THEORIES OF DEVELOPMENT

FREUDIAN STAGES
Developmental Stage Time Period Critical Behaviors
ORAL Birth-15 months Mouth & lips are channel
of gratification and means
by which environment is
explored.
ANAL 15 months-3 years Libidinal energy shifts to
anal area, focus is on toilet
training & muscle control
PHALLIC(Oedipal) 3-6 years Libidinal energy shifts to
genital area, introjection &
identification. Initiates devt
of Superego.
LATENCY 6-12 years Focus on energy is on
intellectual dev’t,
maturation of superego
continues; child moves out
of family system through
school & is subject to
other’s values.
GENITAL 12 years-early childhood Overwhelming supply of
sexual drives; primarily
goal is developing
satisfactory relationships
with persons of opposite
sex.
ERICKSON’S STAGES
DEVELOPMENTAL PSYCHOSOCIAL CRITICAL BEHAVIORS
STAGE CRISIS &
TIME PERIOD

Sensory Trust vs. Mistrust( 0-1 Development of significant

year) relationships
Muscular Autonomy vs. Shame & Child learns to function
Doubt ( 1-3 years) autonomously within the
context of the environment.
Begin verbal skills
Begins acceptance of
reality vs. pleasure
principle.
Locomotor Initiative vs. Guilt Increasing awareness of
(3-6 years) own identity & relationship
to multiple systems.
Increasing awareness of
influence on others.
Asks questions.
Latency Industry vs. Inferiority Energies are directed
(6-12 years) toward creative activities &
the pursuit of learning.
Gains attention by
accomplishments.
Explore things.
Learns to relate to own sex.

Adolescent Identity vs. Role Confusion Transition from childhood

(12-20 years) to adulthood.
Achievement of integration
of values, beliefs, attitudes.
Moves toward
heterosexuality. Begins
separation to family.
Young adulthood Intimacy vs. Isolation Ability to extend self into
intimate relationships with
others. Learn to be creative
and productive.
Adulthood Generativity vs. Stagnation Logical extension of young
adulthood. Realtionships
reflect successful
achievement of intimacy &
the ultimate goal of
developing a family.

Maturity Ego Integrity vs. Despair Perception of life as a

culmination of both
positive & negative.
Acceptance of life it is.
PROFILE OF AN AVERAGE
NEWBORN(NB)
• HEAD CIRCUMFERENCE: 34-35 cm
• CHEST CIRCUMFERENCE: 32-33 cm
• TEMPERATURE: 87.6-98.6 F
• HEART RATE: 120-140 bpm
• RESPIRATORY RATE: 30-60 breaths/minute
• WEIGHT: 2.5-3.4 kg.
• LENGTH: 46-54cm
MUST KNOWS:
• A NB weight more than 10 lbs is associated with diabetic
conditions in the mother.

• NB losses 5-10% body weight within the first few days, then
regains weight in 10 days.

• 75-90% of NB weight is fluid--- THEY GET EASILY

DEHYDRATED

• Head circumference is larger than the chest until 2 years of life.

