NCM 101 Guide

Far Eastern University
Institute of Nursing
Course Guide
CARE OF MOTHER, CHILD AND FAMILY
(Growth and Development, Infancy, Toddler)
Course Name : CARE OF MOTHER, CHILD AND FAMILY
Course Code : NCM 101
Course Description : Principles and techniques of caring for the normal mothers, infants, children and family and the
application of principles and concepts on family and family health nursing process.
Course Credit : 4 units lecture, 4units RLE [1unit Skills Lab/3units Clinical]
Contact Hrs/sem : 72 lecture hours, 204 RLE hours (10 hrs. = 2 hrs/meeting; twice a week)
Pre-Requisite : FNP, Health Assessment, Anatomy and Physiology
Co-requisite : Microbiology and Parasitology
Placement : 2nd year, 1st semester
Course Objectives : At the end of the course, given actual or simulated situations /conditions involving the client (normal
pregnant woman, mother, and/or newborn baby, children and the family), the student will be able to:
1. Utilize the nursing process in the holistic care of client for the promotion and maintenance of health.
1.1 Assess with the client his/her health condition and risk factors affecting health
1.2 Identify wellness /at risk nursing diagnosis
1.3 Plan with client appropriate interventions for health promotion and maintenance of health
1.4 Implement with client appropriate interventions for Health promotion and health
maintenance taking into consideration relevant principles and techniques
1.5 Evaluate with client the progress of one’s health condition and outcomes of care.
2. Ensure a well-organized recording and reporting system
3. Observe bioethical principles and the core values (love of God, caring, love of country and of people)
4. Relate effectively with clients, members of the health team and others in work situations related
to nursing and health
CONTENTS:
Definition
a. Growth - Increase in the number and size of cells; measured in terms of quantity; Orderly and predictable but not even.
Parameters of Growth:
1. Weight
♦ is the most sensitive indicator of growth.
♦ It is measured in grams, kilograms or pounds.
♦ Doubles by 5 to 6 months
Triples by 12 months or 1 year.
Quadruples by 2 – 2 ½ years old
2. Height
♦ is measured in inches, feet or centimeters.
♦ Increases by 1 inch per month in the first six months and by ½” per month from age 7 – 12 months.
b. Development - Indicates an increase in skill or the ability to function; Viewed as a qualitative change in the child that is
demonstrated by functioning or skill and that is achieved through maturation, and learning
NCM 101: MCN (G & D, Infancy, Toddler) Elizabeth Fernandez-Haciñas Page | 2
Ways to measure development:

1. By directly observing the child’s performance.
2. By noting parents description of the child’s progress.
3. By DDST (Denver Developmental Screening Test), in the Philippines, it is modified as MMDST (Metro Manila
Developmental Screening Test).
c. Maturation – means development of those cells until they are ready to function; Literally, it means ripen; An increase in
human competence and adaptability
d. Developmental task - a growth responsibility that arises at a certain time in the course of development
Five Main Areas of Development:

1. Physical
♦ height, strength, muscles, systems, organs and weight
2. Emotional
♦ extend trusting relationships to other adults and to children, attitudes, show a strong sense of self as an
individual, recognize and label their own feelings
3. Intellectual
♦ thinking and understanding
4. Social
♦ interaction with others; show awareness of others’ feelings and might try to give basic help, look to adults for
comfort
5. Spiritual
♦ beliefs and religions
♦ concerns the broad search for transcendental meaning that may be as simple as a young child’s inquiries into
how the world came into being
PRINCIPLES OF GROWTH AND DEVELOPMENT

1. G & D are continuous processes from conception until death
2. G and D follows an orderly pattern
a. Cephalocaudal
 growth proceeds from head to toes
 control of head before the trunk and extremities
 hold back erect before they stand
 control hands before feet
♦ By 3 months, can lift the head, chest and part of the abdomen…
♦ By 5 months, can have enough control, and can turn over….
♦ By 10 months, can control the legs enough to crawl…
♦ By 1 year, can stand upright and perhaps walk…
So, the movement here is from head to lower extremities.
b. Proximo-distal
 growth proceeds from the center, or midline of the body to peripheral
 infants’ shoulder control precedes mastery of hands
 whole hands before fingers
 By 10 months, the infant can coordinate the arm, thumb and Index fingers sufficiently well to use a pincer-like grasp
or able to pick –up an object as fine as a piece of breakfast cereal on a high-chair tray.
c. General to specific (Gross to refined)
 child moves whole hand to indicate certain thing instead of one finger.
 responds through general response like crying & smiling to denote, hunger, pain and joy and produces babbling
sounds, before he can speak words.
 Simple to complex
3. All aspects of development are interrelated

 Intelligence test given in earlier years predicts intelligence of a person
 Bone X-Rays of different parts of the body tell approximately what will be the ultimate size of the individual
 The physical and the mental development of the child are mostly correlated to each other
 A child with good physical health is also above average in intelligence
 A child whose intelligence is above average is also so in health, size, sociability, attitudes and aptitudes
4. Growth is continuous and gradual
 All parts of the body continue to grow gradually until they reach their maximum from infancy, early childhood,
late childhood.
a. There are periods of accelerated & decelerated growth rate
Infancy: most rapid period of growth
Preschool to puberty: slow and uniform rate of growth
Puberty: (growth spurt) second most rapid growth period
After Puberty: decline in growth rate till death
5. Growth is not uniform
 Different parts of body grow at different rates
 Prenatally: head grows the fastest
 During the first year: elongation of trunk dominates till it reaches maturation
6. All individuals are different
7. Early foundations are critical
8. Each phase of development has hazards
9. Each phase of development has characteristic behavior
10. There is an optimum time for initiation of developmental experiences or learning
 A child can not learn tasks until the nervous system mature enough to allow that particular learning.
Example: A child can not learn to sit not until the nervous system matures to allow back control. A child may have the
difficulty of learning a task if it has passed the optimum time for learning of that particular skill.
11. Most developmental skills and behaviors are learned by practice
12. Neonatal reflexes must be lost before motor development can proceed
13. Development is affected by cultural changes
14. There are social expectations for every stage of development
15. Development is a product of heredity and environment
 The child is born with some inherited traits like physical stature and some other traits from his parents and develops
by interacting with his environment
 Nutrition, home climate & school environment regulate social, emotional and intellectual development
Major Factors Influencing Growth and Development

1. Genetics
FROM THE MOMENT OF CONCEPTION, sperm + ovum fuse =basic genetic make-up of an individual is cast.
Although each child is unique, certain GENDER-RELATED characteristics will influence normal growth and development.
In addition to physical characteristics such as EYE COLOR AND HEIGHT POTENTIAL, learning styles and temperament
are also influenced by inheritance.
a. Gender
On the average, GIRLS ARE BORN LIGHTER ( by an ounce or 2) and shorter (by an inch or 2) than boys.
Boys tend to keep this height and weight advantage until pre puberty, at which time girls surge ahead because
they begin their puberty growth spurt by 6 months to 1 year earlier than boys. By the end of puberty (14 to 16
years) boys again tend to be taller and heavier than girls.
b. Health
A child who inherits a genetically transmitted diseases may not grow as rapidly or develop as fully as the healthy
child depending on the type of illness or the therapy available for the disease.
EX: 1922, before insulin was discovered, children with Type I DM were left physically challenged; many of them
died. Because of Insulin therapy and good health supervision, the disease can be minimized so
children with DM may thrive and grow normally.
c. Intelligence
Children with high intelligence do not generally grow faster physically than other children but they do tend to
advance faster in skills. Occasionally, a child with HIGH INTELLIGENCE WILL FALL BEHIND IN PHYSICAL
SKILLS because he /she spends time with books or mental games, rather than with games that develop motor
skills and so does not receive practice in these areas.
2. Environment
Although a child has genetically programmed height potential, he may not grow taller because of some environmental
factors: INADEQUATE NUTRITION because of low socio-economic status. Caregiver may lack skills or not give the child
enough attention. Chronic illness
a. Socioeconomic level
HEALTH CARE and GOOD NUTRITION both cost money. Children born to low income families do not receive
adequate health supervision ( consult when severe or dying) , also immunizations, so they develop childhood
illnesses that would lead to permanent brain damage---- poor G & D.
b. Parent-child relationship
Children who are loved thrive better than those who are not. It is the QUALITY OF TIME SPENT with children
not the amount of time that is important. LOSS OF LOVE from a primary care giver ( death of a parent,
interruption of parental contact through prolonged hospitalization, divorce, absence of parent working abroad)
or inadequate parental love can interfere with child’s desire to eat, improve and advance.
c. Ordinal position in the family
First-born child, middle, youngest and only child) and size of the family has some bearing on the G & D.
FIRST/ONLY CHILD generally excel in language because conversation are mainly with adults. However, they
may not excel in other skills ( like toilet training) because there is no example to watch. Children learn by
watching other children.
d. Health
Children who are ill like those with heart diseases will have limited activity to play and active sport. The disability
due to the damage of the heart will affect the attitude of the people around the child- how disabled they think
the child is and how they treat the child.
3. Temperament
♦ usual reaction pattern of an individual or an individual’s characteristic manner of thinking, behaving or reacting to stimuli
in the environment.
♦ Inborn characteristic.
Reaction Patterns That Determine Temperament

1. Activity level – differs widely
2. Rhythmicity –child with set patterns/irregular rhythmicity.
3. Approach – child’s response on initial contact with a new stimulus.
4. Adaptability – ability to change one’s reaction to stimuli over time.
5. Intensity of reaction
6. Distractibility refers to the tendency to shift easily to a new situation.
7. Attention span and persistence refers to the ability to remain interested to a project or activity.
8. Threshold of response is the intensity level of stimulation that is necessary to evoke a reaction.
9. Mood quality state wherein a person is said to be in negative or positive condition.
Categories Of Temperament
1. THE EASY CHILD
♦ Easy to care for
♦ Predictable rhythmicity, approach and adapt to new situations readily.
♦ Mild to moderate intensity of reaction
♦ Overall positive mood quality.
♦ 40% to 50% of children
2. THE DIFFICULT CHILD
♦ Irregular in habits
♦ Negative mood quality
♦ Withdraw rather than approach new situations.
♦ 10% of children
3. SLO W–TO-WARM-UP CHILD
♦ Overall fairly inactive
♦ Responds mildly
♦ Adapts slowly to new situations
♦ Generally negative mood
♦ 15 % of children
4. Nutrition
♦ Nutrition has become a major focus on health promotion and disease prevention.
♦ The quality of nutrition during the growing years (including prenatally) has a major influence on his/her health and
stature ( natural height).
♦ Poor maternal nutrition may limit the Growth and intelligence potential of the child at birth.
♦ Children with diets that lack essential nutrients show inadequate physical growth.
♦ Lack of energy and stamina prevents children from learning at their best intellectual level.
STAGES OF GROWTH AND DEVELOPMENT

1. Prenatal – from conception to birth.
2. Babyhood
a. Neonatal – is the first 28 days or 4 weeks of life.
b. Infancy – from 29th day to 1 year
3. Early Childhood
a. Toddler – 1 to 3 years
b. Preschool – 3 to 6 years
4. Middle Childhood
a. School Age – 6 to 12 years
5. Late Childhood
a. Adolescence - 12 to 20 years (Pillitteri – 13 to 20)
6. Adulthood
a. Early adulthood – 18 to 45 years old
b. Middle adulthood – 45 to 65 years old
c. Late adulthood – 65 and above
Development of mental function & personality development

♦ Personality is the arrangement of individual adjustment to his environment. It is an all-inclusive term that covers
appearances, abilities, motives, emotional reactivity and experiences that have shaped him to his present person.
♦ It is the totality of one’s physical or inherited attributes as well as those psychological factors that determine one’s
characteristic behaviour.
♦ Psychoanalytic theory suggested that personality is mostly established by the age of five. Early experiences play a large
role in personality development and continue to influence behavior later in life.
Structure of Personality
ID
▪ developed during infancy
▪ "I know what I want and I want it now!”
▪ the only component of personality that is present at birth.
▪ Operates on pleasure principle to reduce tension or discomfort. Thus, a newborn is said to be a “bundle of id”,
seeking pleasure only to satisfy needs and demands immediate gratification to find release from physiological
tension.
▪ “I know what I want and I want it now!
▪ No sense of right or wrong
▪ Derived from the unconscious level of awareness.
▪ Pleasure principle
EGO
▪ developed during toddler period
▪ "I can wait for what I want!"
▪ Reality principle
▪ balances the id and superego
▪ the result of individual’s interaction with the environment.
▪ It promotes satisfactory adjustment in relation to the environment.
▪ It is initiated when the baby recognizes the breast or as part of the environment.
▪ Operates on reality principle
SUPEREGO
▪ developed during preschool
▪ "I should not want that!”
▪ Conscience- Morality principle
▪ Develops as a person unconsciously incorporates standards and restrictions from both parents and society to guide
behaviors, thoughts, and feelings.
▪ It is blindly rigid and strictly moralistic.
▪ Emerges at around age five.
Factors Affecting Personality development:

1. Heredity
♦ certain characteristics that are present at birth
a. body build c. eye color, and skin
b. hair type d. certain aptitudes
2. Birth order
♦ First born are likely to be achievement oriented and responsible
♦ Later born are more likely to be better in social relationships, affectionate, friendly, or rebels and risk-takers.
3. Parents
a. age of the parent c. occupation e. economic status
b. religious orientation d. level of education f. cultural heritage
4. Culture
DEVELOPMENTAL THEORIES:
Theory is a system of principles that provides a framework for explaining some phenomenon.
PSYCHOSEXUAL DEVELOPMENT THEORY (SIGMUND FREUD)

♦ psychosexual energy, or LIBIDO, was described as the driving force behind behavior.
♦ Fixation is a persistent focus on an earlier psychosexual stage. Until this conflict is resolved, the individual will remain
"stuck"
♦ development results from sexual aim or biologic need for tension reduction .
♦ The goal of development is maximizing need gratification while minimizing punishment and guilt, using defenses to
control anxiety.
♦ refers to the developing instincts or sensual pleasure.
Birth to 1 Year – Oral Stage

