
before they walk and walk
before they run.
 Development is
Cephalocaudal – ex: a
newborn can lift his head first,
then his chest, then a part of his
abdomen, then can control the
legs enough to crawl

 Development proceeds from gross to refined skills – ex: newborns

make little use of arms or hands, by 10 months, infant can coordinate
his fingers to pick up fine objects
THEORIES OF GROWTH AND
DEVELOPMENT
 ID – “unconscious mind” – inborn component
FREUD
that is driven by instincts. It obeys the
Three components
principle of immediate gratification of needs of personality:
 EGO – “conscious mind” – serves the reality
principle. It finds realistic means for gratifying
the instincts
 SUPEREGO – “conscience” – functions as
the moral arbitrator and represents the ideal.
 FREUD’S PSYCHOANALYTIC THEORY
STAGE CHARACTERISTICS

INFANT ORAL Explores the world by using MOUTH

TODDLER ANAL Learns to CONTROL urination and defecation

Learns sexual identity through AWARENESS OF

PRESCHOOLER PHALLIC
GENITAL AREA

Child’s sexual drive is repressed; energy is devoted

SCHOOL-AGE LATENT
to acquisition of NEW SKILLS

Genitals are source of pleasure but energies are

ADOLESCENT GENITAL invested in forming FRIENDSHIPS AND
PREPARING FOR MARRIAGE
ERIKSON’S PSYCHOSOCIAL THEORY
AGE TASK
Infant 0 – 18 mos. Trust vs. Mistrust
Toddler 18 mos. – 3yrs Autonomy vs. Shame and doubt
Preschooler 3yrs – 6yrs Initiative vs. Guilt
School-age 6yrs – 12 yrs Industry vs. Inferiority
Adolescence 12yrs – 20 yrs Identity vs. Role confusion
Young Adult 20 yrs – 45 yrs Intimacy vs. Isolation
Middle Adult 45yrs-65 yrs Generativity vs. Stagnation
Late Adult 65 plus Integrity vs. Despair
 PIAGET’S COGNITIVE THEORY
PERIOD AGE CHARACTERISTICS

 Stimuli are assimilated into

beginning mental images.
Behavior is entirely reflexive.
 Infant begins to engage in
SENSORIMOTOR Birth to 2 yrs repetitive then to imitative
behavior.
 Increased awareness of object
permanence.
 PIAGET’S COGNITIVE THEORY
PERIOD AGE CHARACTERISTICS

 Thinking is concrete and literal –

what is seen, heard and felt
 Child is egocentric – unable to
see the viewpoint of another
 Displays static thinking –
PREOPERATIONAL inability to remember the
2 to 7 yrs
THOUGHT beginning such that at the end of
the sentence the child talks about
another topic
 No sense of conservation and is
not aware of reversibility
 PIAGET’S COGNITIVE THEORY
PERIOD AGE CHARACTERISTICS

 Systematic reasoning
 Uses memory to learn broad
concepts
CONCERETE  Understands conservation and
OPERATIONAL 7 to 12 yrs is aware of reversibility
THOUGHT  Able to sort, classify and
organize facts about the
environment
 PIAGET’S COGNITIVE THEORY
PERIOD AGE CHARACTERISTICS

 Abstract thinking
 Able to solve hypothetical
FORMAL problems with scientific
OPERATIONAL 12 – 15 yrs reasoning
THOUGHT  Can deal with past, present,
and future
Kohlberg’s Stages of Moral Development
CHARACTERISTI
LEVEL STAGE
CS
Child does right
Stage 1: Punishment – because a parent tells
2 – 3 yrs.
Obedience Orientation him or her to and to
I. Preconventional avoid punishment.
Level Child carries out
Stage 2: Instrumental – actions to satisfy own
4 – 7 yrs
Relativist Orientation needs rather than
society’s
Kohlberg’s Stages of Moral Development
CHARACTERIS
LEVEL STAGE
TICS

Child follows
rules because of
Stage 3: Good boy – a need to be
7 – 10 yrs.
Nice girl Orientation “good” person in
II. Conventional
own eyes and
Level
eyes of others.