HEAT LOSS IN NB
1. CONVECTION- heat from body to cooler air.
 close windows
2. CONDUCTION- Body heat to surface of objects
 Place blankets on surface
3. RADIATION- heat to a cooler object not in contact
with body
 Place body away from window or air conditioner
4. EVAPORATION- loss of body fluids from skin;
 Dry hair and face immediately, cover head with cap
APPEARANCE OF NB
NORMAL:
• Ruddy complexion due to increased RBC and decreased SQ fat
• Acrocyanosis- bluish hand and feet during the first 24-48 hours
• Generalized mottling
• Central cyanosis due to decreased oxygenation-suction-suction
mouth first
• Jaundice- 2ND-3rd day-hyperbilirubinemia
. Early feeding
. Excessive bilirubin in the blood-kernictus-brain cell
damage.
• Pallor-anemia
• Gray color- infection
• Harlequin sign- dependent side of the body appear red and pale
on upper side
• Skin turgor- for dehydrated newborn, it should be resilient and
elastic
• Mucus in the mouth- excessive may indicate tracheosophageal
fistula
BIRTHMARKS
• Hemangiomas- vascular tumors of the skin
• Nevus Flammeus- “port wine stain”
* Macular purple or dark red lesion level with skin
usually do not disappear
STORK BEAK MARKS
• Lighter pink patches at the back of the neck
Strawberry hemangiomas
• Elevated areas formed by immature capillaries and endothelial
cells. Usually disappears.
Cavernous hemangiomas
• Dilated vascular spaces
• Raised, don’t disappear, may lead to bleeding
Mongolian spots
• Pigment cells(melanocytes); slate-gray patches across sacrum
or buttocks
Lanugo
• Fine downy hair, term babies have lesser lanugo. More lanugo
indicate prematurity, disappears by 2 weeks.
VERNIX CASEOSA- white chessy substance that covers the
skin of newborn. May also indicate maturity, term babies have
lesser vernix caseosa.
DESQUAMATION- peeling of the skin
MILIA- pinpoint white papule on cheeks or over nose; disappears
by 2-4 weeks
MILARIA- clear vesicles on face, scalp & perineum due to
retention of sweat in unopened sweat glands.
*Remove excess clothing & room in a cooler environment
• PETECHIAE OR PURPURA RASH- red or
purple rashes over the body that may be present
in child with thrombocytopenia(platelet
deficiency)
• ERYTHEMA TOXICUM- newborn rash;
“fleabite rash”
• BRUISING- occurs from breech extractions, or
use of forceps. It may decrease circulating
blood– anemia--hypotension
• FONTANELLES
1. Anterior- diamond shaped
• Soft spot
• Should not be indented or bulging
• Closes at 12-18 mos
2. Posterior- triangular shaped
• Closes at 2nd month
SUTURES- overriding, separates line of the skull
• Wide, separated sutures indicates increased ICP or accumulation of
blood.
MOLDING- head molds into the shape of cervix to fit—after birth,
appears to be asymmetric and for primi—dunce cup” shape
CAPUT SUCCEDANEUM- edema of the scalp
CEPHALHEMATOMA- collection of blood between the skull bone
and bone itself due to break of capillaries black and swelling
absorbed in weeks.
CRANIOTABES- localized softening of cranial bones caused by
pressure on bone on older child, it indicates faulty metabolism and
kidney dysfunction
• EYES
• Dark pupils
• Normal on 3RD-12 month
• Should be clear without purulent
discharge or redness
• Red spots on sclera disappears in 2-3 days
until kidneys are capable of draining body
fluids
EARS
• Pinna not completely found
• Top part of the ear should be in line drawn
from inner canthus to back of the head
• Low set ears indicates chromosal disorder
• Test hearing by ringing a bell held at 6th from
crib; take note of negative response.
NOSE
• Large for face
• Test patency by covering mouth and one nostril.
MOUTH
• If one side of the mouth moves more than the other, it may
indicate cranial nerve injury
• Palate should be intact
• Eiptein pearls- glistening, well circumscribed cyst due to
calcium deposits, considered as normal
• Thrush-grayish white adherent milk-curd like plaques found in
the tongue and buccal cavity
CHEST
• Enlarge breast with thin watery fluid( witch
milk) due to maternal hormone
• Retraction during inspiration indicates
respiratory distress
• Ronchi is normal (harsh innocent sound of air
passing over mucus)
• Grunting is abnormal (high-crowning sound;
stridor)
• NECK
• Short and chubby with skin folds
• Head freely rotates; if not– it indicates congenital
torticollis-injury to the sternocleidomastoid muscle.
• 24 hours ROM- nuchal rigidity indicates meningitis
• Makes momentary effort to lift head
• It is normal that trachea is bulging because of
enlarged thymus gland
ABDOMEN
• Sunken abdomen may indicate missing
contents like in diaphragmatic hernia
• Bowel sound should be present within 1 hour
after birth
• Cord falls off by 6th-10th day( about a week)
ANGOGENITAL AREA
• Note passage of meconium within 24 hours. No passage may
mean imperforate anus
• Scrotum- edematous & rugaeted
• 2 descended testes
• Cryptorchidism- one or both testes have not descended
• Penis- if lesser than 2 cm, refer to endocrinologist
• Shortage of urethra:
*Epispadias-opening at dorsal aspect
*Hypospadias- opening at ventral aspect
• PREPUCE(foreskin)- should not be stenosed
* It normally slides back poorly. Do not
attempt to slide
• FEMALE GENITALIA- swollen
*Pseudomenstruation- presence of mucus
secretion, blood tinged is normal due to maternal
hormones
CORD should remain dry
EXTREMITIES
• Appear short
• Fingernails soft, smooth and long
• Conditions associated with Chromosomall disorders:
1. Syndactyly- webbing of toes
2. Polydactyly- extra toes or fingers
3. Unusual spacing of toes
LEGAL RESPONSIBILITIES FOR NB
1. Newborn ID & registration
• 2 bands- wrist & foot
• Contains:
1.Hospital number coinciding with mother
2. Mother’s full name, sex, date, time of birth