1 to 3 years – Anal Stage
3 to 5 Years – Phallic Stage
5 to Puberty – Latent Stage
Puberty to Death – Genital Stage
ORAL STAGE
♦ Infants are so interested in oral stimulation or pleasure during this time.
♦ Site of gratification: mouth
♦ Activities: sucking, biting, crying, etc.
♦ for enjoyment, for nourishment, and to release tension.
Oral-Passive character
♦ weaned too early è eating, drinking, and smoking and biting nails.
♦ The individual is generally passive, needy and sensitive to rejection. They easily “swallow” other
people’s ideas.
Oral-Aggressive personality
♦ life-long desire to bite on things, such as pencils, gum, and other people have a tendency to be
verbally aggressive, argumentative, sarcastic.
Nursing significance
a. Provide oral stimulation even if the baby is placed on NPO by offering a pacifier.
b. Never discourage thumb sucking. (Breastfeeding provide more stimulation than formula because it
requires the infant to expend more energy).
ANAL STAGE
♦ Activities: Toilet training
♦ Elimination or retention of feces or urine
♦ This anal interest is a part of toddler’s self- discovery, a way of exerting independence.
♦ The child greatly enjoys holding it and letting it go.
Cues for toilet training readiness
1. Can stand, squat and walk alone.
2. Can communicate toilet needs.
3. Can maintain himself or herself dry at an interval of 2 hours.
♦ Behavior to observe: Toilet training mastered by the end of this period.
Adult Character
Anal Expulsive Personality (a.k.a. anal aggressive)
♦ little self-control, sloppy, disorganized, generous to a fault.
♦ They maybe cruel, destructive, hostile and given to vandalism and graffiti.
Anal Retentive Personality

♦ tend to be overly clean, perfectionist, dictatorial, very stubborn, and stingy. In other
words, the anal retentive is tight in all ways.
Nursing Significance
a. Help the child achieve bowel and bladder control without undue emphasis on its importance even
if hospitalized. The period when obsessive-compulsive behavior originates.
b. The main cause of failure in toilet training is unreadiness of the toddler.
PHALLIC STAGE
♦ Activity: The child may show exhibitionism and increased knowledge on both sexes.
♦ May exhibit masturbation.
♦ Pleasure through genitals
♦ Touching of genitals
♦ Erotic attachment to parent of opposite sex
♦ Develops fear of punishment (castration anxiety for boys and Penis envy for girls) by parent of same sex
♦ Usually resolve toward end of this period
♦ The Oedipus complex describes these feelings of wanting to possess the mother and the desire to replace
the father. However, the child also fears that he will be punished by the father for these feelings, a fear Freud
termed castration anxiety.
♦ Electra complex has been used to described a similar set of feelings experienced by young girls. Freud,
however, believed that girls instead experience penis envy.
♦ Behaviors to observe:
a. Exhibits interest in sex differences.
b. Exhibits preoccupation with loss of body parts and bodily injury.
c. Asks many questions related to sexuality.
1. Bookworm personality
▪ boy is harshly rejected by his mother and threatened by his father
2. Hyperfeminine belle or wall-flower
▪ girl rejected by father, and threatened by mother
3. Effeminate
▪ if boy is favored by mother over his milquetoast ( timid or submissive) father
4. Masculine and Self-centered
▪ girl is daddy’s little princess and best buddy, and mommy is relegated to a
servant role
Adult Character
♦ Promiscuous
♦ Amoral
♦ Puritanical (Doctrine of opposites)
a. Accept the child fondling his or her genitalia as a normal area of exploration.
b. In case of masturbation, explain to the child that things like this must be done in a private place or
divert the attention.
c. Answer the child’s question directly and honestly as this is the right time to introduce sexuality.
LATENCY STAGE
♦ Known as the “Age of Suppression”
♦ Achievement oriented years.
♦ Behaviors: sense of industry and mastery
♦ Emphasis in this period is development of skills and talents.
a. Energy is used to gain new skills and social relationship and knowledge.
b. Suppression is normal
c. Sexual drive (libido)
▪ controlled and repressed during this period.
d. Normal homosexual
▪ interest on same sex only
a. Help the child achieve positive experiences so that he/she will be ready to face the conflict of
adolescence.
GENITAL STAGE
♦ Site of gratification: genitalia
♦ Activity: Learns to establish satisfactory relationship to the opposite sex.
♦ Nursing significance: Give an opportunity to relate to the opposite sex.
♦ Resurgence of sexual drives
♦ Sexual pleasure through genitals
♦ Sexual identification
♦ Heterosexual is normal
♦ Maturation of the reproductive system
♦ Mastery of this period results in the development of the ability to love and to work
♦ Psychological theme: Maturity, creation and enhancement of life (intellectual and artistic creativity).
♦ Task: Learn how to add something to life and society.
♦ How to achieve this state: Balance both love and work.
♦ Behaviors to observe:
a. Separates from parents
b. Responsible for self
c. Develops sexual identity
d. Relationship with the opposite sex
PSYCHOSOCIAL DEVELOPMENT THEORY (ERIK ERIKSON)

♦ explains an individual’s path to the current personality development
♦ each stage is composed of two opposing forces that must be weighed out and decided upon. The selection of each
stage determines the outcome of the individual’s personality development.
♦ refers to Erickson’s personality development.
0–1 yr - Trust vs Mistrust 11-18 yrs - Identity vs Role Confusion

1-3 yrs - Autonomy vs Shame & Doubt 18-40 yrs - Intimacy vs Isolation
3-5 yrs - Initiative vs Guilt 40-65 yrs - Generativity vs Stagnation
5-11 yrs - Industry vs Inferiority 50+ - Integrity vs Despair
INFANCY (0 – 18 mo.)
♦ Developmental task: Trust vs. Mistrust (learning confidence, learning to love).
♦ Trust is the foundation of all the psychosocial tasks
♦ Infants depend on the primary caregivers for all physiologic & psychological needs.
♦ The newborns react socially to caregivers by paying attention to the face or voice and by cuddling when held.
♦ They are able to interact with the environment by responding to various stimuli such as touch and sound.
♦ Mistrust develops when care is: inconsistent, inadequate, rejecting
♦ è infant becomes fearful and suspicious of the world and of people.
How to develop Trust

1. Satisfy needs on time
2. Care must be consistent and adequate.
3. Give an experience that will add to security: touch, hugs and kisses, eye to eye contact and soft music.
Nursing Implications:
a. Provide a primary caregiver.
b. Provide experiences that add to security such as soft sounds and touch.
c. Provide visual stimulation for active child involvement.
TODDLERHOOD
♦ Developmental task: Learning Autonomy vs. Shame and Doubt (Self-government and independence)
♦ Activities/issues: Bodily functions, toilet training, muscle control and walking
♦ Autonomy develops when child is permitted to assert himself. They feel secure and confident.
♦ Shame and doubt develop if the child does not develop a sense of trust and/or learns his assertiveness as “is not
acceptable”.
♦ There is sense of inadequacy and self-doubt.
How to develop autonomy
1. Give an opportunity for decision making such as offering choices.
2. Encourage the child to make decisions rather than judge.
3. Toddlers begin to develop their sense of autonomy by asserting themselves with the frequent use of the
word “no”.
♦ Although they like to explore the environment, they always have a significant person nearby.
♦ Receptive & expressive language skills are developing quickly.
♦ One of the most admirable and frustrating things about two and three-year-olds is their determination.
♦ "Can do" is their motto.
♦ If we can preserve that "can do" attitude (with appropriate modesty to balance it) we are much better off as adults.
♦ Behaviors to observe
a. Shows a sense of “me”
b. Negativism
c. Ritualistic and stereotyped behavior
d. Temper tantrums
a. Provide opportunities for decision making such as offering choices of clothes to wear or toys to play with.
b. Praise ability to make decisions rather than judging correctness of any decision.
PRESCHOOL AGE
♦ Developmental task: Initiative vs. Guilt
♦ The child learns to do basic things alone and no longer imitate the action of others.
♦ Same is true for language and fantasy activities.
How to develop Initiative
a. Initiative develops if the child is allowed the freedom to initiate small activities and to ask questions.
b. Initiative is encouraged if parents answer the child’s question ( intellectual initiative) and do not inhibit
fantasy or play activity.
c. Give an opportunity to explore new places, and events such as bringing the child to an amusement park
(exploration, adventure and discovery).
d. Guilt develops if the child is made to feel that his activity is bad or wrong.
Inhibition
▪ person will not try things because "nothing ventured, nothing lost" & particularly, nothing to feel guilty about.
Courage
▪ the capacity for action despite a clear understanding of your limitations and past failings.
♦ Behaviors to observe
a. Starts many task; completes few
b. Very imaginative
c. Engages in fantasy play
d. Very curious, asks many questions
e. Boastful
Nursing Implications
a. Provide opportunities for exploring new places or activities.
b. Allow play to include activities including water, clay( for modeling) or finger paint.
♦ Activity: Finger painting and Modeling clay enhances imagination, creativity, and fine motor development.
♦ Virtue developed: Direction and purpose
SCHOOL-AGE PERIOD
♦ Developmental task: Industry vs. Inferiority
♦ How to develop industry: Give short assignments and projects.
♦ Virtue: Competence
♦ Develops sense of competency vs sense of inadequacy.
♦ Industry develops when a child is permitted to do things by himself and praised for the results.
♦ Interested in learning how to do things well.
♦ Inferiority develops if the child’s activities are seen as a nuisance.
♦ They begin to create & develop a sense of competence & perseverance and master skill that will help them function
in the adult world.
♦ They are motivated by activities that provide a sense of worth.
♦ These children compare themselves with others and obtain feedback from teachers & peers.
Narrow virtuosity
♦ we see this in children who aren't allowed to "be children," the ones that parents or teachers push into
one area of competence, without allowing the development of broader interests.
Inertia
♦ includes all of us who suffer from the "inferiority complexes"
♦ If at first you don't succeed, don't ever try again!
♦ Others never developed social skills -- the most important skills of all -- and so we never go out in public
Behaviors to observe:
a. Wants to learn to do things well and completely
b. Participates in variety of activities especially in school
c. Takes pride in accomplishments
a. Provide opportunities such as allowing child to assemble and complete a short project so that child feels rewarded
for accomplishment.
ADOLESCENCE
♦ Developmental task: Identity vs. Role Confusion
♦ The adolescent adjusts to changes in his or her body and seeks freedom from parents to learn who he/she is or what
kind of person he/she will be.
♦ Identity develops when there is a feeling of belongingness and being accepted by himself and others.
♦ Those who are accepted, loved & valued by family and peers generally tend to gain confidence & feel good about
themselves.
♦ Those who have difficulty forming relationships or who are perceived by peers as too different and not included
in adolescent cliques may develop less favorable self-images & low self- esteem.
♦ Role Confusion develops when the adolescent is not sure who he is or what he can do.
To achieve Identity:
♦ Adolescents must bring together everything that they have learned about themselves as son or daughter,
as a friend, student and so on and integrate this different images of themselves as a whole that make
sense hence develop sense of self.
a. Provide opportunities for the adolescent to discuss feelings about events important to him or her.
b. Offer support and praise for decision making
Development Of Sexuality
♦ Influenced by social and cultural aspects
♦ Being held and touched, kissed and hugged, snuggled and tickled allows babies to experience comforting,
positive physical sensations associated with being loved.
♦ The attachments established in these early years help set the stage for bonding and intimacy down the line.
Gender Awareness / Gender Identity
♦ By age 2 or 3, a child starts to develop a sense of being a male or female. Kids this age start to understand
the difference between boys and girls, and can identify themselves as one or the other.
Gender Roles
♦ Certain behaviors associated with being male or female. Gender roles are culturally derived
YOUNG ADULTHOOD
♦ Developmental task: Intimacy vs. Isolation
Intimacy
♦ ability to relate well with other people , not only with members of the opposite sex but also with one’s own
sex to form long-lasting relationship.
♦ A strong sense of personal identity is important for developing intimate relationships.
♦ Studies have demonstrated that those with a poor sense of self tend to have less committed relationships and are
more likely to suffer emotional isolation, loneliness and depression.
Behaviors to observe
a. Develop intimate relationship with another
b. Commitment to career vs avoidance of choices in relationships, work or lifestyle.
c. They face a number of experiences & changes in lifestyle as they progress towards maturity.
d. The multiple roles of adulthood may also create stress as a result of role conflict.
♦ Encourage mutual relationship and responsible sexual behavior.
MIDDLE ADULTHOOD
♦ Developmental Task: Generativity vs. Stagnation
♦ contributes to the next generation by performing meaningful work as they extend their concern to the community and
the world.
♦ Building lives, focusing on career and family.
♦ Those who are successful during this phase will feel that they are contributing to the world by being active in their
home and community.
♦ Those who fail to attain this skill will feel unproductive and uninvolved in the world.
♦ People with a sense of generativity are self-confident and better able to juggle their various lives (mother, teacher,
coach, church member).
♦ People without these sense are stagnated or self-absorbed.
♦ Those who have devoted themselves to only one role are more likely to find themselves at the end of middle age
with a narrow perspective and lack of ability to cope with change.
♦ Most important relationships: Children and community
♦ Issues: “Giving back”, helping, contributing
♦ Virtue/strength: Care and production
♦ Maladaptation/Malignancy: Overextension and rejectivity
LATE ADULTHOOD
♦ Developmental task: Ego Integrity vs. Despair
♦ Older adults try to make sense out of their lives as they have feelings of self- acceptance.
♦ Those who feel proud of their accomplishments will feel a sense of integrity.
♦ Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction.
♦ These individuals will attain wisdom, even when confronting death.
♦ Focused on reflecting back on life.
♦ Those who are unsuccessful during this stage will feel that their life has been wasted and will experience many
regrets. The individual will be left with feelings of bitterness and despair.
♦ Accept their bodily limitations but encourage them to share their wisdom and explore the philosophy
of life and death.
♦ Most significant relationship: Mankind
♦ Virtue Developed: Wisdom and Generosity of the spirit
C. COGNITIVE DEVELOPMENT THEORY (JEAN PIAGET)

♦ refers to the ability to solve problems, to understand and apply learning experience, to accommodate knowledge and
adapt to practical settings, and dexterity to handle new situations.
♦ Measured by Intelligence test and by observing the child’s ability to function effectively in his or her environment.
♦ Child explores the world and observes regularities and makes generalizations.
Schemas
♦ mental representations or ideas about what things are and how we deal with them.
Assimilation
♦ how humans perceive and adapt to new information
Accommodation
♦ process of taking new information in one's environment and altering pre-existing schemas in order to fit in
the new information.
Adaptation
♦ coping behavior ; the ability to handle the demands made by the environment
DEVELOPMENT OF BODY IMAGE

♦ body image is how and what you think and feel about your body
♦ It includes the picture of your body that you have in your mind, which might or might not match your body’s
actual shape and size.
Factors That influence Development of Body Image:
a. Family environment e. The media and advertising
b. Ability f. Fashion industry
c. Disability g. Cultural background
d. Attitudes of peers
DEVELOPMENT OF SELF CONCEPT