Child finds
Stage 4: Law and
10 – 12 yrs. following rules
order Orientation
satisfying
Kohlberg’s Stages of Moral Development
CHARACTERIS
LEVEL STAGE
TICS
Stage 5: Social Follows standards
Older than
contract – legalistic of society for the
12
orientation good of people
III. Postconventional Follows
Stage 6: Universal
internalized
Ethical Principle
standards of
Orientation
conduct
DEVELOPMENTAL STAGES
THE INFANT
 Definition: 1 to 12 months of age
 Weight: Doubles birth weight in 6
months; triples by 1 year
 Height: Doubles by 1 year
 Head: Head circumference is greater
than chest circumference

a. Posterior fontanel – closes at 2 to

3 months

b. Anterior fontanel – closes at 12 to

18 months
THE INFANT
 Dentition: Eruption of deciduous

“baby” teeth at 6 months; Two

lower central incisors erupt first

 Nutrition: Infants can hold

approximately 2 tablespoons (30

mL)

a. Breast milk is the most

desirable food for the first 6

months of life
THE INFANT

b. Solid foods should be

introduced between 4
to 6 months. Give one
new food at a time
over a few days to
determine allergy or
intolerance.
THE INFANT
 Rice cereal is suggested as the

initial food – easily digested

and has low allergenic potential

 Weaning is best accomplished

at approximately 8 months

 Junior foods or chopped table

foods introduced by 12 months

THE INFANT
 Psychosexual Development (FREUD): Oral Stage

a. Do not discourage thumb sucking

b. Provide oral stimulation by giving pacifiers

 Psychosocial Development (ERIKSON): Trust vs. Mistrust

a. Most important person is the MOTHER.

b. Provide a primary care giver

c. Provide experience that adds to security such as soft sounds and touch.
 Cognitive Development (PIAGET): Sensorimotor

a. Provide enjoyable activities to promote stimulations

THE INFANT
 Play : SOLITARY - play with their own body
 Age-appropriate toys – should stimulate all senses

 Peek-a-book  Pat-a-cake

 Mobiles  Teething rings

 Rattles  Textured balls

 Musical box  Large, soft, cuddy

toys
THE INFANT
 Greatest Fears:

a. Birth to 3 months: Sudden

movements, loud noises,
and loss of physical
support

b. 4 to 12 months: Stranger
Anxiety
THE INFANT
 Accidents:

a. Aspiration – round objects

are dangerous

b. Falls

c. Suffocation – deflated
balloons can be sucked
into the mouth
THE INFANT
 Concept of Death: No concept of death
 Traits : Regression – use of behavior that is more appropriate to an
earlier stage
 Hospitalizations: Approach in a non-threatening manner
THE TODDLER
 Definition : 1 to 3 years of age
 Weight: Growth rate slows
considerably
 Height: at 2 years, 50% of
future adult height
 Posture: Lordotic; potbelly
THE TODDLER
 Dentition:

a. Deciduous teeth are all

present by 2 ½ years;

b. First trip to the dentist,

c. supervise tooth brushing –

pea size toothpaste
THE TODDLER
 Nutrition:

a. Picky, ritualistic eaters;

b. “FOOD JAG” :eating the

same kind of food – Give
finger foods and allow for
food choices
THE TODDLER
 Psychosexual Development (FREUD): Anal Stage

a. Help children achieve bowel and bladder control without undue

emphasis on its importance

b. Toilet training – accomplished before bladder control

 Clues to readiness for toilet training
• Can stand alone and walk steadily
• Can keep self dry for intervals of at least 2 hours
• Is able to use words or gestures regarding toileting
needs
THE TODDLER
 Psychosexual Development (FREUD): Anal Stage

a. Help children achieve bowel and bladder control without undue

emphasis on its importance

b. Toilet training – accomplished before bladder control

 Age of achievement
• Bowel control – 18 months of age
• Daytime bladder control – 2 ½ years of age
• Nighttime bladder control – 3 years of age
THE TODDLER
 Psychosocial Development (ERIKSON): Autonomy vs. Shame and
Doubt

a. Most important person: PARENTS

b. Provide opportunities for decision making by offering choices

of clothes to wear or toys to play with.

c. Praise for ability to make decisions rather than judging

correctness of any decisions.
THE TODDLER
 Cognitive Development (PIAGET): Preoperational Thought

a. Provide items that requires imagination – modeling clay,

finger-paints, and the like.
 Moral Development (KOHLBERG): Preconventional level – Stage
1: Punishment – Obedience Orientation

a. Give clear instructions to avoid confusion.

b. Child needs help to determine what are right actions

THE TODDLER
 Play: PARALLEL - Plays alongside but not together
 Age – appropriate toys

