Chapter 10:

Stages of Child Learning

When planning, designing, implementing,
and evaluating an educational program, the
nurse as educator must carefully consider
the characteristics of learners with respect
to their developmental stage in life. The
more heterogeneous the target audience,
the more complex the development of an
educational program to meet the diverse
needs of the population. Conversely, the
more homogeneous the population of
learners, the more straightforward the
approach to teaching.
2
An individual‘s developmental stage significantly
influences the ability to learn. Pedagogy, andragogy,
and gerogogy are three different orientations to
learning in childhood, young and middle adulthood,
and older adulthood, respectively. To meet the
health-related educational needs of learners, a
developmental approach must be used. Three major
stage-range factors associated with learner
readiness—physical, cognitive, and psychosocial
maturation—must be taken into account at each
developmental period throughout the life cycle.

3
CHARACTERISTICS
As noted earlier, actual chronological age is
only a relative indicator of someone‘s physical,
cognitive, and psychosocial stage of
development. Growth and development interact
with experiential background, physical and
emotional health status, and personal
motivation, as well as numerous environmental
factors such as stress, the surrounding
conditions, and the available support systems,
to affect a person‘s ability and readiness to
learn. 4
Musinski (1999) describes three phases of learning:
dependence, independence, and interdependence.
These passages of learning ability from childhood to
adulthood, labeled by Covey (1990) as the ―maturity
continuum,‖ are identified as follows:

• Dependence
is characteristic of the infant and young child, who
are totally dependent on others for direction, support,
and nurturance from a physical, emotional, and
intellectual standpoint (unfortunately, some adults are
considered to be stuck in this stage if they
demonstrate manipulative behavior, do not listen, are
insecure, or do not accept responsibility for their own
actions).
5
• Independence
occurs when a child develops
the ability to physically,
intellectually, and emotionally
care for himself or herself and
make his or her own choices,
including taking responsibility for
learning.
6
• Interdependence
occurs when an individual has
sufficiently advanced in maturity to
achieve self-reliance, a sense of self-
esteem, and the ability to give and
receive, and when that individual
demonstrates a level of respect for
others. Full physical maturity does not
guarantee simultaneous emotional
and intellectual maturity.
7
 STAGES OF
CHILDHOOD
Pedagogy is the art and science of helping
children to learn (Knowles, 1990;
Knowles, Holton, & Swanson, 2011). The
different stages of childhood are divided
according to what developmental theorists and
educational psychologists define as specific
patterns
of behavior seen in particular phases of growth
and development. One common attribute
observed throughout all phases of childhood is
 ncy (First 12 Months of Life) and
Toddlerhood (1-2 Years of Age)
The field of growth and development is highly complex,
and at no other time is physical, cognitive, and
psychosocial maturation so changeable as during the
very early years of childhood. Because of the
dependency of members of this age group, the main
focus of instruction for health maintenance of children is
geared toward the parents, who are considered to be the
primary learners rather than the very young child (
Crandell et al., 2012; Palfrey et al., 2005; Santrock, 2011
). However, the older toddler should not be excluded from
healthcare teaching and can participate to some extent in
the education process.
  
 
 
Ages and Stages of
“Choosing quality care that is in a healthy and
safe Development
environment should be your number one
priority. Look for child care that stimulates and
encourages your child‘s physical, intellectual, and
social growth. Keep your child‘s age and
personality in mind when looking for the program
that best meets his needs. Understanding what
makes your child feel secure and knowing the
activities he enjoys and will learn from will make a
difference in your final child care decision. 10
  
 
Personality
“
Each child has his own personality and responds to
caregivers or experiences differently. Just like adults,
children may have outgoing, shy, or even-tempered
natures. Your caregiver should be in tune with your child‘s
special personality and treat your child in a positive and
caring manner that agrees with his special personality. This is
crucial to nurturing his healthy emotional growth. By
understanding your child‘s personality, you and your
caregiver can help him succeed by offering care, activities,
and discipline that best fit his needs.