♦ self-concept is about "who I am“
♦ Achieving concept of object permanence is basic to development of self image.
♦ By the end of the first year, infants recognize that they are distinct from their parents.*
♦ As motor skills develop, they learn that their body are useful
♦ Important to transmit positive messages to infants about their bodies
DEVELOPMENT OF SELF-ESTEEM
♦ Self esteem refers to the extent to which we like, accept or approve of ourselves or how much we value
ourselves
Four Major Factors that Influence Self esteem Argyle (2008)
1. Reaction of others
♦ Admire us = Positive self esteem or Avoid us = negative
2. Comparison with others
♦ If friends appear to be more successful, happier = negative BUT if they are less successful
than us = Positive
3. Social roles
♦ Some social roles carry prestige (doctor, airline pilot) = Positive
♦ Other roles carry stigma (prisoner, unemployed)= Negative
4. Identification
♦ We identify with the positions we occupy, the roles we play and the groups we belong to.
JEAN PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

Cognitive development is an orderly and sequential process in which a variety of new experiences (stimuli) must exist
before intellectual abilities can develop
Stage Age Description

1. Sensorimotor Stage Birth –2 years ♦ infants are only aware of what is immediately in front of them. They focus on
what they see, what they are doing, and physical interactions with their
immediate environment.
♦ Because they don't yet know how things react, they're constantly experimenting
with activities such as shaking or throwing things, putting things in their mouths,
and learning about the world through trial and error.
♦ Understanding of the world involves only perceptions and objects with which the
infant has directly experienced. Actions discovered first by accident are repeated
and applied to new situations to obtain the same results.
“Practical Intelligence”
♦ Communication is by the use of senses and reflexes because the child can
not use words or symbols for thinking and problem solving yet.
♦ Infants see, hear, touch the world.
♦ Infants don’t think about things they do not see in the world. They progress
rapidly towards using language and experimenting the way things work.
♦ Has six schema
a. Simple Reflexes Birth-6 wks ♦ "Coordination of sensation and action through reflexive behaviors".
♦ Three primary reflexes are described by Piaget: sucking of objects in the mouth,
following moving or interesting objects with the eyes, and closing of the hand
when an object makes contact with the palm (palmar grasp).
♦ Over the first six weeks of life, these reflexes begin to become voluntary actions.
For example, the palmar reflex becomes intentional grasping.
♦ Pre- religious
♦ Behavior is entirely reflexive.
♦ Stimuli are assimilated into beginning mental images.
♦ Totally narcissistic being.
b. Primary circular 6 wks - 4 mos ♦ Primary circular reactions is reproduction of an event that initially occurred by
reactions phase chance. (thumbsucking)
♦ The main focus is still on the infant's body". As an example, an infant might
repeat the motion of passing their hand before their face.

♦ Objects are perceived as extensions of the self
♦ Object permanence (a child’s understanding that objects continue to exist even
though he or she cannot be seen or heard)
♦ Refers to activities related to one’s own body. Example: Thumbsucking
♦ Used to show that repetition of behavior occurs.
Ex. An Infant accidentally brings his/her thumb to the mouth and enjoys the
sensation of sucking so he repeats it.
♦ Hand-mouth and ear–eye coordination developed.
♦ Infants spending much time looking at objects and separating self from them.
♦ Beginning intention of behavior is present like thumb to mouth for a purpose
to suck.
♦ Enjoyable activity: Rattle or tape of parent’s voice.
c. Secondary circular 4 – 8 months ♦ Development of habits. "Infants become more object-oriented, moving beyond
reactions self-preoccupation; repeat actions that bring interesting or pleasurable results".
♦ Secondary circular reactions, or the repetition of an action involving an external
object begin; for example, moving a switch to turn on a light repeatedly.
♦ Children become aware of things beyond their own body and become more object
oriented. (ex: accidentally shaking a rattle and continuing to do so for the sake of
satisfaction)
♦ Secondary refers to the activities that are separate from the child’s body.
Ex. Baby hits a mobile and notices that this makes it move, so hits it again.
♦ Involves an act that extends out to the environment
Ex. Squeeze a rubber duck. It goes “quack.” It’s great, so does it again,
and again, and again.
♦ She is learning “procedures that make interesting things last.”
♦ Infants learn to initiate, recognize, and repeat pleasurable experiences from
environment.
♦ Memory traces are present; anticipates familiar events (parent coming near
him will pick him up).
♦ Good toy for this period: mirror, good game: peek-a-boo.
d. Coordination of 8 – 12 months ♦ "Coordination of vision and touch—hand-eye coordination;
secondary circular ♦ coordination of schemas and intentionality.
reactions ♦ This stage is associated primarily with the development of logic & the
coordination between means and ends holding what Piaget calls the "first
proper intelligence.”
♦ This stage marks the beginning of goal orientation, the deliberate planning of
steps to meet an objective.
♦ Children start to show intentionality (ex: using a stick to reach something)
♦ Children use previous experiences or behavioral experiences as a foundation
for adding new intellectual skills to their expanding repertoire.
♦ Largely transitional …….increasing motor skills
>>>greater exploration of the environment.
♦ Marks beginning intellectual reasoning
>>> removing an obstacle will reveal a hidden object
♦ Intentionality develops, ….when infants attempt to remove a barrier in order to
achieve the goal….
>>> climb or push away anything that come their way.

♦ Exhibits goal directed behavior
♦ Increasing separateness
♦ Because of increased sense of separateness, infant experiences separation
anxiety when primary caregiver leaves.
♦ Good toy: Nesting toys, colored boxes.
♦ Infants can plan activities to attain specific goals.
♦ Perceives that others can cause activity, and that activities of own body are
separate from activities of other objects.
♦ Can search for and retrieve toy that disappears from view. Recognizes size
and shapes of familiar objects.
e. Tertiary circular 12 – 18 months ♦ "Infants become intrigued by the many properties of objects and by the many
reactions things they can make happen to objects; they experiment with new behavior".
♦ describes the child as the "young scientist," conducting pseudo-experiments to
discover new methods of meeting challenges.
♦ start to explore new possibilities of objects
♦ Uses active experimentation to achieve unattainable goals >>>>> uses newly
acquired skills for the function they serve
♦ Incorporates old learning and applies the combined knowledge to new
situations with emphasis on experimentation.
>>>>>>beginning of RATIONAL JUDGEMENT and INTELLECTUAL
THINKING
♦ The “Young Scientist”
♦ Child is able to experiment (trial and error) to discover new characteristics of
objects and events. Ex. Dropping objects
♦ Capable of space perception and time perception as well as permanence.
♦ Good game: Throw and retrieve.
f. Invention of New 18 – 24 months ♦ "Infants develop the ability to use primitive symbols and form enduring mental
Schemas representations".
♦ associated primarily with the beginnings of insight or true creativity.
♦ Uses mental imagery to understand the environment
♦ Uses fantasy or “make-believe”
♦ A shift to symbolic thinking
1. Animism
♦ inanimate objects are capable of actions and have lifelike qualities
2. Artificialism
♦ the belief that environmental characteristics can be attributed to human
actions or interventions.
For example, a child might say that it is windy outside because someone is
blowing very hard, or the clouds are white because someone painted them
that color.
♦ Child is in final sensorimotor stage.
♦ Most dramatic change is object permanence. Child will search for an object in
several hiding places.
♦ Can infer a cause when they are experiencing the effect. ( “Candy is missing,
sister is smiling”)
♦ Can infer that an object is hidden in any number of places even if they only saw
the original hiding place.

♦ Transitional phase to the next period.
♦ Uses memory and imitation to act.
♦ Can solve basic problems, foresee maneuvers that will succeed or fail.
♦ Good toy: Those with several uses: blocks, colored plastic rings
Pre-operational 2 to 7 years ♦ Emerging ability to think
♦ young children are able to think about things symbolically.
♦ They develop memory and imagination, which allows them to understand the
difference between past and future, and engage in make-believe.
♦ Their thinking is based on intuition and still not completely logical.
♦ They cannot yet grasp more complex concepts such as cause and effect, time,
and comparison.
♦ The preoperational child is completely egocentric (the child has difficulty seeing
the viewpoint of others)
♦ This stage is the age of curiosity; preschoolers are always questioning and
investigating new things. Since they know the world only from their limited
experience, they make up explanations when they don’t have one.
Centration
♦ the act of focusing all attention on one characteristic or dimension of a
situation, whilst disregarding all others.
Moral realism
♦ the belief that the child's way of thinking about the difference between
right and wrong, is shared by everyone else around them. Due to this
aspect of the stage, children begin to respect and insist on obedience of
rules at all times, and they are not able to take anything such as motives
into account.
a. Pre-conceptual 2 – 4 years ♦ Thinking tends to be egocentric
Stage ♦ Exhibits use of symbolism (when something is allowed to stand for or
symbolize something else)
♦ This substage is characterized by the child's inability to understand all the
properties of classes.
Class inclusion
♦ inability to focus on two aspects of a situation at once inhibits them from
understanding the principle that one category or class can contain several
different subcategories or classes.
For example, a four-year-old girl may be shown a picture of eight dogs and three
cats. The girl knows what cats and dogs are, and she is aware that they are both
animals. However, when asked, "Are there more dogs or animals?" she is likely to
answer "more dogs". This is due to her difficulty focusing on the two subclasses
and the larger class all at the same time. She may have been able to view the
dogs as dogs or animals, but struggled when trying to classify them as both,
simultaneously.
♦ Egocentric ( unable to see the viewpoint of another)
♦ use of symbols. - a thing that represents something else
♦ Language developed
♦ Displays static thinking ( inability to remember what he/she started to talk about
so that at the end of a sentence, the child is talking about another topic).
♦ Concept of time is now, & concept of distance is only as far as he can see.
♦ Centering or focusing on a single aspect of an object cause distorted reasoning

♦ No awareness of reversibility ( for every action there is an opposite reaction)
is present.
♦ Thinking is based more on feelings than on logic. They have a good imagination
about things, but often find it hard to see situations from the perspective of
another person
♦ creative play (wherein checkers are cookies, papers are dishes, a box is the
table, and so on. )
♦ drawing, a written word, or a spoken word comes to be understood as
representing a real dog
♦ Good toy for this period: Items that require imagination, such as modeling clay.
b. Intuitive Stage 4 – 7 years ♦ Unable to break down a whole into separate parts
♦ Able to classify objects according to one trait
♦ have formed a more complete understanding of concepts and have stopped
transductive reasoning (a faulty type of logic that involves making inferences
from one specific to another. It can lead to correct or accurate conclusions, but
it is not guaranteed to do so). For example, if a child hears the dog bark and
then a balloon popped, the child would conclude that because the dog barked,
the balloon popped.
♦ Their thinking has become more logical, although it is structured more about
perception than logic.
Conservation
♦ the awareness that altering a substance's appearance does not change its
basic properties.
Example: Children are shown two identical beakers filled to the same level with
water. The experimenter then pours the contents of one beaker into a tall thing
tube. Participants who had previously said the amount in each beaker were
equal are now asked whether there is as much, more or less water in the new
container. At the intuitive stage, they will almost always say that there is more
because the water level is much higher in the tube.
1. Centering
♦ children tend to look at an object and see only one characteristic.
2. Lack of conservation
♦ inability to discern truth, although physical properties change.
3. Lack of reversibility
♦ inability to retrace steps.
4. Role fantasy
♦ how children would like something to turn out
5. Assimilation
♦ taking in information and changing it to fit their existing ideas. Ex. Garden
6. Learning accommodation
♦ change ideas to fit reality rather than the reverse.
7. Egocentrism is still present
♦ can’t understand the viewpoint of others.
8. Magical thinking
♦ believing that one event happens as a result of another without a plausible
link of causation. For example: "I got up on the left side of the bed today;
therefore it will rain."
9. Animism
♦ perceive animals and objects as having feelings and thoughts.

Concrete Operations 7 to 11 years ♦ Learn to reason about events in the here-and-now
♦ Demonstrate logical, concrete reasoning.
♦ Children's thinking becomes less egocentric and they are increasingly aware of
external events.
Decentering
♦ when someone stops believing that they are the center of the world
♦ Operations are labeled “concrete” because they apply only to those
objects that are physically present.
Reversibility
♦ The primary characteristic of concrete operational thought
♦ when the child realizes that an action could be reversed and certain
consequences will follow from doing so). The child can mentally reverse
the direction of his or her thought. A child knows that something that he
can add, he can also subtract.
Conservation
♦ is the ability to see that objects or quantities remain the same despite a
change in their physical appearance.
Compensation
♦ is a property defined by the logical consequences of combining more
than one operation or more than one dimension.
Classification
♦ is another achievement of this period. This means that children acquire
the skills they lead to the ability to describe things by terms of classes,
numbers, and series.
Seriating
♦ occurs when a child can order objects in a series because they have
acquired knowledge of them through experience. This child has arranged
her dolls by height which is a form of seriation.
♦ Children can use logic, but tend to be literalistic.
♦ Abstract concepts (include many spiritual truths) are not easily understood
♦ Concrete problem solving, some reversibility, categorical labels
(number or animal)
1. Includes systematic reasoning and recognize cause-and-effect relationship.
Ex. Beads
2. Uses broad concepts and subgroups of concepts. Knows how to classify.
Ex. Sorting objects by color, seriation
3. Child is aware of reversibility.
♦ Activity: Sorting, classifying
4. Understands conservation, sees constancy despite transformation (mass or
quantity remains the same even if changes in shape or position)
5. Uses memory to learn broad concepts (Fruits) and subgroups of concepts(
apple, orange, grapes).
6. Classification involves sorting objects accordingly.
ACTIVITY: Collecting and classifying natural objects such as plants, sea
shells, etc.
Formal Operations 11 years & ♦ Able to see relationships & to reason in the abstract
above ♦ Deals with the present, the here and now and can think of the future
♦ marks the start of abstract thought and deductive reasoning (involves using a
generalized principle in order to try to predict the outcome of an event).