 Push – pull  Pounding pegs

toys
 Building blocks  Stuff toys

 Toys to ride
one
THE TODDLER
 Greatest Fear:
• Separation Anxiety – Explain the reason why
parents have to leave, avoid sneaking out.

a. Protest – child appears sad, agitated and

angry

b. Despair – acts ambivalent when parents

return

c. Detachment – child appears happy, may

ignore parents
THE TODDLER

ACCIDENTS

 Drowning – Ensure multiple

barrier to tubs, and pails
 Poisoning – Store all
chemicals, cleaners, and
personal care products out of
child’s reach.
 Falls – Supervise child during
indoor or outdoor play.
THE TODDLER

ACCIDENTS

 Burns – Childproof access to

electrical outlet, cords and
appliances
 Aspiration – Selecting toys
according to manufacturer’s
recommendation.
THE TODDLER
 Concept of death: No concept of death
 Traits

a. Negativistic (their favorite word is “NO!”) – limit close ended

questions but do not compromise chance to choose

b. Ritualistic – needs to maintain sameness and reliability

c. Temper tantrums - Ignore the behavior or direct them to

activities that they can master

d. Security blankets – due to fear of separation

THE TODDLER
 Hospitalizations

a. Preparation for a procedure should be brief due to a short

attention span.

b. Explanation should be done IMMEDIATELY PRIOR to the

procedure by describing sensations that they may feel

c. Provide favorite and comforting objects

Physical
 a. Height and weight increase in a
step-like fashion, reflecting growth
spurts and lags.
 b. Head circumference increases about
1 inch between ages 1 and 2;
thereafter, head circumference
increases about ½ inch per year until
age 5.
 c. Anterior fontanel closes between
ages 12 to 18 months.
 d. Weight gain is slower than in
infancy; by age 2, the average weight
is 22 to 27 lb.
 e. Normal height changes include a
growth of about 3 inches per year; the
average height of the toddler is 34
inches at age 2 years.
 f. Lordosis (pot belly) is evident.
 g. The toddler should see a dentist
soon after the first teeth erupt, usually
around 1 year of age; fluoride
supplements may be necessary if the
water is not fluoridated.
 h. A toddler should never be allowed
to fall asleep with a bottle containing
milk, juice, soda pop, or sweetened
water because of the risk of nursing
(bottle-mouth) caries.
 i. Typically, the toddler sleeps through
the night and has one daytime nap; the
daytime nap is normally discontinued
at aboutage 3.
 j. A consistent bedtime ritual helps
prepare the toddler for sleep.
 k. Security objects at bedtime may
assist in sleep.
Vital signs

The Toddler's Vital Signs

 Temperature: Axillary, 97.5° to

98.6° F
 Apical rate: 80 to 120
beats/min
 Respirations: 20 to 30
breaths/min
 Blood pressure: Average, 92/55
mm Hg
Nutrition
 a. Most toddlers prefer to feed
themselves.
 b. The toddler generally does best
by eating several small nutritious
meals each day rather than three
large meals.
 c. Offer a limited number of foods
at any one time.
 d. Offer finger foods and avoid
concentrated sweets and empty
calories.
 e. The toddler is at risk for
aspiration of small foods that are
not chewed easily, such as nuts,
foods with seeds, raisins, popcorn,
grapes, and hot dog pieces.
 f. Physiological anorexia is normal
because of the alternating
 stages of fast and slow growth.
 g. Sit the toddler in a high chair at
the family table for meals.
 h. Allow sufficient time to eat, but
remove food when the toddler
 begins to play with it.
 i. The toddler drinks well from a
cup held with both hands.
 j. Avoid using food as a reward or
punishment.
Skills
 a. The toddler begins to walk with
one hand held by age 12 to 13
months.
 b. The toddler runs by age 2 years
and walks backward and hops on
one foot by age 3 years.
 c. The toddler usually cannot
alternate feet when climbing stairs.
 d. The toddler begins to master
fine motor skills for building,
undressing, and drawing lines.
 e. The young toddler often uses no
even when he or she means yes to
assert independence.
 f. The toddler begins to use short
sentences and has a vocabulary of
about 300 words by age 2.
Signs of Readiness for Toilet
Training
 Child is able to stay dry for 2
hours.
 Child is waking up dry from a nap.
 Child is able to sit, squat, and
walk.
 Child is able to remove clothing.
 Child recognizes urge to defecate
or urinate.
 Child expresses willingness to
please parent.
 Child is able to sit on toilet for 5 to
10 minutes without fussing or
getting off.
Bowel and bladder control

 a. Certain signs indicate that a toddler

is ready for toilet training

 b. Bowel control develops before

bladder control.