11
 Developmental stages
“
As your child grows, you may find yourself searching for
clues to her behavior. As a parent, you may hear the
words ―developmental stages.‖ This is just another
way of saying your child is moving through a certain time
period in the growing-up process. At times, she may be
fascinated with her hands, her feet, and her mouth. As she
grows, she may get into everything. Lock your doors and
cabinets, and take a deep breath during those exploration
years! Then there will be an age when independence is all
she wants. At every stage, what she needs is your love,
understanding, and time.
12
 Parent Tip
“
Recent brain research indicates that birth to age three are the
most important years in a child‘s development. Here are
some tips to consider during your child‘s early years:
• Be warm, loving, and responsive.
• Talk, read, and sing to your child.
• Establish routines and rituals.
• Encourage safe explorations and play.
• Make TV watching selective.
• Use discipline as an opportunity to teach.
• Recognize that each child is unique.
• Choose quality child care and stay involved.
• Take care of yourself.
13
 Parent Tip
“
Recent brain research indicates that birth to age three are the
most important years in a child‘s development. Here are
some tips to consider during your child‘s early years:
• Be warm, loving, and responsive.
• Talk, read, and sing to your child.
• Establish routines and rituals.
• Encourage safe explorations and play.
• Make TV watching selective.
• Use discipline as an opportunity to teach.
• Recognize that each child is unique.
• Choose quality child care and stay involved.
• Take care of yourself.
14
“
Tips for looking for a child care provider
during the first eighteen months of life
Look for a provider who:
• Is warm and friendly.
• Interacts with your infant and has eye contact.
• Talks to your infant while diapering.
• Includes your infant in activities, but keeps her safe from
older children.
• Avoids the use of walkers.
• Has feeding and sleeping practices similar to yours.
• Allows the infant to eat and sleep whenever she wishes
rather than follow a schedule.
15
 Ages and stages
“Depending upon the age of your child, his learning
style and personality, your child will have different
needs. The first five years are especially crucial for
physical, intellectual, and social-emotional
development. Keep your child’s personality and
age in mind when looking for child care
experiences and activities. The following pages
provide insight into a child’s developmental stages
from birth through fourteen years.
16
 Birth
“Inmiraculous to eighteen months: an
the first eighteen months after birth, an infant makes
overview progress. In this relatively short time span, an
infant sees her world through her senses. Babies gather
information through touch, taste, smell, sight, and sound.
To help infants mature and learn, the caregiver should stimulate but
not overwhelm them. The overall goal is not to “teach” your baby but
to interact and explore her world with her. Older infants are on the
move. They take great pleasure in discovering what they can do with
their voice, hands, feet, and toes. Soon they practice rolling skills,
crawling, walking, and other great physical adventures. Through “the
eyes of a child,” here is what you might expect during the first
eighteen months.
17
 
 What is child
development
and what skills do
children develop
at different ages
hat is child development?
Child development is a process every
child goes through. This process involves
learning and mastering skills like sitting,
walking, talking, skipping, and tying
shoes. Children learn these skills, called
developmental milestones, during
predictable time periods.
 five
ain areas of development:
1.Cognitive Development
This is the child's ability to learn and
solve problems. For example, this includes a
two-month-old baby learning to explore the
environment with hands or eyes or a five-
year-old learning how to do simple math
problems.
 
2.Social and Emotional
Development

This is the child's ability to interact with

others, including helping themselves
and self-control. Examples of this type of
development would include: a six-week-old
baby smiling, a ten-month-old baby waving
bye-bye, or a five-year-old boy knowing how
to take turns in games at school.
  
3.Speech and Language
Development

This is the child's ability to both

understand and use language. For example,
this includes a 12-month-old baby saying his
first words, a two-year-old naming parts of
her body, or a five-year-old learning to say
"feet" instead of "foots".
  
4.Fine Motor Skill Development

This is the child's ability to use small

muscles, specifically their hands and
fingers, to pick up small objects, hold
a spoon, turn pages in a book, or use a
crayon to draw
5.Gross Motor Skill
Development

This is the child's ability to use large

muscles. For example, a six-month-old
baby learns how to sit up with some support,
a 12-month-old baby learns to pull up to a
stand holding onto furniture, and a five-year-
old learns to skip.
What is a development
milestone?
A developmental milestone is a skill that a child
acquires within a specific time frame. For
instance, one developmental milestone is
learning to walk. Most children learn this skill or
developmental milestone between the ages of
9 and 15 months.

25
 What IF MY CHILD DOES
NOT MEET A
DEVELOPMENTAL
MILESTONE?
Each child is an individual and may meet developmental
milestones a little earlier or later than his peers. You may
have heard people say things like, "he was walking
before he turned 10 months, much earlier than his older
brother" or "she didn't say much until she was about 2
years old and then she talked a blue streak!" This is
because each child is unique and will develop at his or
her own pace.

26
How can I help m child meet
these development
milestone?
As parents, we all want our children to succeed and be the
best they can be. We know from research that two factors
influence how your child succeeds and grows: genes and
environment. One of the factors that influence our child's
development is their genetic makeup or "genes." Some
people refer to this as "nature." Genes are the genetic
material we pass onto our children. Children are born with
their "genes" in place. These genes act like a blueprint for
what characteristics a child may have. For example, genes
determine if a child will have blue eyes or brown eyes; they
also determine if he will be left- or right- handed. 27
 every-day activities you can do
with your child to encourage
brain development.
• Give your child lots of love and attention. No matter what a child's age, holding,
hugging, and listening are important ways to show your child they matter.
• Interact with your child by talking, singing, playing, eating, and reading with your
child. Your child will grow up feeling special and important to you. You will also learn
a lot about your child's interests and skills.
• Read, read, read. Research has shown that children who are read to by their
parents have a larger vocabulary than other children. Reading also provides
children with new perspectives about the world we live in.
• Learn some simple parenting skills for helping your child to learn how to behave.
The most important parenting skills are having consistent rules, rewarding behaviors
you want to see your child do more of, and having consequences
for behaviors you do not want your child to continue to do.
• Limit TV time and video time to no more than 1-2 hours of educational viewing per
day.
• Ask for help when you need it from your spouse, partner, family, friends, and your
child's doctor or nurse practitioner. Parenting is wonderful but it is not always easy. 28
 important to a
child’s development