For example, a child will understand that "A is more than B" and "B is more than
C". However, when asked "is A more than C?", the child might not be able to
logically figure the question out in their heads.
♦ Thought is more flexible, rational, and systematic.
♦ can think about thoughts and “operate on operations, not just concrete objects.
♦ Able to see relationships & to reason in the abstract
♦ Deals with the present, the here and now and can think of the future
♦ marks the start of abstract thought and deductive reasoning (involves using a
generalized principle in order to try to predict the outcome of an event).
For example, a child will understand that "A is more than B" and "B is more
than C". However, when asked "is A more than C?", the child might not be able
to logically figure the question out in their heads.
♦ Thought is more flexible, rational, and systematic.
♦ can think about thoughts and “operate on operations, not just concrete objects.
Transitive inference
♦ using previous knowledge to determine the missing piece, using basic logic.
An example of transitive inference would be when a child is presented with
the information "A" is greater than "B" and "B" is greater than "C". This child
may have difficulty understanding that "A" is also greater than "C".
♦ Condition where cognition achieves its final form.
♦ Can solve hypothetical problems with scientific reasoning.
♦ Understands causality and can deal with past present and future. They are
capable of abstract and formal thought.
♦ Activity: Talk time that will sort through attitudes and opinions.
♦ Abstract concept can be understood and reasoned with.
♦ Multiple hypotheses and outcomes can handle proposition.
♦ hypothetical thinking
♦ using logical operations, and using them in the abstract, rather than the
concrete
♦ Adolescent egocentrism can be dissected into two types of social thinking:
1. Imaginary audience
♦ believes and imagines that people are enthusiastically watching her
2. Personal fable
♦ involves a sense of personal uniqueness and invincibility
MORAL DEVELOPMENT THEORY (LAWRENCE KOHLBERG)

♦ refers to the ability to know right from wrong and to apply these to real life situations.
♦ Moral development is influenced by the child’s motivation or need, child’s opportunity to learn social roles, & the
forms of justice the child encounters in the social institutions where he lives
♦ body image is how and what you think and feel about your body
♦ It includes the picture of your body that you have in your mind, which might or might not match your body’s actual
shape and size.
Factors That influence Development of Body Image:
a. Family environment e. The media and advertising
b. Ability f. Fashion industry
c. Disability g. Cultural background
d. Attitudes of peers
Level 1. Pre-conventional Morality Level II. Conventional Morality Level III. Postconventional Morality
Stage 1. Obedience and Punishment Stage 3. Good Interpersonal Stage 5. Social contract &
Stage 2. Individualism and Exchange Relationships Individual Rights
(The good boy/good girl attitude) Stage 6. Universal Principles
Stage 4. Maintaining the Social Order (Principled conscience)
(Law and order morality) Stage 7. Transcendental Morality or
Morality of Cosmic Orientation
LAWRENCE KOHLBERG’S STAGES OF MORAL DEVELOPMENT

Moral development is influenced by the child’s motivation or need, child’s opportunity to learn social roles, & the forms of
justice the child encounters in the social institutions where he lives.
STAGE AGE DESCRIPTION

I. Pre Conventional Level Up to age 9 ♦ Morality of self interest: to avoid punishment or gain concrete rewards
♦ People at this stage do not really understand conventions/ rules of society
Stage 1: Punishment Infancy ♦ Rules are obeyed to avoid punishment
and Obedience ♦ Consequences of acts determine whether they are good or bad
♦ Infant period is a pre-religious stage.
▪ Infants have little concept of any motivating force beyond that of their
parents.
▪ Infants learn that when they do certain actions, parents give affection
and approval
▪ For other actions, parents scold and call the behavior as bad.
♦ The child does right because the parent tells him/her to avoid punishment.
The child is good because the parent said the child must be, not that it is
right to be good.
♦ Children see morality as something external to themselves, as that which
the big people say they must do.
♦ Nursing implication:
♦ Child needs help to determine what are right actions.
♦ Give clear instructions to avoid confusion
Stage 2: Instrumental – Pre School age ♦ Rules are obeyed for personal gain
Relativist ♦ The ethics of “What’s in it for me?”
♦ Obeying rules and exchanging favors are judged in terms of the benefit to
the individual
♦ At this stage, children recognize that there is not just one right view that is
handed down by authorities. Different individuals have different viewpoint.
Since everything is relative, each person is free to pursue his /her own
interest.
♦ Carries out actions to satisfy his own needs rather than society’s.
♦ Will do something for another if that person does something for the child
(Egocentrism).
Nursing Implication:
♦ Child is unable to recognize that like situations require like actions.
♦ Unable to take responsibility for self-care, because meeting own needs
interferes with this.
♦ “What is in it for me?”

II. Conventional Level Most ♦ Morality of law & social rules: to gain approval/avoid disapproval
adolescents ♦ People at this stage conform to the conventions/rules of society
and adults
Stage 3: Good boy- School age ♦ Rules are obeyed for approval and maintain friendly relations
Good girl Orientation ♦ Ethical decisions are based on concern for or the opinion of others
♦ Orientation of interpersonal relationship of mutuality.
♦ “Good Boy, Good Girl”/Nice Boy, Nice Girl” stage
♦ At this stage children--who are by now usually entering their teens--see
morality as more than simple deals.
♦ They believe that people should live up to the expectations of the family
and community and behave in "good" ways.
♦ Good behavior means having good motives and interpersonal feelings
such as love, empathy, trust, and concern for others.
♦ Child follows rules because of a need to be a “good” person in own eyes
and eyes of others.
♦ Lying is common to disguise that they have been involved in an action that
is not “nice”.
Nursing implication:
♦ Child enjoys helping others because this is a nice behavior.
♦ Allow child to help with bedmaking and other like activities.
♦ Praise for desired behavior such as sharing.
Stage 4: Law and Teens ♦ Rules are obeyed for social order. Orientation toward fixed rules
Social Order ♦ Right behavior consists in doing one’s duty, showing respect for authority
and maintaining the given social order for its own sake
♦ There is maintenance of social order, fixed rules and authority.
♦ The child becomes more broadly concerned with society as a whole.
♦ The emphasis is on obeying laws, respecting authority, and performing
one's duties so that social order is maintained.
♦ The child finds following rules satisfying.
♦ Follows rules of authority figure to keep system working.
♦ Law should be obeyed even if it is not fair.
♦ Child follows rules and is something “right”
♦ May have difficulty modifying a procedure because one method may not
be “right”.
♦ Follows self-care measure only if someone is there to enforce them.
III. Post Conventional Over 20’s ♦ Morality of abstract principles: to affirm agreed-upon rights & personal
Level ethical principles
♦ The moral principles that underline the conventions of a society are
understood
♦ The post-conventional level, also known as the principled level, consists of
stages five and six of oral development.
♦ There is a growing realization that individuals are separate entities from
society, and that the individual's own perspective may take precedence
over society's view.
♦ Because of this level's "nature of self before others", the behavior of post-
conventional individuals, especially those at stage 6, can be confused
with that of those at the pre-conventional level

Stage 5: Social Adulthood ♦ Rules are obeyed if they are impartial; democratic rules are challenged if
Contract Orientation they infringe on the rights of others; Morally right and legally right are not
always the same
♦ Rules and laws represent agreements among people about behavior that
benefits society. Rules can be changed when they no longer meet
society’s needs
♦ Social contract, utilitarian law making perspectives.
♦ Follows standards of the society for the good of all people.
♦ Those which do not promote the general welfare should be changed when
necessary to meet "the greatest good for the greatest number of people".
♦ This is achieved through majority decision, and inevitable compromise.
Thus democratic government is ostensibly based on stage five reasoning.
♦ Children basically believe that a good society is best conceived as a social
contract into which people freely enter to work toward the benefit of all .
♦ They recognize that different social groups within a society will have
different values, but they believe that all rational people would agree on
two points.
♦ First, they would all want certain basic rights, such as liberty and life, to be
protected. Second, they would want some democratic procedures for
changing unfair law and for improving society.
♦ Involves consideration of the formal rules and guidelines of the entire
society and of personal values and opinions.
♦ An adolescent can be responsible for self-care because he/she views
this as a standard of adult behavior.
Stage 6: Universal Adulthood ♦ Moral principles are more important than the rules of the land
Ethical Principle ♦ Right is defined by the decision of conscience in accord with self-chosen
ethical principles appealing to logical comprehensiveness, universality
and consistency
♦ Follows internalized standards of conduct.
♦ Moral principles are more important than the rules of the land
♦ Many adults do not reach this level of development.
STAGE 7: Transcendental ♦ Linked religion with moral reasoning
Morality Or Morality Of ♦ Love and respect for all living things
Cosmic Orientation
STAGES OF FAITH DEVELOPMENT (JAMES FOWLERS)

Stage 0 – Primal or Undifferentiated (birth to 2 yrs) Stage 4 – Individuative - reflective (early adult)
Stage 1 – Intuitive - predictive (3-7 yrs) Stage 5 – Conjunctive (middle adult)
Stage 2 – Mythical - literal (6-12 yrs) Stage 6 – Universalizing (late adult)
Stage 3 – Synthetic - conventional (12-adult)
JAMES FOWLER’S SEVEN STAGES OF FAITH

Spiritual component refers to individual’s understanding of their relationship with the universe & their perceptions
about the direction & meaning of life.

Stage 0 : Birth to 2 yrs ♦ Faith is based on infant’s relationship with his parents
Primal or Undifferentiated
Stage 1: 3to 7 yrs old ♦ Intuitive images of good and evil
Intuitive - Projective Faith ♦ Fantasy and reality are the same
♦ Fantasy-filled, imitative phase in which the child can be powerfully and
permanently influenced by examples, moods, actions and stories of the
visible faith of primarily related adults
Stage 2: 6 to 12 yrs old ♦ More logical, concrete thought
Mythic - Literal Faith ♦ Literal interpretation of religious stories
♦ God is like a parent figure
♦ The person begins to take on for himself the stories, beliefs and
observances that symbolize belonging to his community
"If I follow the rules, God will give me a good life."
"If I pray, God will grant my wish."
Stage 3: Teen agers ♦ More abstract thought
Synthetic - Conventional ♦ Conformity to religious beliefs of others
Faith ♦ A person’s experience of the world now extends beyond the family. A
number of spheres demand attention: family, school or work, peers,
street society & media, and perhaps religion
♦ "Synthetic" - beliefs are not the result of any type of analytical thought.
Any attempts to reason with a person in this stage about his beliefs, any
suggestion of demythologizing his beliefs is seen as a threat.
♦ "Conventional" means that most people in this stage see themselves as
believing what "everybody else" believes and would be reluctant to stop
believing it because of the need they feel to stay connected with their
group.
"Synthetic"
♦ pulling together of one’s valued images and values as well as sense of
self and identity
"Conventional"
♦ means that most people in this stage see themselves as believing what
"everybody else" believes and would be reluctant to stop believing it
because they feel they need to stay connected with their group.
Stage 4: 17 or 20 to late ♦ Individuals are capable of taking full responsibility for their religious beliefs
Individuative - Reflective 30 yrs old ♦ In-depth exploration of one’s values and religious beliefs is carried out
Faith ♦ Particularly critical for the person must begin to take seriously the burden
of responsibility for his own commitments, lifestyle, beliefs and attitudes.
Stage 5: Conjunctive Faith 35 to 40 yrs old ♦ Becoming more open to paradox and opposing viewpoints
♦ Stems from awareness of one’s finiteness and limitations
♦ Involves the integration into self and outlook of much that was suppressed
or unrecognized in the interest of Stage 4’s self-certainty and conscious
cognitive and affective adaptation to reality
♦ People in this stage are willing to engage in dialog with those of other
faiths in the belief that they might learn something that will allow them to
correct their own truths.

Stage 6: Middle and ♦ Transcending belief systems to achieve a sense of oneness with all being
Universalizing Faith Late Adulthood ♦ Conflictual events are no longer viewed as paradoxes
♦ Have generated faith compositions in which their felt sense of an ultimate
environment is inclusive of all being. They have become incarnators and
actualizers of the spirit of an inclusive and fulfilled human community.
♦ able to sacrifice their own well-being to that of their cause.
DANIEL LEVINSON’S FOUR ERAS OF LIFE OR SEASONS OF THE LIFE CYCLE

♦ Periods of change interspersed with periods of relative calm
I. Childhood and adolescence: birth to 20 III. Middle adulthood: 40 - 65

II. Early adulthood: 17- 45 A. Midlife transition: 40 - 45
♦ establishes a distinction between the “me” and ♦ neglected parts of self- seeking expression; aware of
“not-me”; death
♦ beginning of a more independent, responsible adult B. Entering middle adulthood: 45 - 50
life that includes sexual maturity ♦ choices are made; commit to new tasks
A. Early adult transition: 17- 22 C. Age fifty transition: 50 - 55
♦ seeks independence by separating from family ♦ evaluate the entire life structure
B. Entering the adult world: 22 - 28 D. Culmination of middle adulthood: 55 - 60
♦ experiments with different careers & lifestyles ♦ opportunity to prepare self in order to carry out main
C. Age thirty transition: 28 - 33 objectives for the coming era
♦ makes lifestyle adjustments IV. Late adulthood: 60+
D. Settling down: 33 - 40 ♦ spends time reflecting on past achievements & regrets;
♦ experiences greater stability ♦ makes peace with self and others
A. Late adult transition: 60 – 65
♦ need to reduce the level of responsibility ;
♦ less authority and power which needs getting used to
STEPHEN JAY GOULD’S SEVEN STAGES OF ADULT DEVELOPMENT

16-18 - want to separate from their family
18-22 - feel they could be pulled back into their family
22-28 - autonomous but still feel the need to prove themselves to their parents
28-35 - marriage & careers are well established; no longer feel necessary to prove self
35-43 - period of self- reflection; see time as finite, with little time left to shape lives of children
43-50 - interested in social activities with friends & spouse & desire both sympathy & affection from spouse
50-60 - period of transformation, with a realization of mortality & a concern for health; increase in warmth and
decrease in negativism
ROBERT PECK’S THEORY ON ADULT DEVELOPMENT

Stage 1: Ego Differentiation vs Work-role preoccupation
♦ Ego Differentiation - A person finds new meaning and value in his or her life.
♦ Work Role Preoccupation - defining oneself through work or an occupation
♦ One role should replace the work role as a source of self- esteem on retirement
Stage 2: Body transcendence vs Body preoccupation
♦ Body Transcendence - A person accepts the limitations that accompanies the aging process
♦ Body Pre-occupation - dwells on diminishing abilities
♦ Individual should adjust to decreasing physical capacities & at the same time maintain feelings of well being
Stage 3: Ego transcendence vs Ego preoccupation

♦ Ego Transcendence - person believes his or her life has worth and “life contributions” will live on after
death
♦ Ego Preoccupation - person feels that he or she has lived a useless life
♦ Acceptance without fear of one’s death as inevitable and not to hold on to life because he lived a useless
life; Self-examination occurs
ROBERT HAVIGHURST – DEVELOPMENTAL TASKS

♦ Each human has three sources for developmental tasks:
1. Tasks that arise from physical maturation:
a. Learning to walk and talk c. Behaving in an acceptable manner to opposite sex
b. Control of bowel & urine d. Adjusting to menopause
2. Tasks that arise from personal values:
a. Choosing an occupation
b. Figuring out one’s philosophical outlook
3. Tasks that arise due to pressures of society
a. Learning to read
b. Learning to be responsible citizen
HAVIGHURST’S DEVELOPMENTAL TASKS
DEVELOPMENTAL STAGE DEVELOPMENTAL TASK