 c. By age 3, the toddler achieves fairly

good bowel and bladder control.

 d. The toddler may stay dry during the

day but may need a diaper at night
until about age 4.
Play

 a. The major socializing mechanism is parallel play, and

therapeutic play can begin at this age.
 b. The toddler has a short attention span, causing the
toddler to change toys often.
 c. The toddler explores body parts of self and others.
 d. Typical toys include push-pull toys, blocks, sand, finger
paints and bubbles, large balls, crayons, trucks and dolls,
containers, Play-Doh, toy telephones, cloth books, and
wooden puzzles.
Safety
 a. Toddlers are eager to explore the world around them.
 b. The toddler should be supervised at play.
 c. The toddler can be placed in an upright forward-facing
position in a car safety seat (convertible restraint); the
transition point for switching to a forward-facing position
is defined by the manufacturer of the car seat but is
generally at a body weight of at least 20 lb and 1 year of
age.
 d. Convertible restraints (car safety seats) are used until
the child weighs at least 40 lb
 e. Booster seats are used for children
shorter than 4 feet, 9 inches tall and
weigh more than 40 lb (typically
between 4 and 8 years of age); a
booster seat is used until the child can
sit against the back of the seat with
feet hanging down and legs bent at the
knees.
 f. Children should use specially
designed car restraints until they
weigh at least 60 lb or are 8 years old.
 g. Lock the car doors.
 h. Four-door cars should be equipped
with child safety locks on the back
doors.
 i. Use back burners on the stove to
prepare a meal, and turn pot handles
inward and toward the middle of the
stove.
 j. Keep dangling cords from small
appliances away from the toddler.
 k. Place inaccessible locks on
windows and doors, and keep furniture
away from windows.
 l. Secure screens on all windows.
 m. Place gates at stairways.
 n. Do not allow the toddler to sleep or
play in an upper bunk bed.
 o. Never leave the toddler alone near a
bathtub, pail of water, swimming pool,
or any other body of water.
 p. Keep toilet lids closed.
 q. Keep all medicines, poisons,
household plants, and toxic products
high and locked out of reach.
 r. Keep the poison control number
available.
When the child reaches 1 year
of
age and 20 lb, the car safety
seat
can be adjusted to a forward
facing, upright position. The
seat
is appropriate for the toddler
until the child weighs about 40
lb.
The
safety straps should be
adjusted
to provide a snug fit, and the
seat
should be placed in the back
seat
of the car, ideally in the
middle.
THE PRESCHOOLER
 Definition: 3 to 6 years of age
 Weight/ Height: Grow is slow
and steady
 Dentition: Reinforce regular
dental hygiene
 Nutrition: Demonstrates food
preferences
THE PRESCHOOLER
 Psychosexual Development (FREUD): Phallic

a. Accept child’s interest such as fondling genitals, as a normal area

of exploration

b. Answer child’s questions about birth or sexual differences.

 Psychosocial Development (ERIKSON): Initiative vs. Guilt

a. Most important person: PARENTS

b. Provide opportunities for exploring new places or activities

c. Allow play to include activities involving water, modeling clay,

or finger paint
THE PRESCHOOLER
 Cognitive Development (PIAGET): Preoperational Thought

a. Provide items that requires imagination – modeling clay,

finger-paints, and the like.
 Moral Development (KOHLBERG): Instrumental – Relativist
Orientation

a. Child is unable to recognize that like situations require like

actions

b. Unable to take responsibility for self-care because it interferes

with meeting own needs
THE PRESCHOOLER
 Play: ASSOCIATIVE OR COOPERATIVE
 Age – appropriate toys

 Housekeeping  Picture /coloring

toys books

 Playground  Materials for

equipment cutting/pasting
(swing, slide)

 Tricycle  Watercolors;
finger-paints;
clay
THE PRESCHOOLER
 Greatest Fears

a. Castration Complex – Explain gender differences.

b. Body mutilation – Explain any sensations to be felt by the child;

do not exaggerate things when quantifying pain.

c. Fear of the dark – Open the lights when the child is going to
sleep
THE PRESCHOOLER
 Accidents:

a. Motor vehicles – Teach safety with tricycle (look before crossing

driveways; do not cross streets).