2. Footprint-placed in chart
3. Birth Registration within 30 days in civil registry
4. Birth record & documentation
NB CARE RESPONSIBILITIES
• KEEP NB WARM
• PROMOTE ADEQUATE BREATHING PATTERN &
PREVENT ASPIRATION
• INSPECT & CARE FOR CORD
• ADMINISTER EYE CARE-CREDE TX
• FEEDING
• BATHING
• SLEEPING
• DIAPER AREA CARE
• NB SCREENING
• PREVENT BLEEDING
• CIRCUMCISION
• done to manage PHEMOSIS- constriction of foreskin of penis
obstructing urinary meatus
• *not essential at birth
• *done 1st or 2nd day of life
• *Don’t‘ wash away yellowish mucus over glans penis
• CAR SAFETY
*use car seat
*If child is already able to sit up without support, seat may face
front car
RECOGNISING THE ILL BABY
• RESPIRATORY DISTRESS SYNDROME(RDS)
Signs
• Difficulty initiating respirations
• Low body temp
• Nasal flaring
• Tachypnea
• cyanotic membranes, grunting
• PRIORITIES:
*respirations- use of ventilator, oxygenation &
humidification
• Suction as every 2 hours or more
• Position: side with neck slightly extended
• Nutrition – TPN, daily weighing
• Prepare for surfactant therapy
HEMORRHAGIC DISEASE OF NB
• Deficiency of Vitamin K
• Signs: petechiae, bleeding at conjunctiva,
mucus membranes, retina, vomit blood, black
tarry stools
• 2nd- 5th day of life
• Management: Vit k 1 mg
SEPSIS
• Infection in blood due to wrong aseptic
techniques
• Signs: pallor, tachypnes, poor feeding-
abdominal distention
• Management: Monitor respirations, prevent
apnea, oxygen administration, keep warm and
assess feeding
MECONIUM ASPIRATION
SYNDROME
• SIGNS:
• Hypoxia of fetus in utero
• Amniotic fluid is greenish black
• Tachypnea, retractions, cyanosis
PRIORITIES
• Suction while at perineum before delivery of shoulders
• Intubate and suction asap
• Do not oxygenate by bag or mask until after intubated & suctioned
• Antibiotics
• Observe for signs of heart failure
• Maintain good temperature
APNEA
• SIGNS:
*Absence of respirations longer than 20 seconds with
bradycardia
*cyanosis
PRIORITIES:
*gently shake infant or rub sole or foot
*maintain good temperature
*handle gently
*burp well
SIDS
• Unexplained death that peaks on 2nd-4th months of life
• Risk: adolescent mothers, close spacing between pregnancies,
preterm infants.
• Major factor of death: Apnea
• Usually found with blood-flecked sputum or vomitus in mouth
Does not make any sound before death manifesting
laryngospasm.
POSSIBLE PREVENTION:
*Prevent apnea
*Avoid lying on abdomen
OPTHALMIA NEONATORUM
Conjuctivitis due to gonnorheal and Chlamydial
infections (STDs)
*Put eye ointment- erythromycin
*Use gloves
INFANT GROWTH & DEV’T
MONTH MOTOR FINE SOCIALIZAT PLAY
DEVT MOTOR ION&
DEVT LANGUAGE
1 Largely reflex Keeps hands Enjoys watching
fisted, able to face of primary
follow object caregiver,
midline listening to
soothing sounds
2 Holds head up Social smile Makes cooing Enjoys bright-
when prone sounds, diff.cry colored mobiles
3 Holds head and Follows Laughs out loud Spends time
chest up when objects fast looking at hands
prone midline or uses them as
toy
4 Grasp, Nee space to
stepping, tonic turn
neck reflexes
fading
MONTH MOTOR FINE SOCIALIZAT PLAY
MOTOR ION
5 Turns front to May say bowel Handles rattle
back, no longer sounds well
has head lag
when pulled
upright, bears
partial weight
on feet when
held upright

6 Turns both May say bowel Enjoy bath tub

ways; Moro sounds toys; rubber
reflex fading ring for
teething
7 Reaches out in Shows Likes objects
anticipation of beginning fear that are good
being picked of strangers size for
up, sits transferring
unsteadily