29
PLAY
- builds your child's creativity and
imagination as well as other skills.
Whether it is simply rolling a ball back
and forth with a sibling or
putting on a costume and imagining
she's an astronaut—she's developing
important social skills such as learning
to take turns, cooperating, and getting
along with others.
30
UNOCCUPIED PLAY
- Unoccupied play refers to activity
when a child actually isn't playing at all.
He may be engaged in seemingly
random movements, with no objective.
Despite appearances, this definitely is
play and sets the stage for future play
exploration.

31
SOLITARY(INDEPENDENT)PLAY
- Solitary play is just what it sounds like—when your
child plays alone. This type of play is important because
it teaches a child how to keep himself entertained,
eventually setting the path to being self-sufficient.
 
Any child can play independently, but this type of play is
the most common in younger children around ages 2 or
3. At that age, they are still pretty self-centered and lack
good communication skills. If a child is on the shy side
and doesn't know his playmates well, he may prefer this
type of play.

32
ONLOOKER PLAY
- Onlooker play is when a child simply
observes other children playing and doesn't
partake in the action. It's common for younger
children who are working on their
developing vocabulary.
 
Don't worry if your little one is behaving this
way. It could be that the child feels shy, needs
to learn the rules, or maybe is the youngest
and wants just to take a step back for a while.
33
PARALLEL PLAY
-Put two 3-year-olds in a room together and this is what
you are likely to see: the two children having fun, playing
side by side in their own little world. It doesn't mean that
they don't like one another, they are just engaging in
parallel play.
 
Despite having little social contact between playmates,
children who parallel play actually learn quite a bit from
one another like taking turns and other social niceties.3
Even though it appears they aren't paying attention to
each other, they truly are and often mimic the other
one's behavior.
34
ASSOCIATIVE PLAY
- Slightly different from parallel play, associative play also
features children playing separately from one another. But in
this mode of play, they are involved with what the others are
doing—think children building a city with blocks. As they build
their individual buildings, they are talking to one another and
engaging each other.
 
This is an important stage of play because it helps little ones
develop a whole host of skills—socialization (what should we
build now?) and problem solving (how can we make this city
bigger?), cooperation (if we work together we can make our
city even better) and language development (learning what to
say to get their messages across to one another). Through
associative play is how children begin to make real friendships.
35
COOPERATIVE PLAY
- Cooperative play is where all the stages come
together and children truly start playing together. It is
common in older preschoolers or in younger
preschoolers who have older siblings or have been
around a lot of children).
 
Cooperative play uses all of the social skills your child
has been working on and puts them into action.5
Whether they are building a puzzle together, playing a
board game, or enjoying an outdoor group game,
cooperative play sets the stage for future interactions as
your child matures into an adult.
36
While these stages are important and necessary for
a child's social development, there are other types
of play that also contribute to a child's maturity.
These types of play usually develop as a child
begins to engage in cooperative play and include:

• Dramatic/Fantasy Play
• Competitive Play
• Physical Play
• Constructive Play
• Symbolic Play

37
DRAMATIC/FANTASY PLAY
- When your child who loves to play
dress-up, doctor, or restaurant, it's
dramatic or fantasy play. Through this
type of play, not only does your child's
imagination get a workout, but she
learns how to take turns, cooperate,
share and work on language
development. Through roleplay, kids are
also able to learn about functioning in
the greater community. 38
COMPETITIVE PLAY
- Whether she's beating her brother at
Chutes and Ladders or playing on a
local soccer team, your child is
engaging in competitive play. Rules and
turn-taking, and functioning as part of a
team are the big lessons taken from this
type of play. You may have to give your
child guidance about dealing with both
winning and losing.
39
PHYSICAL PLAY
- Gross and fine motor skills really come
into play here, whether your child is
throwing a ball or riding a bike. Physical
play encourages kids to be active.

40
CONSTRUCTIVE PLAY
-Forms of constructive play include building
with blocks, making a road for toy cars, or
constructing a fort out of couch pillows.
Constructive play teaches kids about
manipulation, building, and fitting things
together.6 Cognitive skills are used to figure out
how to make something work best, whether it
is a block tower that won't stand up or a
sandcastle that keeps collapsing.

41
SYMBOLIC PLAY
- This type of play can be vocal
(singing, jokes, rhymes), graphic arts
(drawing, coloring), counting, or making
music. This type of play helps children
learn to develop skills in expressing
themselves and exploring their
experiences, ideas, and emotions.

42