b. Falls – Supervise preschoolers at play grounds

c. Burns – Store matches in closed containers.

d. Drowning – Teach beginning swimming

e. Strangers (Abduction) – Teach preschooler that not all p people are

“friends” (Do not talk to strangers or take any candy from strangers.)

f. Poisoning – Never take a medication in front of a child nor present a

medication as candy.
THE PRESCHOOLER
 Concept of Death:  Traits:

a. Temporary and Reversible a. Imitation – loves to dress-

b. Magical thinking belief up; fantasy play

that the dead person will b. Curiosity - Favorite word

come back is, “why?”

c. Imaginary playmates are

common – normally until
age 5
THE PRESCHOOLER
 Traits

d. Oedipal complex - Boy's feelings of desire for his mother and

jealously and anger towards his father; boy views him as a rival
for his mother's affections

e. Electra complex – Girl’s feelings toward her father and anger

towards her mother.

f. Sibling rivalry – Role play on a doll on how to care for younger

sibling
THE PRESCHOOLER
 Hospitalizations

a. Form of punishment because they have done something wrong

b. Provide therapeutic play to deal with fears and concerns related

to illness or hospitalization
Physical
 a. The preschooler grows 2½ to 3 inches per year.
 b. Average height is 37 inches at age 3, 40½
inches at age 4, and 43 inches at age 5.
 c. The preschooler gains approximately 5 lb per
year; average weight of 35 to 40 lb at age 5.
 d. The preschooler requires about 12 hours of
sleep each day.
 e. A security object and a nightlight help with
sleeping.
 f. At the beginning of the preschool period, the
eruption of the deciduous (primary) teeth is
complete.
 g. Regular dental care is essential, and the
preschooler requires assistance with brushing and
flossing of teeth; fluoride supplements may be
necessary if the water is not fluoridated.
Vital signs
The Preschooler's Vital Signs

 Temperature: Axillary, 97.5° to 98.6° F

 Apical rate: 70 to 110 beats/min
 Respirations: 16 to 22 breaths/min
 Blood pressure: Average, 95/57 mm Hg
Nutrition
 a. The preschooler exhibits food fads and strong taste
preferences.

 b. By 5 years old, the child tends to focus on social

aspects of eating, table conversations, manners, and
willingness to try new foods.
Skills
 a. The preschooler has good
posture.
 b. The child develops fine motor
coordination.
 c. The child can hop, skip, and run
more smoothly.
 d. Athletic abilities begin to
develop.
 e. The preschooler demonstrates
increased skills in balancing.
 f. The child alternates feet when
climbing stairs.
 g. The child can tie shoelaces by
age 6.
 h. The child may talk continuously
and ask many why questions.
 i. Vocabulary increases to about
900 words by age 3 and to 2100
 words by age 5.
 j. By age 3, the preschooler
usually talks in three- or four-word
 sentences and speaks in short
phrases.
 k. By age 4, the preschooler
speaks five- or six-word sentences
 and, by age 5, speaks in longer
sentences that contain all parts of
speech.
 l. The child can be understood
readily by others and can
 understand clearly what others are
saying.
Bowel and bladder control

 a. By age 4, the preschooler has daytime control of bowel

and bladder but may experience bed-wetting accidents at
night.