Infancy and ♦ Learning to walk.
Early Childhood ♦ Learning to crawl
♦ Learning to take solid food
(Ages 0–5) ♦ Learning to talk
♦ Learning to control the elimination of body wastes
♦ Learning sex differences and sexual modesty
♦ Getting ready to read
♦ Forming concepts and learning language to describe social and physical reality
♦ Relate emotionally to others
♦ Distinguish right from wrong thru development of conscience
♦ Achieve psychological stability
Middle Childhood ♦ Learning physical skills necessary for ordinary games
♦ Learning to get along with age mates
(Ages 6–12) ♦ Building wholesome attitudes toward oneself as a growing organism
♦ Learning on appropriate masculine or feminine social role
♦ Developing concepts necessary for everyday living
♦ Developing conscience, morality and a scale of values
♦ Achieving personal independence
♦ Developing attitudes toward social groups and institutions
♦ Gain basic reading, writing , & mathematical skills
Adolescence ♦ Achieving new and more mature relations with age mates of both sexes
♦ Achieving a masculine or feminine social role
(Ages 13–18) ♦ Accepting one’s physique and using the body effectively
♦ Achieving emotional independence of parents and other adults
♦ Preparing for marriage and family life
♦ Acquiring a set of values and an ethical system as a guide to behavior
♦ Desiring and achieving socially responsible behavior
♦ Selecting an occupation
DEVELOPMENTAL STAGE DEVELOPMENTAL TASK

♦ Achieve assurance of economic independence
♦ Acquire skills necessary to fulfill civic responsibilities
Early Adulthood ♦ Selecting a mate
♦ Learning to live with a partner
(Ages 19-30) ♦ Starting family
♦ Rearing children
♦ Managing home
♦ Getting started in occupation
♦ Taking on civic responsibility
♦ Finding a congenial social group
♦ Selecting a mate
♦ Learning to live with a partner
♦ Starting family
♦ Rearing children
♦ Managing home
♦ Getting started in occupation
♦ Taking on civic responsibility
♦ Finding a congenial social group
Middle Adulthood ♦ Assisting teenage children to become responsible and happy adults
♦ Achieving adult social and civic responsibility
(Ages 30–60) ♦ Maintain an economic standard of living
♦ Reaching and maintaining satisfactory performance in one’s occupational career
♦ Developing adult leisure time activities
♦ Relating oneself to one’s spouse as a partner
♦ To accept and adjust to the physiological changes of middle age
♦ Adjusting to aging parents
Late Maturity ♦ Adjusting to decreasing physical strength and health
♦ Adjust to retirement & altered income
(60 and over) ♦ Adjust to death of spouse
♦ Develop affiliation with one’s age group
♦ Meet civic and social responsibilities
♦ Establish satisfactory living arrangements
INFANCY
Definition of terms
a. Infancy - is the period from one month to 1 year of age
b. Developmental milestones – are major markers of growth and development that serve as the basis for assessing
developmental delay or advancement
c. Gross Motor – ability to accomplish large body movements
d. Fine Motor - ability to coordinate hand movement.
Characteristics of Infancy stage:

1. Infancy is the shortest of all developmental periods.
♦ Infancy begins at 28 days and ends at 1 year
2. Infancy is a preview of later development
♦ It is not possible to predict exactly what the future development of the individual will be on the basis of the development
at birth. We notice only a clue of what to expect later on.
3. Infancy is the time of radical adjustments.

Major adjustments of Infancy:
a. Change in temperature
♦ From 37.8 degrees C in the uterine sac to 15.6 to 21.1 degrees C in the hospital or home.
b. Breathing by own starts
♦ When the umbilical cord is cut the infant must begin to breathe on its own.
c. Sucking and swallowing starts.
♦ When the umbilical cord is cut off, The child gets nourishment by the reflexes of sucking and
swallowing instead of receiving it from the mother through umbilical cord.
d. Elimination of waste products begin
♦ Letting out urine and stools is not a matter of adjustment. But some infants are seen to have trouble
with elimination matters.
4. Infancy is a hazardous period.
♦ Infancy is a hazardous period both physically and psychologically. Physically the infant finds it difficult in making
adjustments to the new environment. Psychologically the infant suffers a little when the attitudes of significant
people towards the infant radically changes
5. Infancy is a plateau in development.
♦ There is a slight regression such as loss of weight, less strong and healthy than it was at the time of birth. This
characteristic of plateau is due to the necessity for radical adjustments to the postnatal environment. Once the
adjustments are made the infant resumes its growth and development.
GROWTH & DEVELOPMENT OF THE INFANT

A. Biologic: Proportional changes and maturation of systems
a. 1 – 4 months
♦ Head growth; posterior fontanel closes, grasp and tonic neck reflex disappear at 3 months, moro and
rooting reflexes disappear at 4 months
♦ Until 3 to 4 months, extrusion reflex prevents the infant from feeding effectively
♦ Immune system becomes functional at 2 months
b. 5 – 6 months
♦ Birth weight doubles
♦ Length: Gains 13.75 cm (5.5 in.) by 6 mos. & gains ½ inch for the next 6 mos
♦ Eruption of teeth begins, typically central incisor
♦ Ability to adjust to cold is mature by 6 months
♦ Develop additional adipose tissues to serve as insulation
♦ Moro and palmar reflexes have completely faded
c. 7 – 9 months
♦ Teething continuous, one tooth erupts monthly
♦ Anterior fontanelle – 4-6 cm diameter; diamond shaped & closes at 9-18 mos
d.10 – 12 months
♦ Birth weight is tripled
♦ Add another 7.5 cm (3 in.) at 12 mos
♦ Head and chest circumference are equal; CC is larger after 1 yr.
♦ The amount of brown fat decreases during the first year
♦ Posterior fontanelle – between parietal bones & occipital bone & closes at 4-8 wks. after birth
B. Physiologic
1. Respiratory: RR = 20 – 30 bpm
2. Cardio-Vascular: HR = 80 – 120 /min.; BP = 90/55 - 100/60
3. Hematologic
♦ Physiologic anemia at 2-3 mos.
♦ Another decrease in serum iron levels at 6-9 mos.
4. GIT
♦ GIT matures gradually though liver is still immature
♦ Deciduous teeth erupts at 6 mos.
5. Endocrine System
♦ Kidneys and the endocrine are still immature
6. Neurologic and Sensory System
♦ At 6 mos, can shiver in response to cold & adipose tissues are developed to serve as insulation
7. Immune System
♦ Functional at 2 months.
♦ At 1 yr. able to produce both :
a. IgG for natural passive immunity
b. IgM - bactericidal for gram negative bacteria
c. IgA (against respiratory pathogens)
d. IgE (for hypersensitivities)
e. IgD (immunologic role still under investigation) are not plentiful till pre-school age.
8. Sensory changes:
a. Neonatal:
♦ hearing and touch well developed at birth; sight not fully developed until 6 years
b. 1 -4 months
♦ Begins to coordinate stimuli from various sense organs; hearing; locates sound by turning head
and visually searching; binocular vision developing; beginning hand-eye coordination, hand
regard, prefers human face; follows objects 180 degrees. Ability to accommodate is equal to
adult
c. 5 – 6 months
♦ With organized depth perception at 6 months; can localize sounds above and below ear; with
difficulty establishing eye coordination at six months; smiles at own mirror image and
responds to facial expression of others; sucking needs have decreased; chewing, biting,
and taste begin to develop.
d. 7 – 9 months
♦ Can fixate on small objects; depth perception has matured hence can perform transferring object
from one hand to the other.
e. 10 – 12 months
♦ Able to follow rapidly moving objects; visual acuity is 20/50 or better; binocularity is well
established. Beginning of object permanence. Can easily locate sound in any direction and
turn towards it.
DEVELOPMENTAL MILESTONES:
Motor development
♦ is the process of learning, controlling and integrating muscular responses
a. Neonatal Period
♦ Motor development: mainly reflex controlled, lifts head momentarily, with moro reflex
b. 1 – 4 months
♦ Gross: reflexes begin to fade; gains head control start of neck righting reflex, rolls from back to
side; begins voluntary head to mouth activity; gains head control beyond the plane of the
body at 3 months; rolls from back to side
♦ Fine: begins voluntary hand to mouth activity; At 2 mos. holds objects momentarily then drops;
hands held open not in fists. At 4 mos. brings hands together and pull to their clothes;
beginning thumb apposition; fingers are used in scooping and raking motion. Palmar and
plantar grasp disappear
c. 5 – 6months
♦ Gross: Parachute reflex starts to develop; Intentional rolling over; willfully turning over from
abdomen to back at five months, and back to abdomen at six months. Sits with support
♦ Fine: Increased manipulative skill; can grasp and let go voluntarily; plays with toes as objects; can
hold spoon and can feed himself with much spilling
d. 7 – 9 months
♦ Gross: At seven months, sits alone with hands held forward. Bounces with enjoyment in standing
position. Sits independently at 8 months. At 9 months, goes from prone to sitting upright,
can creep, crawl, pulls self to standing position
♦ Fine: Can transfer toy from one hand to the other; develops finger thumb apposition; uses crude
pincer grasp; preference for dominant hand is evident; diminished ineffective grasping at 8
months due to advanced eye-hand coordination.
e. 10 – 12 months
♦ Gross: creeps with abdomen off floor; walks with help or cruises; may attempt to stand alone; can
sit down from upright position
♦ Fine: 10 months, the pincer grasp is sufficiently established to enable infants to pick up a raisin
and other finger goods. Uses one finger to point to objects; offers object to people but can’t
release them. By 11 months, they put objects into a container and like to remove them. By
age 1, infants try to build a tower of two blocks but fail, drink in a cup and pull up socks. Can
draw a straight line using a crayon.
LANGUAGE DEVELOPMENT
Neonatal period Six months

♦ throaty sounds ♦ Infants learn the art of imitating.
One month ♦ May imitate a parent’s cough or say “Oh!” as a way
♦ small cooing, dove-like sounds to attract attention
2 months 7 months
♦ differentiates cry ♦ can imitate vowel sounds such as “oh –oh’” “ah –ah,”
3 mos “oo – oo,”
♦ squeals in response to nodding, smiling & laughs Eight months
out loud ♦ Cries when scolded
♦ The infant squeals in response to nodding, smiling 9 months
face or a friendly tone of voice. ♦ speaks first word such as “da –da,” or “ba – ba,”
♦ The baby becomes often more fun to be with. Laughs “ma –ma”.
out loud. 10 months
♦ Parents spend more time with the baby because they ♦ masters words such as “bye – bye,” or “no – no.”
enjoy their company. 12 months
4 months ♦ says 2 words beside “ma – ma,” or “da – da”;
♦ very talkative, cooing, babbling and gurgling when ♦ Can recognize their names and listen when acutely
spoken to spoken to
5 months Preoperational stage
♦ says simple vowel sounds; says “goo-goo,” ♦ child is able to represent the world through mental
“gah –gah” ; images and symbols, but in this stage, these
♦ Learns the art of imitating such as parent’s cough or symbols depend on his own perception and his
“Oh” to attract attention. intuition.
STAGES OF LANGUAGE DEVELOPMENT

1. Pre verbal Stage
♦ cooing and babbling
2. Holophrastic stage
♦ 1 word (“ma-ma” “da-da”)
3. Telegraphic stage
♦ 2 words
4. Multi word stage
♦ sentence
PSYCHOSOCIAL DEVELOPMENT (ERIK ERIKSON) : Developmental task: Trust versus Mistrust

♦ Cries to express displeasure
♦ The infant and parent must jointly learn to satisfactorily meet their needs for mutual regulation of frustration
to occur.
Trust develops:
a. when the infant’s needs are met consistently when those needs arise,
b. discomforts are quickly removed, who are cuddled and played with and talked to, come to view the world
as safe place and people as helpful and dependable; Care must be consistent and adequate
c. Give an experience that will add to security: touch, hugs and kisses, eye to eye contact and soft music
COGNITIVE DEVELOPMENT BY JEAN PIAGET : Sensorimotor : Neonatal Period - reflexive behavior only
a. 1 – 4 months : Primary circular Reaction
♦ Activities related to the body, repetitive behavior ♦ Discovers own body parts
♦ Recognizes familiar faces ♦ Totally narcissistic being
♦ Is interested in surroundings
b. 4 - 8 months: Secondary circular reaction
♦ Further separation of self from environment. ♦ Beginning object permanence
♦ Able to imitate selective activity from several events. ♦ Idea of quality and quantity.
♦ Awareness of before and after the sequence of events. ♦ Can find partially hidden objects
♦ Beginning recognition of symbols as type of communication.
c. 8 – 12 months: Coordination and Secondary Reactions
♦ Concept of object permanence advancing.
♦ Actively searches for hidden objects
♦ Associates symbols with events but classification is based on own experience.
♦ Distinguishes objects from related activity and perceives them as objects.
♦ Distinguishes end products from their means; attempts to remove barriers to achieve the end. Actively
searches for hidden objects.
♦ Comprehends meaning of words and simple commands.
♦ Know that gestures have certain meaning (bye-bye, kiss ).
♦ Associates bye-bye with “Daddy going to work”.
♦ Able to put objects in container.
♦ Works to get toy that is out of reach.
♦ Ventures away from parents to explore surroundings.
SOCIAL DEVELOPMENT:
♦ Infants social development is influenced by their reflexive behavior, such as the grasp and eventually and depends
primarily on the interaction between them and the principal caregiver.
♦ Attachment of parent and child begins before birth and increasingly becomes significant until the first year of life
♦ Infant’s first means of verbal communication is crying, a biologic sign that conveys a message of urgency and signals
displeasure.
♦ Personal-social behavior includes the child’s personal responses to the environment

