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General Concepts of Childs Care 1.

Infants should be treated as individuals and part of the family; should not be treated as adults 2. To provide total health maintenance, family centered care, and promotion of health 3. Childs care are influenced by genetics and home and environment 4. Play and Interaction (important medium of expression and communication) Growth - increase in physical size or quantitative change Development - Increase in skill or ability to function How to measure development: 1. Observe a childs ability to perform a task (ex. Picking up objects) 2. Recording childs progress by the parents 3. Denver Development Screening Test (DDST) MMDST Metro Manila Development Screening Test Maturation synonym to development; readiness Psychosexual Development Refers to developing instincts and sensual pleasure (Freudian Theory) Psychosocial Development Refers to Eriksons Stages of Personality Development Moral Development Ability to know the right and wrong and apply in real life situations. Kohlbergs Theory Cognitive Development Ability to learn or understand from experiences to acquire and retain knowledge, to respond to a new situation and to solve problems. Piaget Theory of Cognitive Development Measured by IQ or Intelligence Test used by observing childs ability to function effectively in environment. Principles of Growth and Development 1. Continuous process from conception until death (womb to tomb) 2. Proceed in an orderly sequence Occurs in one sequence (ex. From smaller to larger) Occurs in predictable order (ex. Child sit, creep, stand before they walk) Unobserved stages or Skipped a stage quickly Childs progress in different order 3. Different children pass through predictable stages at different rates Ex. Both develop normally but able to walk at different age. 4. All body systems dont develop at the same time 5. Development is Cephalocaudal (head to tail) 6. Development proceeds from Proximal to Distal Parts 7. Development proceeds from Gross to Refined skills 8. Neonatal reflexes must be lost before development can proceed 9. Skill and behaviour is learned by practice 10. Principle of Asynchronism (not all body parts grow at the same time or rate) 11. Each child is unique

Primary Factors a. Heredity (Non-modifiable) or Nature Factors Race Intelligence Sex Nationality b. Environment (Modifiable) or Nurture factors Quality of Nutrition Socioeconomic Status Health Ordinal Position of the Family Parent child relationship

12. Directional Trends occur in regular direction that reflects development of neuromuscular functions; physical, mental, social, and emotional development. Factors Affecting Growth and Development 1. Genetics 2. Gender 3. Health 4. Intelligence 5. Temperament usual reaction pattern of an individual; individuals manner of thinking, behaving, or reacting to stimuli. 9 Reaction Patterns 1. Activity Level different levels of activity that reflect motor activity; one char. Of temperament 2. Attention Span and Resistance ability to remain interested in a project or activity 3. Approach childs response or initial contact with new stimulus 4. Adaptability ability to change ones reaction to stimuli over time; infants who are adaptable can change their first reaction to a situation w/o exhibiting extreme distress 5. Distractability easily distracted or shifting attention to a new situation 6. Intensity of Reaction reaction to situations 7. Rhythmicity rhythm of physiologic function 8. Mood Quality a child whos always happy & laughing has a positive mood quality 9. Threshold of Response intensity level of stimulation necessary to evoke a reaction. Theory systematic statement of principles that provides a framework for explaining some phenomenon Developmental Task role of responsibility arising at a particular time in an individuals life, the achievement of this skill provides a foundation of learning Basic Divisions of Childhood 1. Neonatal first 28 days of life 2. Infant 1 month to 1yr 3. Toddler 1 3 y/o 4. Preschooler 4 6 y/o 5. School Age 6 12 y/o; starting point of young adult 6. Adolescent 13 20 y/o


Psychoanalytic Theory of Personality Development
Childs development is a sense of Psychosexual Stages Childs Sexual Gratification becomes focused in relation to a particular body part Infant Birth - 1 yrs Psychosexual Stage ORAL STAGE Child explores world by using the mouth, especially tongue Activities: Biting, Crying Sucking for enjoyment and release of tension ANAL STAGE Child learns to control urination & defecation PHALLIC STAGE Child learns sexual identity thru awareness of genital area. LATENT STAGE Childs personality development appears non active or dormant (no malice) GENITAL STAGE Develops sexual maturity and learns to establish satisfactory relationships with opposite sex o o o Nursing Implications Provide oral stimulation by giving pacifier Dont discourage thumb sucking Breastfeeding may provide more stimulation than formula feeding b/c it requires infant to expend more energy. Help children achieve bowel and bladder control w/o undue emphasis on its importance. If possible, continue bowel & bladder training while child is hospitalized Accept childs sexual interest, such as fondling his or her own genitals, as a normal area of exploration. Help parents answer childs question about birth or sexual differences Help child have a positive experiences so his or her self esteem continuous to grow and child prepares for the conflicts of adolescence