 b. By age 5, the preschooler achieves bowel and bladder

control, although accidents may occur in stressful
situations.
Play
 a. The preschooler is cooperative.
 b. The preschooler has imaginary playmates.
 c. The child likes to build and create things, and play is simple
 and imaginative.
 d. The child understands sharing and is able to interact with peers.
 e. The child requires regular socialization with mates of similar
 age.
 f. Play activities include a large space for running and jumping.
 g. The preschooler likes dress-up clothes, paints, paper, and
 crayons for creative expression.
 h. Swimming and sports aid in growth development.
 i. Puzzles and toys aid with fine motor development.
 Safety
 a. Preschoolers are active and inquisitive.
 b. Because of their magical thinking,
they may believe that daring feats seen in
cartoons are possible and may attempt
them.
 c. The preschooler can learn simple
safety practices because they can follow
simple verbal directions and their
attention span is longer.
 d. Once the child has outgrown the
convertible restraint car safety seat
(weight more than 40 lb), the preschooler
should be placed and restrained in a
booster seat.
 e. Booster seats are used for children
shorter than 4 feet, 9 inches tall and
weight more than 40 lb (typically
between 4 and 8 years of age); a booster
seat is used until the child can sit against
the back of the seat with feet hanging
down and legs bent at the knees (
 f. Children should use specially
designed car restraints until they
weigh at least 60 lb or are 8 years old.
 g. Teach the preschooler basic safety
rules to ensure safety when playing in
a playground near swings and ladders.
 h. Teach the preschooler never to play
with matches or lighters.
 i. The preschooler should be taught
what to do in the event of a fire or if
clothes catch fire; fire drills should be
practiced with the preschooler.
 j. Guns should be stored unloaded and
secured under lock and key
(ammunition should be locked in a
separate place); the preschooler should
be taught to leave an area immediately
if a gun is visible and to tell an adult.
A high-backed booster seat
designed to hold car lap and
shoulder belts properly is
strongly
recommended for children who
have outgrown a child safety seat.
Booster seats raise the young child
high enough to allow the car seat
belt to be positioned correctly over
the child's chest and pelvis.
THE SCHOOL-AGE SCHILD
 Definition: 6 to 12 years of age
 Weight/ Height: steady, slow
growth
 Dentition: Loose first
deciduous teeth at 6; by 12 yrs,
has all permanent teeth except
final molars
 Nutrition: Tendency to eat
empty calories – “junk foods”
THE SCHOOL-AGE CHILD
 Psychosexual Development (FREUD): Latent stage

a. Help a child have positive experiences so his or her self-esteem

continues to grow and the child prepares for the conflict of
adolescence.
 Psychosocial Development (ERIKSON): Industry vs. Inferiority

a. Most important person: Teacher and Classmate

b. Provide opportunities by allowing the child to assemble and

complete a short project so that the child feels rewarded for
accomplishment.
THE SCHOOL-AGE CHILD
 Cognitive Development (PIAGET): Concrete Operational Thought

a. Provide a more intellectual – based activities: collecting and

classifying natural objects such as plants, shells, animals, etc.

b. Expose child to other view points by asking questions such as,

“How do you think you’d feel if you were a nurse and had to

tell a boy to stay in bed?”

THE SCHOOL-AGE CHILD
 Moral Development (KOHLBERG): Conventional Level ( Good-

Boy and Nice-girl Orientation; Law and Order Orientation)

a. Child enjoys helping others because this is “nice” behavior.

Allow child to help with bed making and other like activities.

b. Praise for desired behavior such as sharing.

c. Child often asks what the rules. May have difficulty modifying

a procedure because one method may not be “right”.

 THE SCHOOL-AGE CHILD
 Play – COMPETITIVE  Greatest Fears
 Age – appropriate toys a. Fear of
replacement/displacement
 Sports  Table games
in school
 Dolls  Bicycles;
skateboard b. Loss of privacy
 Trains and  Trains and model
model kits kits
 Collecting  Collecting objects
objects
THE SCHOOL-AGE CHILD
 Accidents:  Concept of Death:

a. Bicycle – Use appropriate a. Death is irreversible

helmet for bike riding; b. By age 9, understands
supervise child closely death is universal
when in public settings

b. Firearms – Instruct child

on dangers of weapons
and fires.
THE SCHOOL-AGE CHILD
 Traits:  Hospitalizations: More detailed

a. Hero worship – peaks at 7 teaching and preparation and

years of age allow to make choices

regarding care
b. School phobia - bullying

c. Displacement in school
Physical
 a. Girls usually grow faster than
boys.
 b. Growth is about 2 inches per
year between ages 6 and 12.
 c. Height ranges from 45 inches at
age 6 to 59 inches at age 12.
 d. School-age children gain weight
at a rate of about 4½ to 6½ lb
 per year.
 e. Average weight is 46 lb at age 6
and 88 lb at age 12.
 f. The first permanent (secondary)
teeth erupt around age 6, and
deciduous teeth are lost gradually.
 g. Regular dentist visits are
necessary, and the school-age
child needs to be supervised with
brushing and flossing teeth;
fluoride supplements may be
necessary if the water is not
fluoridated.
 h. For school-age children with
primary and permanent dentition,
the best toothbrush is one with soft
nylon bristles and an overall
length of about 6 inches.
 i. Sleep requirements range from
10 to 12 hours a night.
Nutrition
 a. School-age children have increased growth needs.

 b. Children require a balanced diet from foods in the

MyPyramid Food Guide; healthy snacks should be
emphasized to prevent childhood obesity.

 c. Children still may be picky eaters but are willing to try

new foods.
Skills
 a. School-age children exhibit refinement of fine motor
skills.

 b. Development of gross motor skills continues.

 c. Strength and endurance increase.