Children Learn to Socialize by :
1. Meeting, living with people of various ages & culture
2. Participating in activities of family life & the activities of their peer groups.
Play: Solitary Play (Infants)
1. Use their bodies as the primary avenue to explore the world.
2. Learn to participate in and control simple social interactions with caregivers.
3. Learn to recognize, explore, and control objects, sights, sounds, textures, and tastes.
4. Explore, master, and learn to use their body parts.
5. Learn how to get desired reactions from people and objects.
Examples of appropriate infant toys: mobiles, rattles, toys with wheels, stacking and nesting toys, unbreakable
mirrors, washable stuffed animals and dolls, cloth and heavy cardboard books. (Try to avoid
electronic toys that do things infants can't understand or control.)
a. 1 -4 months
♦ Stares at parent’s faces when talking at 1 month
♦ Smiles socially at 2 months
♦ Shows excitement when happy at 4 months
♦ Demands attention, requires interaction with people at 4 months
b. 5 – 6 months
♦ Vocalization: begins to initiate sound
♦ Recognizes parents, beginning separation anxiety
♦ Comfort habits begin
♦ Plays with a variety of toys that he can handle such as blocks, plastic rings, keys, rattles, squeeze
toys, and clothespin at 5 months.
♦ Fear: “Stranger anxiety” – begins by 6 to 7 months, peaks by 8 months and diminishes by 9 mos.
c. 7 – 9 months
♦ Verbalizes all vowels and consonants
♦ Shows increased stranger anxiety and anxiety over separation from parents
♦ Exhibits aggressiveness by biting at times
♦ Understands the word “no”
♦ Enjoys teething rings and enjoys transferring toys such as blocks, rattles, and plastic keys.
♦ Enjoys toys that have different feels to them such as velvet, fuzzy, fur, smooth or rough
♦ At 9 months, enjoys creeping out of a crib or playpen and interested with nesting toys or rings that
fit on a center post, and pot and pans that stack together.
d. 10 – 12 months
♦ Imitates animal sounds, can say only 4 to 5 words but understands many more
♦ Begins to explore surroundings
♦ Plays games such a s “pat-a-cake” or “peek-a-boo”
♦ Shows emotions such as jealousy, affection, anger, fear (esp in new situation).
♦ Enjoys putting things in and out of the container
♦ Interested in pull toys as soon as they can walk
♦ Enjoys listening to nursery rhymes
♦ Most overcome the fear of stranger and are alert and responsive again when approached.
♦ Likes to play interactive nursery rhymes and dance in rhymes with others.
♦ They like being at the table and join family activities
PSYCHOSEXUAL DEVELOPMENT: ORAL PHASE (SIGMUND FREUD)

♦ Site of gratification is the mouth and receives gratification through sucking.
♦ Activities: sucking, biting, crying and the like for enjoyment and to release tension and for nourishment
EMOTIONAL DEVELOPMENT
a. The infant usually reacts by crying and kicking. Trust is an integral part of infant’s total development.
b. An infant learns to trust others through the relief of his basic needs (Erickson’s Theory)
DEVELOPMENT OF BODY IMAGE:

♦ Parallels sensorimotor development
♦ Infant’s kinesthetic and tactile experiences are the best perception of their body, and the mouth the center of
pleasurable sensations. Other parts are primarily objects of pleasure – hands and fingers to suck and toes to
play with.
♦ As physical needs are met, they feel comfort and satisfaction with their body. Achieving object permanence is basic
to the development of self-image.
TEMPERAMENT
♦ The infant’s temperament or behavioral style influences the type of interaction that occurs between the child and
parents and other family members.
♦ The more dissonance (lack of harmony) between the child’s temperament and the parent’s ability to accept and deal
with the behavior, the greater the risk for subsequent parent-child conflicts.
CONCERNS OF THE INFANT

1. Separation anxiety
♦ fear of being separated from parents, universal fear, begins at about six months of age and persists throughout
the preschool period. The following reassure the continued presence of parents even if they are out of sight:
1. Talking to infants when leaving the room
2. Allowing them to hear one’s voice on the telephone
3. Using transitional objects (favorite blanket or toy).
Three phases of Separation Anxiety
Protest
♦ cries/screams for parents
♦ inconsolable by others
Despair
♦ crying ends; less active; uninterested in food/play
♦ clutches “security” object if available
Denial
♦ appears adjusted; evidences interest in environment
♦ ignores parent when he/she returns
♦ resigned, not contented
2. Stranger fear / Anxiety
♦ a form of distress that children experience when exposed to people unfamiliar to them
♦ usually begins at around eight or nine months and generally lasts into the child's second year
1. Talk softly
2. Meet the child at eye level
3. Maintain a safe distance from the infant
4. Avoid sudden, intrusive gestures, such as holding the arms out or smiling broadly
3. Spoiled child Syndrome
♦ Excessive self-centered and immature behavior, resulting from the failure of parents to enforce consistent age-
appropriate limits.
♦ Provide guidelines for acceptable behaviors
4. Limit setting and discipline
Discipline
♦ is setting rules and road signs so children know what is expected of them.
Punishment
♦ a consequence that results from a breakdown in discipline, from the child’s disregard of the rules that were
learned.
♦ Parents should instill some sense of discipline early in life because part of it involves setting safety limits and
protecting others or property.
1. Parents begin with negative voice and stern eye contact.
2. Time out commensurate with the child’s abilities
3. Parents should provide safe alternatives, putting away dangerous household items during
exploratory period
4. Give consistent discipline and nurturing
5. Alternative child care arrangements
♦ Basic types of care: in-home care, parent’s or caregiver’s home (family daycare) and center-based care usually in
a daycare center.
6. Thumb sucking and use of pacifier
♦ Thumb sucking starts in utero, shown by sonogram and sucking blisters.
♦ Thumb sucking should be stopped at school age.
♦ Thumb sucking may begin at 3 months peaks at about 18 months.
♦ An infant who completes feeding and still seems restless and discontent, and who actively searches for something
to put on his mouth may need a pacifier.
♦ Parents should attempt to wean the infant from pacifier anytime after 3 months and when the sucking reflex is
fading at 6 to 9 months
♦ The best approach is to be certain an infant has adequate sucking pleasure and then ignore thumb sucking
7. Teething
♦ A physiologic process with some discomfort as the crown of the tooth breaks through the periodontal membrane.
♦ Giving frozen teething ring or ice cube wrapped in a cloth
The following manifestations are not normal during tooth eruption :
a. High fever c. Diarrhea
b. Seizures d. Vomiting
♦ Check articles within baby’s reach to be sure that they are safe to chew or edible as teething infants tend to place
almost any object in the mouth
♦ Give frozen teething ring or ice cube
wrapped in a cloth
8. Maternal deprivation - is the term used for an infant’s lack of a warm relationship
♦ Infants deprived from maternal care by their own mothers or by an adequate mother substitute lack all that goes
with love and seldom perceive sufficient stimulation to promote normal development.
PROMOTION OF HEALTH DURING INFANCY

1. Medicine Administration
a. Flavor oral medicine to disguise disagreeable taste. (being careful not to increase the amount to beyond what the
child will readily take).
b. Offer a drink of flavorful fluid afterwards to counter medicinal taste.
c. Never administer medicine in an infants formula to prevent changing the taste of the formula
2. Promotion of Sensory Stimulation
a. Talk to infants while you care for them so they come to know you.
b. Remember that infants focus longest on a human face
c. Provide a crib mirror or mobile, because visual stimulation is satisfying to an infant.
3. Nutrition
0-3 months Seven to Ninth-month old
a. Feed only on breast milk or formula for first year a. Introduce finger foods and cup when an infant
b. Always hold infant when feeding and never prop is able to sit up.
bottle when feeding. b. Have infant join family at mealtimes.
c. Limit water intake to ½ oz at a time. c. Allow self-feeding with observation to prevent
d. Avoid use of honey or corn syrup. choking.
e. Allow non-nutritive sucking. d. Offering fluids after solids.
e. Introduce limited amounts of diluted juice in a cup.
f. Avoid sugary deserts and soda.
Four to Six-month old Tenth to Twelfth-month old
a. Introduce solid foods without added salt or sugar a. Offer 3 meals and healthy snacks.
and iron-fortified cereal. b. Begin to wean from bottle and beginning
b. Introduce one food at a time, waiting 5 to 7 days table foods.
between new items. c. Avoid fruit drinks and flavored milk.
c. Avoid use of juice or sweetened drinks. d. Avoid infant to feed self with spoon.
d. Introduce the food before the formula or breast e. A newborn’s stomach can hold approximately
feeding when an infant is hungry 2 tablespoons (30 ml). By 1 year, stomach
e. Introduce small amounts of new foods (1 -2 tsp at can hold no more than approximately 1 cup
a time). (240 ml).
f. Use of spoon only.
g. Respect infant food preferences : a child cannot be Suggested Schedule for Introduction of Food
expected to like all new tastes well equally ♦ 5-6 months iron-fortified cereal mixed with breast
h. Use only minimal to no salt and sugar on solid milk, orange juice or formula
foods to minimize the number of additives Rationale: aids in preventing iron-deficiency
i. Remember that the extrusion reflex is present for anemia; the least allergenic type of food;
the first 4-6 months of life so any food placed on an easily digested food
an infants tongue will be pushed away ♦ 7 months- Vegetables
j. To prevent aspiration., do not place food in bottles Rationale: good source of vitamin A;
with formula adds new texture and flavors to diet
k. Introduce foods with a positive , ‘you’ll like this ♦ 8 months- Fruits
attitude” Rationale : best source of vitamin c, good source
of vitamin A; adds new texture & flavors to diet
♦ 9 months - meat
Rationale: Good source of protein, iron, & Vit. B
♦ 10 months- egg yolk
Rationale: Good source of iron
Problems related to nutrition:

1. Thumbsucking
♦ because it's comforting and calming.
♦ when she's tired, scared, bored, sick, or trying to adjust to challenges
♦ consider distracting her with substitute activity, like a rubber ball to squeeze or finger puppets to play with
2. Colic
♦ any healthy, well-fed infant who cries more than 3 hours a day, more than 3 days a week, for more than 3
weeks Due to:
a. A growing digestive system with muscles that often spasm
b. Gas
c. Hormones that cause stomach pain or a fussy mood
d. Oversensitivity or overstimulation by light, noise, etc.
e. A moody baby
f. A still-developing nervous system
3. Spitting up
♦ The peak age for spitting up – also known as reflux – is 4 months.
♦ Breastmilk oversupply or forceful let-down
♦ Food sensitivities
♦ Babies with Gastroesophageal Reflux Disease (GERD)
♦ Caused by teething
a. Smaller, more frequent feedings can be easier to digest.
b. Positioning baby in a semi-upright or sitting position when breastfeeding,
c. Fussy, reluctant feeders: try lots of skin to skin contact, breastfeeding in motion (rocking, walking),
in the bath or when baby is sleepy.
d. Ensure good latch to minimize air swallowing.
e. Allow baby to completely finish one breast (by waiting until baby pulls off or goes to sleep) before
you offer the other.
4. Weaning
Supplementary Feedings
♦ Feedings provided in place of breastfeeding
♦ may include expressed or banked breast milk
Complementary Feedings
♦ Feedings provided in addition to breastfeeding after 6 months
♦ A NB’s stomach holds 30 ml but a 1 yr. old hold 240 ml.
♦ Needs 100 ml / kg BW due to rapid growth
When is the Infant Ready for Solid Foods :
1. He is nursing every 3-4 hrs. taking more than 32 oz. of formula a day and does not seem satisfied
2. When extrusion reflex fades (3-4 mos.) and sucking reflex is diminished
3. Biting movement begins at 3 mos. while chewing movement begin at 7-9 mos.
4. Able to keep his head in a steady, upright position
5. Sitting well when supported to swallow well
6. Curiosity about what the family is eating
Principles in giving complementary feeding:
1. Introduce one solid at a time every 5 days:
a. To help discern possible food allergy
b. Helps establish sense of trust because it minimizes the number of new experiences in any
one day.
2. Feed the first solid food with infant held in parent’s arm to minimize the amount of stress associated
with it.
3. An infant’s introduction to solid food should be a pleasant experience
4. A small serving is all that an infant will take at first
5. A new food should be offered before his formula.
6. The feeder should be calm, patient, gentle, and pleasant in her approach to the infant.
Sequence of foods to offer
1. Pureed or semi-liquid food
2. Strained or mashed food
3. Small pieces of finger foods
♦ Offer 2 to 4 ounces of water per day in a sippy cup
5. Baby Bottle syndrome
♦ Tooth decay in infants and very young children
♦ Happens when sweetened liquids or those with natural sugars (like milk, formula, and fruit juice) cling to an
infant’s teeth for a long time.
♦ Bacteria in the mouth thrive on this sugar and make acids that attack the teeth
a. Wipe the baby's gums with a clean gauze pad or washcloth after each feeding.
b. Begin brushing your child's teeth, without toothpaste, when his or her first tooth comes in.
If you choose to use toothpaste, use a fluoride-free one.
c. Clean and massage gums in areas without teeth.
d. Floss once all the baby teeth have come in.
e. Make sure your child is getting enough fluoride, which helps lessen cavities. If your local water
supply does not contain fluoride, ask your dentist or doctor if you need to use a supplement.
f. Schedule regular dental visits by your child's first birthday. Dentists also offer special sealant
coatings, which can help prevent tooth decay in children.
g. Don't fill bottles with sugar water and soft drinks. Bottles are for milk, water, formula, and special
electrolyte-containing solutions when the child has diarrhea . Juices, mixed half and half with
water to avoid empty calories, are a way to interest your child in a "sippy cup." Soft drinks
are not recommended for children, as they have no nutritional value.
h. Never allow your child to fall asleep with a bottle containing anything but water.
i. Never give your child a pacifier dipped in anything sweet.
j. Reduce the sugar in your child's diet, especially between meals.
6. Constipation
♦ babies 0 to 4 months of age poop on average three to four times a day, and after the introduction of
solid foods, that reduces to approximately one bowel movement per day.
♦ milk-protein allergy or intolerance, dairy in mom's diet that's passed through the breast milk.
♦ A change in formula or in Mom's diet
♦ fruits and veggies, such as pears and broccoli
7. Loose Stools
♦ An infection with a virus, bacteria, or parasite.
♦ Babies can pick up these germs through contact with unclean food or water or when they touch germy
surfaces and then put their hands into their mouths.
♦ A food allergy or sensitivity to medicines
♦ Drinking too much fruit juice
8. Poisoning
PROMOTING INFANT DEVELOPMENT IN DAILY ACTIVITIES

1. Bathing
2. Skin Care
Common skin problem
a. Seborrhea
♦ a common skin problem which causes a red, itchy rash and white scales
b. Diaper rash
♦ infection that can cause a baby's skin to become sore, red, scaly, and tender.
c. Miliaria
♦ prickly heat
3. Care of teeth
♦ Deciduous teeth, baby teeth, temporary teeth, milk teeth
♦ 20 temporary or deciduous teeth
♦ The last of the permanent teeth to appear are called “third molars,” or “wisdom teeth.”
They usually begin to erupt—pushing their way through the gums—between ages 17 and 21 years.
4. Dressing
5. Sleep
Sleep Problems
♦ Breast-fed infants tend to wake up more often than formula fed infants because breast milk is easily digested
thus, infants gets hungry sooner