Toddler 1 - 3 yrs

o o o

Pre-schooler 4-6 y/o

o o

School Age 6/yo Puberty Adolescent 12 30 y/o Puberty and after

o Provide opportunities for the child to relate with opposite sex o Allow child to verbalize feelings about new relationships


Assessing a persons social view of himself or herself Stressing importance of culture & society Infant Birth 18 mos Developmental Task TRUST vs MISTRUST Child learns to love and be loved Beginning on developing self confidence AUTONOMY vs SHAME & DOUBT Child learns to be independent and make decisions for self Nursing Implications Provide primary caregiver (parents are the significant persons) Provide experiences that add to security (ex. Touch, hug, kiss, eye to eye contact, soft music- mozart) Provide visual stimulation for active child movement Provide opportunities for decision making (ex. offering choices of clothes to wear or toys to play)

Toddler 18 mos 3 yrs

Praise for ability to make decisions rather than judging correctness

Preschooler Late Childhood 3-5 y/o

School Age (6-12y/o) Adolescent

Saying wrong develops doubt Provide opportunities for exploring new places or activities (right time for Child learns how to do basic things amusement parks, zoo, playground) (basic problem solving) and that Activities: doing things is desirable a. Include water b. Clay modelling c. Finger Painting SENSE OF INDUSTRY vs Allow child to assemble & complete INFERIORITY short project and assignments so child feels rewarded for accomplishment Child learns how to do things well (unfinished project develops inferiority) SENSE OF IDENTITY vs ROLE Allow to discuss feelings about events CONFUSION important to him or her. Adolescents learn who they are Offer support and praise decision and what kind of person they will making be by adjusting to a new body image, seeking emancipation (freedom) from parents, choosing a vocation and determining system value INITIATIVE vs GUILT


PHASES AND STAGES A. Sensorimotor Phase Stage 1 Use of Reflexes Stage 2 Primary Circular Reaction Stage 3 Secondary Circular Reaction Stage 4 Coordination of Secondary Schemata Stage 5 Tertiary Circular Reaction Stage 6 Inventions of New Means B. Preconceptual Phase AGE SIGNIFICANT BEHAVIOR Birth 2 yrs Birth 1 mo Most action is Reflexive 1 4 mos 4 8 mos 8 12 mos Perception of events is centered on the body Objects are extension of self Ex. Breastfeeding; Foreplay Acknowledges external environment Actively makes changes in environment Can distinguish a goal from a means of attaining it. Able to experiment and discover new properties of objects (ex. Shapes) Tries and Discovers new goals and ways to attain goals Rituals are important Interprets environment by Mental Image Uses make believe and Pretend Play Uses Egocentric Approach to accommodate the demands of environment Everything is significant and relates to ME Explores the environment Rapid Language Development Associates words with object Egocentric thinking diminishes Thinks one idea at a time Includes others in environment Words express thoughts Solves concrete problems Begins to understand size Understands Right and Left Cognizant of Viewpoints (areas can come up with summary; asks opinion with other people) Uses Rational Thinking Reasoning is deductive and futuristic

12 18 mos 18 24mos 2 4 yrs

C. Intuitive Phase

4 7 yo

D. Concrete Operations Phase

7 11 yo

E. Formal Operations Phase

11 15yo

Kohlbergs Stages of Moral Development

Level Preconvential Egocentric Focus Person is responsive to cultural rules, labels of good and bad, right and wrong. Person reasons in terms of punishment, reward, or exchange of favors Conventional Societal Focus Person maintains expectations and rules of family, group, nation or society Sense of Guilt developed Values conformity, loyalty, and social order. Conformity means good behaviour or what pleases or helps another. 4. Law and Order Orientation Person wants established rules from authorities. Reason of behaviour is that social and sexual rules demand the response. Ex. Ill do something because its the law and my duty Adolescence and Adulthood *Most men are in this stage* Stage 1. Punishment and Obedience Orientation Fear of punishment and no respect for authority is the reason for behaviour, decision, and conformity 2. Interpersonal Relativist Orientation CONFORMITY is based on egocentricity and narcissism. No feeling of justice, loyalty, and gratitude. Ex. Ill do something if I get something for it or because it pleases you 3. Interpersonal Condordance Orientation Decisions and behaviour are based on others reaction. Person wants approval or reward. Empathic Response (understanding on how another person feels) Ex. I can put myself in your shoes Average Age Toddler to 7 years old

Preschool to School Age

School Age to Adulthood *most American woman are in this stage*

PostConventional Universal Focus Person lives autonomously and according to principles that are universally agreed and appropriate for life.

5. Social Contract Legalistic Orientation Social rules are not based on decisions and behaviour b/c the person believes a higher moral principles such as equality, justice, or due process

Middle Age or Older Adult *20% of American achieved this stage* Middle Age or Older Adult *seen in times of crisis or extreme situations

6. Universal Ethical Principle Orientation Decisions and behaviours are based on internalized rules, conscience rather than social laws.