8 Sits securely Peak of Enjoys

w/o support stranger manipulation,
anxiety rattles, toys of
different
textures
MONTH MOTOR FINE SOCIALIZAT PLAY
MOTOR ION
9 Creeps or Says first Needs space for
crawls word(da-da) creeping
10 Pulls self to Uses pincer Patty-cake;
standing grasp(thumb&f peek-a-boo
inger) to pick
small objects
11 Cruises-walks cruises
with support
12 Stands alone; Holds cup & Days 2 words+ Likes toys that
some infants spoon well; ma-ma & da-da fit inside each
take 1st step helps to dress other( pots &
pans); nursery
rhymes; pull
toys as soon as
walking
SOLID FOOD(introduced at 6 months)
AGE FOOD INTRODUCE RATIONALE
5-6 Iron-fortified infant cereal Aids in preventing iron-
mixed with breastmilk, deficiency anemia; the
orange juice or formula least allergenic type of
food; an easily digested
food
7 Vegetables Good source of Vit.A; adds
texture & flavors to diet
8 Fruit Good source of Vit. C,
good source of Vitamin A;
adds new texture & flavor
9 Meat Good source of protein,
iron, vitamins B
10 Eggyolk Good source of iron
GUIDELINES IN INTRODUCING
SOLID FOODS:
• Introduce food one a time, 1 week apart to detect any allergy.
• Hold infant when introducing food to reduce stress.
• Wait for a few days & reintroduce food infant does not take it
immediately.
• Do not overfeed.
• Do not add sugar to cereal, nor add cereal to formula milk.
• Do not add butter or salt to vegetables
• Feed child from a dish and not from the jar of commercial solid food.
• TABLE FEEDING:
• Feed child first, then allow to have some small amount to feed self or
piece of cracker.
• A high chair is one of the most dangerous equipments in the home.
Always fasten child and never leave unattended.
GROWTH & DEVELOPMENT
MILESTONES
TOODLER PRE- SCHOOL ADOLESCEN
SCHOOL AGE T
GROWTH Begins to slow, Slight height & Grows slowly Rapid growth
prominent weight gain. but steadily. —
abdomen, wide Future body Sexual Puberty to
legged gait type appear maturation cessation of
starts body growth
LANGUAGE 2-word 900 words, Full sentences. Adult
sentences always says “bathroom conversation
“how” & language”
“why” Adult
conversation
EMOTIONAL Autonomy vs. Initiative vs. Industry Identity vs
DEV’T Shame & doubt guilt vs.Inferiority Role Confusion
Structural Value system
activities Career
Problem decisions
solving intimacy
Learn to live
with others
 TOODLER PRESCHOOL SCHOOL ADOLESCEN
AGE T
Socialization Resistant to Play with Group Peer group,
sitting on laps group. activities but solitary time.
& being Gender roles one-on-one Increased
cuddled. Oedipus contact if under responsibility-
Imitate others. &Electra stress. Keep part time jobs
Gender Complex”BFF” promises. Peer
differences group “gang”
age.
Play Parallel play Imitating, Rough games. Sports
magical Engage in engagement
thinking, sports.Girl Team loyalty
imaginary games, boy
friends games
Cognitive 5th-6th stages of Intuitional Operational Formal
sensorimotor thought-self- thought:Decent operations
thought. centered. No ering-considers -abstract terms
Pretend & use concept other’s views & use scientific
deferred conversation Accomodation- method
imitation object there are more -able to plan
permanence is than 1 reason for future
complete for a thing
Safety Issues Poisoning Motor vehicles, Sports injuries Vehicular
 TOODLER PRE- SCHOOL ADOLESCEN
SCHOOL AGE T
NUTRITION Decreased Decreased Good appetite- Increased
appetite. Allow appetite influenced by appetite
feeding the activities of “fad” diets,
himself. Finger the day “quick snacks”
foods, give Use food to
choices. Don’t rebel
like “mixed Include in
up” foods planning meals
BEHAVIOR Ritualistic Telling tall School phobia Stalking.
Negativism tales Stealing 7 y.o Risk for
Fear-separation Difficulty substance
Temper sharing abuse, suicide
tantrums Regression & running
Sibling rivalry away.
Fear: dark,
mutilation,
separation
CONCEPT OF DEATH & DYING
ACROSS CHILDHOOD

INFANT No understanding of death

Fear over separation
PRE-SCHOOL AGE Something that happens to
others.
Not permanent.
Death is reversible, won’t
happen to them
SCHOOL AGE Death is final & universal
ADOLESCENT Able to understand death in
logical manner. Death is
permanent.