♦ Remaining awake for long periods of time and waking at night is common during the late infancy period
♦ To eliminate night waking or cope with this situation the following should be done:
1. Delay bed time for 1 hour
2. Shorten afternoon sleep period
3. Do not respond immediately to infants so that they can have time to sleep on their own
4. Provide soft toys and music to allow infant to play quietly alone
Newborns (0-3 months) ……….… 14-17 hrs / day Teenagers (14-17) ……………………… 8-10 hrs / day
Infants (4-11 months) ……….…… 12-15 hrs / day Younger adults (18-25) ………………….. 7- 9 hrs / day
Toddlers (1-2 years) ……….……. 11-14 hrs / day Adults (26-64) …………………………….. 7- 9 hrs / day
Preschoolers (3-5) ………….……. 10-13 hrs / day Older adults (65+) ………………………… 7-8 hrs / day
School age children (6-13) …….… 9-11 hrs / day
6. Play
♦ Infants learn many things thru play
1. Infants practice motor skills
2. General coordination of movement and specific coordination of hand-eye movements
3. Infants learn to relate to objects and people
4. Express their feelings and ward off frustrations
5. Play is important in the development of the child’s personality
Essential factors in the selection of toys:
1. Should be safe for the child’s use
2. Should be washable
3. Easy to handle
4. Smooth with rounded edges, no sharp points
5. Not too heavy
PROMOTION OF INFANT’S SAFETY

♦ Accidents are leading causes of death in children from one month through 24 years of age, but second to acute
infections as a cause of acute morbidity and physician visit.
♦ Preventive measures for infants:
1. Know the whereabouts of the infants at all times.
2. Choose babysitters carefully and explain and enforce all precautions when babysitters are in-charge.
1. Aspiration Precaution
a. Potential threat for infants throughout the first year. Round , cylindrical objects, (an inch, 3.2 cm, such as a
hotdog and carrot ) can totally obstruct infant’s airway.
b. Deflated balloon can be sucked into the mouth obstructing in the same way.
c. Feeding bottles should not be propped and left when feeding infants.
d. Nothing should come within the reach of infants.
e. When solid foods are introduced, encourage parents to offer small piece of hot dogs or grapes, not large
chunks.
f. Children under 5 years of age should not be offered popcorn or peanuts because of the danger of aspiration.
g. Parents should check small parts of toys as infants become more adept at toys.
h. Pacifiers should come in one-construction with flange large enough to keep it from entering the child’s mouth.
2. Fall Prevention
♦ Second major cause of infant accidents.
♦ Focus is teaching parents to be prepared for their infants to roll over by 2 months of age.
♦ Two months is about the maximum length of time infants can safely sleep in a bassinet
a. Never leave an infant on a raised/unprotected surface, such as a bed or couch, even the child is in an infant
seat. If a child sleeps in a crib, the rails should be 2 3/8 in. apart.
b. Place a gate at the top and bottom of stairways
c. Do not allow an infant to walk with a sharp object in the hands or mouth (it could pierce the throat in a fall).
d. Be sure crib sides are raised and locked before walking away from the crib.
e. Ensure that the space between the mattress and headboard is small enough to trap the child’s head.
3. Safety with Siblings
a. Parents should be reminded that children below 5 years of age are not responsible enough or knowledgeable
enough about infant to be left unattended with them.
b. They might introduce an unsafe toy or engage in a play that is too rough for the infant.
c. The preschoolers might be jealous of a new baby that they physically harm the infant if left alone.
4. Suffocation
a. Allow no plastic bags within the infant’s reach.
b. Do not use pillows in a crib.
c. Store unused appliances such as refrigerators or stoves with the door removed.
d. Buy a crib that is approved for safety (spacing of siderails is not over (2 3/8 inch) 6 cm apart
e. Remove constricting clothing such as bib from neck at bedtime.
5. Drowning
♦ Do not leave infants alone in a bath tub or unsupervised near water (even buckets of cleaning water).
6. Animal Bites
♦ Do not allow an infant to approach a strange dog
♦ Supervise play with family pets.
7. Poisoning
a. Never present medication as a candy
b. Buy medications in containers with safety caps: put away immediately after use
c. Never take medications in front of infants. Place all medications and poisons in locked cabinets
d. Never leave medication in a pocket or hand bag.
e. Use no lead-based paint in any area of the home.
f. Hang plants per set on high surfaces
g. Post telephone number of the poison control center by telephone.
8. Burns
a. Test warmth of formula and food before feeding
b. Do not smoke or drink hot liquids while holding an infant
c. Use sunscreen on a child over 6 months when in direct sunlight; limit the sun exposure to less than 30 min.
d. Monitor infants near candles
e. Keep electric wires and cords out of reach; Cover electrical outlets with safety plugs
f. Keep sharp jagged objects out of child’s reach
g. Keep diaper pins closed
9. Car Safety
a. Never transport unless an infant is buckled into an infant car seat in the back seat of the car.
Be aware of the proper technique for placing an infant in a car seat.
b. Infants up to 20 lbs should be placed in rear-facing seats in the back because an inflating front-seat airbag
could suffocate the infant.
c. Do not be distracted by an infant while driving.
d. Do not leave an infant unattended in a parked car (can become dehydrated form excess heat or can
be abducted).
10. Bodily damage
a. Keep sharp jagged objects out of child’s reach.
b. Keep diaper pins closed.
11. Immunizations
♦ a measure of preventing communicable disease
♦ our immune system helps the body fight germs by producing substances to combat them. Once it does, the
immune system "remembers" the germ and can fight it again.
♦ Vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine
triggers the immune system to respond and thus build immunity.
Obstacles faced by family with regards to immunization
1. Belief: immunization causes fever
2. Ignorance: some parents are not aware of the importance of immunization
3. Lack of money: although health centers give free immunization, some vaccines are not available in
the health centers.
Kinds of Immunization:
1. BCG 4. Measles Vaccine
2. DPT 5. Hepa Vaccine
3. Polio Vaccine 6. Others
Diphtheria, Measles
Hemophilus
Pertusis Pneumo Mumps Hepatitis Papilloma
Hepa B Influenza Rotavirus Influenza
Tetanus coccus Rubella A Virus
Type B
Polio Chicken Pox
On birth
1st Dose
in hosp.
2nd
1 mo.
Dose
2 mo. 1st Dose 1st Dose 1st Dose 1st Dose
4 mos 2nd Dose 2nd Dose 2nd Dose 2nd Dose
3rd Dose
6 mos 3rd Dose Addition 3rd Dose 3rd Dose
Starting
of bOPV
from
12 mos 4th Dose 4th Dose 3rd Dose 1st Dose 6mos
18 mos 1st Dose two
24 mos 2nd Dose doses,
6 yrs followed
(Grade 2nd Dose by one
1) dose per
7 yrs year
(Grade Booster before the
2) influenza
13 yrs Booster 3 Doses season
(without (girls
Grade 8) Polio) only)
Changes in height at different age
From birth to 3 months 9 cm
From 3 to 6 months 8 cm
First part of infancy CC < HC
Middle of infancy CC = HC
Later part CC > HC
Average increase in head circumference
First year of life Gain Total
First 4 months ½ in per month 2 inches
Next 8 months ¼ in per month 2 inches
2nd year 1 inch
3 – 5 years ½ in /year 1.5 inches
5 – 20 years ½ in/5 years 1.5 inches
At 6 years old, head circumference is almost the same

as the adult.
TODDLER
Toddler
♦ a child whose age is from 1 year old to 3 years old
♦ The toddler period is marked primarily by increasing strength and skill in performance
CHARACTERISTICS OF TODDLERHOOD:
1. A true foundation of age
♦ Many behavior patterns, attitudes and emotional expressions are established
♦ It is a critical period in setting the pattern for personal and emotional adjustments
2. Age of rapid growth and change
♦ They grow physically and psychologically
♦ Change in height and weight; develop interests and attitudes
♦ There is development of body control (Sitting, standing, walking)
3. Age of decreasing dependency
♦ Begins to do things himself
♦ Rebellion against being treated as a baby
♦ A protest comes in forms of angry outbursts and crying when independence is denied
4. Age of increased individuality
♦ Develop along lines suited to their interests and abilities
♦ Individuality is shown in appearance and in patterns of behaviors
♦ No longer thrive on same food or same schedules of eating and sleeping
5. Beginning of socialization
♦ Able to understand many things and communicate needs and wants
♦ Show desire to become part of groups and start protesting when left alone
♦ Try to win the attention of others by all means
♦ Exhibit attachment behavior and develops strong emotional ties with their mothers
6. Beginning of sex-role typing
♦ Begins stereo-typed toys
7. Appealing age
♦ Babies are disproportionate and are appealing because of the big heads, protruding abdomens, small thin
limbs and tiny hands and feet
♦ When they are dressed in baby clothes and wrapped in baby-blankets, they become even more appealing
♦ Their helplessness and dependency make them more appealing
8. Beginning of creativity
♦ Because of lack of muscle coordination and their inability to control their environment, babies are incapable of
doing anything that can be regarded as creative.
♦ They are learning however in these early months of life to develop interests and attitudes that lay the foundations
of later creativity.
9. A hazardous age
♦ The physical hazards are illness, accidents, disabilities and death. Psychological hazards are disinterests and
negative attitudes
GROWTH & DEVELOPMENT OF THE TODDLER

Biologic:
♦ This is a period of slow growth
♦ Weight: gain of approximately 11 lb (5 kg) during this time; (birth weight x4 by 2½ years
♦ Height: grows 20.3 cm (8 inches); adult height about 2 times height at 2 years
♦ Head circumference: 19½ - 20 inches by 2 years; anterior fontanel closes by 18 months
♦ Pulse 110; respirations 26; blood pressure 99/64
♦ Primary dentition (20 teeth) completed by 2½ years
♦ Develops sphincter control necessary for bowel and bladder control
♦ Have prominent abdomen - pouchy- belly although walking well their abdominal muscles are not yet strong
enough to support abdominal contents. They have forward curvature of the spine at the sacral area ( lordosis),
waddle or walk with wide stance but it will correct itself naturally.
Maturation of Body Systems:
♦ Respirations slow slightly but continue to be mainly abdominal.
♦ HR slows from 110 to 90 bpm ;
♦ blood pressure increases to about 99/64 mmHg.
♦ Brain develops about 90% of adult size.
♦ Respiratory system - the lumens of vessels enlarge progressively so respiratory infection threat becomes less.
♦ GIT: Stomach secretions become more acidic; Stomach capacity increases to a point a child can eat three meals
a day.
♦ GUT: Control of the urinary and anal sphincters becomes possible with complete myelination of the spinal cord.
♦ Immune System: IgG and IgM antibody production becomes mature at 2 years of age.
♦ Passive immunity obtained intrauterinely is no longer operative.
♦ Primary dentition (20 teeth) completed by 2½ years. Eight new teeth (canines & first molars erupt during the 2 nd
year.
♦ Develops sphincter control necessary for bowel and bladder control.
Developmental milestones
1. Motor development
a. Gross Motor:
♦ Mobility: walks alone by 15 months; climbs stairs and furniture by 18 months; can walk up an down the
stairs holding on to a person’s hand or railing at 18 months; walks up alone the stairs by 24 mo;
jumps from step or chair by 2 ½ years; balances on one foot momentarily by 2 ½ years; rides tricycle
by 3 years
b. Fine Motor:
♦ By age 15 months, they can drop a pellet into a narrow-necked bottle. Scribbles voluntarily with a pencil
or a crayon; holds a spoon well but still turns upside down on the way to the mouth; Casting or
throwing objects and retrieving them become an almost obsessive activity,
♦ By 18 months, spoon no longer rotates; they can throw a ball overhand without losing their balance. turns
doorknob; unscrew lids.
♦ Ability to build tower of blocks: 3 blocks; 24 months - 6-7 blocks; 30 months – a tower of eight or more;
♦ 36 months – copies circle, uses scissors, button and unbuttons.
PSYCHOSOCIAL DEVELOPMENT (ERIK ERIKSON) : Autonomy versus Shame and doubt

♦ increases independence; better able to tolerate separation from primary caregiver
♦ Less likely to fear strangers
♦ Able to help with dressing/undressing at 18 months; dresses self at 24 months
♦ Has sustained attention span
♦ May have temper tantrums during this period; should decrease by 2 ½ years
♦ Vocabulary increases from about 10 – 20 words to over 900 words by 3 years
♦ Has beginning awareness of ownership at 18 months; shows proper uses of pronouns by 3 years
♦ Moves from hoarding and possessiveness at 18 months to sharing with peers by 3 years
♦ Beginning of problem solving
♦ Toilet training usually completed by 3 years.
COGNITIVE DEVELOPMENT (JEAN PIAGET) : 12 – 18 months: Tertiary Circular reaction

♦ Knows own name by 12 months; refers to self;
♦ Able to identify geometric forms by 18 months
♦ Achieves object permanence
♦ Uses “magical” thinking; believes own feelings affect events
♦ Experiments by trial and error
♦ Uses ritualistic behavior
♦ May develop dependency on “transitional object”
♦ Insatiable curiosity about the environment.
♦ Uses all sensory cues for exploration.
♦ Ventures away from parents for longer periods.
♦ Uses physical skills to achieve a particular goal.
♦ Can find hidden objects, but only in first location.
♦ Able to insert round objects into a hole.
♦ Fits smaller objects into each other (nesting).
♦ Gestures “up” and “down”.
♦ Puts objects into container and takes them out.
♦ Realizes that out of sight is not out of reach, opens doors and drawers to find objects.
♦ Gains comfort of parents voice even if not visible
18 to 24 months: Invention of New Means Through mental combinations
♦ Searches for objects at several hiding places.
♦ Follows simple direction by 2 years
♦ Begins to use short sentences at 18 months to 2 years
♦ Can remember and repeat 3 numbers by 3 years
♦ Gives first name by 24 months; gives full name by 3 years
♦ Will infer cause by associating 2 experiences such as candy missing, sister smiling.
♦ Can pretend and use deferred imitation; object permanence is complete
♦ Imitates words and sounds of animals.
♦ Imitates adult behavior (domestic mimicry).
♦ Follows directions and understands requests.