Play

 a. Play is more competitive.

 b. Rules and rituals are important aspects of play and
games.
 c. The school-aged child enjoys drawing, collecting items,
 dolls, pets, guessing games, board games, listening to the
 radio, TV, reading, watching videos or DVDs, and
computer games.
 d. The child participates in team sports.
 e. The child may participate in secret clubs, group peer
activities, and scout organizations.
 Safety
 a. The school-age child experiences less fear in play
activities and frequently imitates real life by using
tools and household items.
 b. School-age children are ready to transition from
booster seats when the adult seat belts fit correctly
(the shoulder belt fits across the chest and shoulder,
the lap belt fits across the thighs, and the child is tall
enough to sit comfortably against the seat back with
the knees bent, without slouching, for the length of the
trip). This typically occurs when the child is at least 4
feet 9 inches tall and is between 8 and 12 years of age.
 c. Car safety belts should be worn across the thighs;
the shoulder belt is used only if it does not cross over
the child's neck and face.
 d. Major causes of injuries include bicycles,
skateboards, and team sports as the child increases in
motor abilities and independence.
 Safety
 e. Children should always wear a helmet
when riding a bike or using in-line skates
or skateboards.
 f. Teach the child water safety rules.
 g. Instruct the child to avoid teasing or
playing roughly with animals.
 h. Teach the child never to play with
matches or lighters.
 i. The child should be taught what to do in
the event of a fire or if clothes catch fire;
fire drills should be practiced with the
 child.
 j. Guns should be stored unloaded and
secured under lock and key (ammunition
should be locked in a separate place); the
school-age child should be taught to leave
an area immediately if a gun is visible
and to tell an adult.
 k. Teach the school-age child that
if another person touches his or
her body in an inappropriate way,
an adult should be told.
 l. Teach the school-age child to
avoid speaking to strangers and
never to accept a ride, toys, or
gifts from a stranger.
 m. Teach the child traffic safety
rules.
 n. Teach the child how to dial 911
in an emergency situation.
 o. Keep the poison control number
available.
THE ADOLESCENT
 Definition: 13 to 18 years of
age (Age of PUBERTY)
 Weight/ Height: Rapid period
of growth; growth spurt
 Dentition: Final molars erupt
 Nutrition: Appetite increases;
Fad Diets
THE ADOLESCENT
 Psychosexual Development (FREUD): Genital

a. Allow child to verbalize feelings about relationships of

opposite sex
 Psychosocial Development (ERIKSON): Identity vs. Role Confusion

a. Most important person: PEERS

b. Provide opportunities for an adolescent to discuss feelings

about events important to him or her.

c. Offer support and praise for decision making

THE ADOLESCENT
 Cognitive Development (PIAGET): Formal Operational Thought

a. Spend “talk time” periods to sort through attitudes and

opinions
 Moral Development (KOHLBERG): Social contract – legalistic
Orientation

a. An adolescent can be responsible for self-care because he or

she views this as a standard of adult behavior.
THE ADOLESCENT
 PLAY (Recreations): Social  Greatest Fear:
Interactions a. Loss of independence
a. Sports and cultural b. Loss of identity – centers
activities on peer approval and
feelings of normalcy

c. Body image disturbance –

focuses on appearances
 THE ADOLESCENT
 Accidents: c. Sports accidents – Use
a. Motor vehicular accidents – Use protective equipment.
seat belt whether as driver or Recognize and set own
passenger. Do not drink alcohol limit for sports
while driving and refuse to ride
participation
anyone who has been drinking.
d. Suicide – Encourage
b. Firearms – Always consider all
non violent responses
guns loaded and potentially
to conflict resolutions.
lethal.
THE ADOLESCENT
 Concept of Death:  Traits:

Irreversible, a. Are bothered by the statement, “Who am

universal and I”

inevitable b. Tend to rebel against authority – flexibility

of rules is necessary to give way to a
growing sense of independence; make
available all sorts or needed information

c. Pubescent changes in males usually begin

later than in females
THE ADOLESCENT
 Hospitalizations: Full and
honest explanations to be able
to make good choices