♦ Uses words “up”, “down”, “come”, and “go” with meaning.
♦ May sit at table for meals at short periods.
♦ Has some sense of time,; wait in response to just a minute; may use word “now”.
♦ Refers to self by name.
♦ Engages in parallel play; demonstrates awareness of ownership.
♦ Concerned with ritualistic, routinized schedule.
2 to 3 years: Preoperational Thought period ( Preconceptual)
♦ Children become more symbolic
♦ Can arrive at answers mentally instead of thorough physical attempt.
♦ Can not view one object as necessarily being different from another
♦ Child is egocentric and unable to see viewpoint of another.
♦ Able to use assimilation or change situation to fit thoughts
♦ Displays static thinking.
♦ Concept of time is now, and concept of distance is only as far as he can see.
♦ They draw conclusions from obvious facts they see (prelogical reasoning)
The key features of the preoperational stage:

1. Centration
♦ the tendency to focus on only one aspect of a situation at one time
2. Egocentrism
♦ child's inability to see a situation from another person's point of view
♦ Each child is absorbed in its own private world and speech is egocentric. The main function of speech at this
stage is to externalize the child’s thinking rather than to communicate with others
3. Symbolic Representation
♦ the ability to make one thing - a word or an object - stand for something other than itself
♦ Pretend (or symbolic) play: Toddlers often pretend to be people they are not (e.g. superheroes, policeman), and
may play these roles with props that symbolize real life objects.
♦ Children may also invent an imaginary playmate
4. Animism
♦ the belief that inanimate objects (such as toys and teddy bears) have human feelings and intentions.
Piaget has identified four stages of animism:
a. First stage (Up to the ages 4 or 5 years)
♦ child believes that almost everything is alive & has a purpose
b. Second stage (5-7 years)
♦ only objects that move have a purpose
c. Third stage (7-9 years)
♦ only objects that move spontaneously are thought to be alive
d. Fourth stage (9-12 years)
♦ the child understands that only plants and animals are alive
5. Artificialis
♦ This is the belief that certain aspects of the environment are manufactured by people (e.g. clouds in the sky)
6. Irreversibility
♦ the inability to reverse the direction of a sequence of events to their starting point
SOCIAL DEVELOPMENT: Play: Parallel play

♦ Imitation of adults often part of play
♦ Begins imaginative and make-believe play
♦ Provide toys appropriate for increased locomotive skills
♦ Give toys to provide outlet for aggressive feelings
♦ Provide toys to help develop fine motor skills, problem solving abilities
♦ At 15 months:Names familiar objects; 4 to 6 words undress, point 2 – 3 body part;
♦ 24 months: use 2 – 3 word phrases
♦ 30 months – gives first and last names
♦ 36 months – Tells stories, talks non-stop, 500 – 900 vocabularies
Importance of play
1. Physical development
♦ Develop and exercise muscles of the body.
2. Social development
♦ Enjoys parallel play
♦ Explore relationships between objects and how to control them.
♦ See themselves as part of the community and develop skills to participate, especially language.
3. Therapeutic value
♦ Helps child release emotional tension
♦ Uses symbols and make-believe in play.
4. A means of education
♦ Learns to know color, shapes, sizes, texture of play materials.
♦ Expand understanding of object permanence (hide-and-seek activity)
5. Develops a beginning understanding of moral values
Factors in selecting toys for toddler
1. Consider toddler’s likes and dislikes
2. Toddler’s like to pull and push toys and enjoys pedal propelled toys
3. Consider toddlers’ being imaginative
4. Should be safe
5. No sharp edges
6. No rough edges
7. No small, removable parts nor flammable
8. Should not be lead painted
Examples of appropriate toddler toys
1. Pull-push toys
2. Blocks
3. Assortment of balls
4. Picture books
5. Play Doh with simple tools (craft sticks and wooden rollers)
6. Containers, scoops, sifters, and other objects for sand and water play
7. Toys and props for dramatic play like scarves, hats, a toy telephone, stuffed animals, and generic
baby dolls
8. Large pegged-top puzzles
9. A small climbing structure
SPIRITUAL DEVELOPMENT (James Fowler) : Stage I – Intuitive-projective stage

♦ Faith is magical and inventive, a faith derived primarily from significant others or parents.
♦ Child is egocentric.
♦ Child's imagination is formed but reality is not well-differentiated from fantasy. For this reason, adults preaching about
the negative aspects of religion - the devil and the evils of sin - can cause great harm to a child of this age,
leading him toward a very rigid, brittle and authoritarian personality as an adult.
MORAL (LAWRENCE KOHLBERG) : Level I- Preconventional, Stage 1 – Obedience and punishment

♦ The child does right because the parent tells him/her to avoid punishment. The child is good because the parent said
the child must be, not that it is right to be good.
♦ Children see morality as something external to themselves, as that which the big people say they must do.
♦ Nursing implication: Child needs help to determine what are right actions. Give clear instructions to avoid confusion.
PSYCHOSEXUAL DEVELOPMENT (SIGMUND FREUD) : Anal phase

♦ The childs interest widens and his main interest is focused on the anal region. Elimination takes a new importance.
He finds pleasure in both retention of feces and in defecation. This anal’s interest is a part of child’s discovery of self
and a way of exerting his independence The process of toilet training is regarded as the resolution of this conflict.
♦ Toilet training usually completed by 3 years.
BODY IMAGE DEVELOPMENT

♦ Body Image: The toddler has dim self-awareness but as he develop more of a sense of autonomy, he becomes more
correctly aware of his body as a physical entity and one with emotional capabilities
CONCERNS OF TODDLERS
1. Toilet training
♦ one of the biggest tasks the toddler must achieve, during this period.
♦ Important development levels that must be reached before toilet training begins: one physiologic, and 2 cognitive
Markers of readiness:
a. Can stand, squat and walk alone
b. Can communicate toilet needs
c. Can maintain himself/herself dry for an interval of 2 hours
Stages of Toilet Training:

a. Bowel control – 18 months
b. Daytime bladder control – 2 ½ yrs of age
c. Nighttime bladder control – 3 yrs
2. Ritualistic behavior
♦ Repetitive phenomena, such as rituals and rigid routines frequent between the ages of two and four years old
♦ Engaging in repetitive behavior may be a toddler’s way of trying to establish predictability and order in a world
where they have little to no control or understanding of the world around them, which can be anxiety
provoking.
♦ can be reduced by setting rules and guidelines, and not letting the child to be over dependent.
3. Negativism
♦ signals the transition from babyhood to childhood.
♦ child’s way of asserting herself - seeing how it feels to make decisions on her own. And part of making these
decisions is disagreeing with her parents.
a. Offer your child a choice of limited options: "Do you want a cheese sandwich or a peanut butter sandwich
for lunch today?" rather than "What do you want for lunch today?"
b. Use as few commands as possible, and insist on obedience only when absolutely necessary.
c. Emphasize the positive. "We will have a treat later" works much better than "You cannot have a cookie
now." Negative statements from you can prompt negative behavior from your child.
d. Limit the number of questions asked of the child. Making statements instead of asking questions can avoid
a great many negative responses.
4. Discipline
♦ is setting rules and road signs so children know what is expected of them. Punishment is a consequence that
results from a breakdown in discipline, from the child’s disregard of the rules that were learned.
♦ Parents should instill some sense of discipline early in life because part of it involves setting safety limits and
protecting others or property.
General rules to follow when teaching discipline:

a. Parents need to be consistent
b. Rules are learned best if correct behavior is praised rather than the wrong behavior punished.
c. Timeout is a technique of helping children learn that actions have consequences. To use it effectively,
parents need to be certain that their child understands the rule they are trying to enforce.
d. Give warning first before giving a time out. The length of time is 1 min per year of age.
5. Separation anxiety
♦ ``begins at about six months of age and persists throughout the preschool period.
♦ a child becomes fearful and nervous when away from home or separated from a loved one -- usually a parent or
other caregiver -- to whom the child is attached
Stages of Separation Anxiety
1. Protest – clinging to parents, pleading for parents to stay
2. Despair – child is hopeless and becomes quiet, withdrawn, apathetic
3. Detachment – lack of protest when parents leave but if parents reappear, child may ignore
Prevention:
1. Reduce anxiety in the child
2. Develope a sense of security in the child and the caregivers
3. Educate the child and family/caregivers about the need for natural separations
4. Reinforce a child's independence and self-esteem through support and approval
6. Temper tantrums
♦ the frontal lobe of your toddler’s brain (the part that controls logic, reasoning, planning, judgment, self-control,
and emotional processing) is underdeveloped.
♦ Feels frustrated and angry that he can’t do something, but he can’t mentally process those feelings. He lacks the
self-control necessary to keep those emotions in check. And he certainly can’t express his feelings verbally,
the way an adult would. Therefore, he resorts to kicking and shrieking and throwing things, because those are
skills he does have.
a. Give your toddler choices, when possible.
b. Institute a countdown. institute a countdown before a transition takes place: “3 more books, and then it’s
bedtime” or “5 more minutes to play trucks, and then we have to stop and eat lunch”.
c. Avoid attempts to reason with your toddler. Remember, your toddler is not a creature of logic. calmly and
firmly offer a short explanation that he can understand and then repeat it as necessary.
d. Remain calm and consistent. If your toddler sees that she is not able to get a rise out of you, she will
probably calm down faster. It is also important that you remain firm and consistent – avoid giving in to your
toddler’s demands when she’s throwing a tantrum.
e. Avoid overtiredness. Try to watch for your toddler’s sleep cues. Is she rubbing her eyes? Yawning?
Looking glassy-eyed? If so, then get her to bed quickly. It is worth repeating: an exhausted toddler is more
likely to throw a whopper of a tantrum before nap time or bedtime than a toddler who’s well-rested. So try
to stay ahead of the overtiredness, and make sure she is getting the rest she needs.
7. Sibling Rivalry
♦ It can be tough for a toddler to welcome a new baby into his domain. As siblings get older, they may show their
jealousy by arguing, name-calling, teasing, pushing, and occasionally fighting. But the toddler won't
understand his feelings of jealousy, or what he can do about that annoying newborn. He just wants attention,
and may react by misbehaving or even regressing.
a. Tell the toddler about the approaching birth
b. Explain what's going to happen once the baby arrives
c. Let the toddler get involved in the preparations
d. Involve the toddler in looking after the baby
e. Ask the toddler for help and advice
f. Spend time with the toddler
g. Be prepared for aggression
h. Don't compare the children

i. Teach the toddler to resolve conflicts on his own
PROMOTION OF HEALTH
1. Safety measures
A. Motor Vehicle Accidents
1. Always use a car seat
2. Keep child safe in strollers and carts
B. Burns
1. Have and maintain smoke detectors
2. Plan and practice escape routes
3. identify dangers in the home and remove them or block child’s access to them
4. Prevent children from getting near firecrackers or fireworks
5. Keep toddler out of the sun; if not, cover child's skin with hats and clothing. Protect any bare skin with a
small amount of sunscreen.
6. Small bodies can develop heat exhaustion much more quickly than adults. Do not keep child out in warm
weather for long periods, and keep water or other drinks on hand.
C. Drowning
1. Supervise all baths at all times
2. Deal with water hazards and teach swimming safety
3. Keep pools and hot tubs safe
4. Empty all buckets and coolers when not in use
5. Keep toilet lids down, and consider securing them with safety latches.
D. Falls
1. Don't allow your child to walk or run with objects in his or her mouth.
2. Avoid using baby walkers. Children can fall down stairs and get hurt. An activity center is a better choice.
3. High chairs should have a wide, stable base and make sure the high chair is locked in the upright position
before use. Use the safety straps, and supervise your child at all times while he or she is in the high chair.
4. Changing tables should have a railing on all sides that is 2 in. (5.1 cm) high. Always use the safety strap,
and keep one hand on your child. Have diapers and other items handy, but keep them out of your child's
reach.
E. Poisoning
1. Wash your hands and working surfaces while preparing food
2. Cook foods to safe temperatures, and refrigerate foods promptly
3. Identify any products that could harm the child when eaten or inhaled.
4. Store these products out of your child's reach.
5. Children may chew on contaminated paint flakes or painted objects.
6. Use a carbon monoxide detector, and have your furnace checked each year.
7. Protect the child from second hand smoke, mold, and other indoor air pollutants
F. Choking
♦ Child can choke on things smaller than 1.25 in. (3.2 cm) in diameter and 2.25 in. (5.7 cm) long. These
include button batteries and coins.
1. Keep items like these out of your child's reach.
2. Learn to recognize signs of choking (a child who is choking can't talk, cry, breathe, or cough)
G. Strangulation And Suffocation
1. Keep cords for blinds and drapes out of child's reach.
2. Cords with loops should be cut and given safety tassels instead.
3. Never use accordion-style gates. A baby or young child may trap his or her head in the gate and may
strangle.
4. Make sure that furniture does not have cut out portions or other areas that can trap your child's head.
5. Always lock car doors, and keep the keys out of your child's sight and reach.
6. If you are storing an old refrigerator or freezer, remove the door.
7. Do not let your child play with plastic sacks, and keep them out of his or her reach. Many children like to
play with sacks and put them over their heads.
8. Cribs should have less than 2.4 in. (60 mm) of space between slats.
9. Playpens should have spaces in the mesh material that do not exceed 0.25 in. (0.6 cm) across. Wooden
slats should measure less than 2.4 in. (60 mm) apart.
10. Grown up children can get tangled in mobiles or may use larger toys
2. Nutrition
Specific suggestions for feeding toddlers:
a. Serve food in small portions. Child likes plain food and eats one food at a time.
b. Chop or cut the food into small pieces
c. Diet for each day should include the following: Toddlers should consume at least 1,300 kcal daily
c.1. meat and fish – one serving, one egg daily or cheese
c.2. liver – one or more servings a week.
c.3. green and yellow vegetables – two or more servings a day
c.4. citrus fruits, raw or cooked – fruit two or more servings a day (one could be citrus or tomato juice)
c.5. cereal and bread enough to meet his caloric needs
c.6. butter or margarine
c.7. milk 16 ounces to a maximum of 1 quart or part of which may be used in cooking or on cereals
d. Satisfy the child’s appetite with nutritious foods and avoid offering him candy cake, ice cream and the like.
Nutritious snacks may be given between meals.
e. Give vitamins as suggested by the physician
f. Since child is growing less rapidly, he may eat less than he did at the end of the first year.
Don’t force him to eat.
g. High sugar should be avoided.
h. Fats should generally not be restricted for children under 2 years old however children over 2 years old
should consume no more than 30% of total daily calories from fat.
i. Adequate calcium and phosphorus intake is important.
j. Milk should be whole milk until 2 years
3. Daily physical care:
a. Bath should be given as part of his care
b. Prevention of tooth decay in the deciduous dentition is important
c. Clothing should be light and bright colored with large easily managed buttons, straps placed where child can
reach them
d. Amount of sleep the toddler needs depends upon his health, age, emotional tension and activity during the day.
PRESCHOOLER
♦ The Preschooler is a child from 4 to 6 years old
THE CHARACTERISTICS OF A PRESCHOOLER
1. A toy age
♦ The age of playing with toys most of the time
2. A pre gang age
♦ The child is learning the foundations of social behaviour. This learning prepares him for the more highly organized
social life of the school.
3. The Pre school age
♦ The period preceding the child’s entry into school.
4. An Exploratory age
♦ They want to know what their environment is and how it works, how it feels, and how they can be a part of it. Child
explores the environment and gains control over it

5. A questioning age
♦ At first questions are concerned with physical causality and then on diverse number of categories. If not satisfied with
the answer, they raise more and more questions in chain until they are satisfied.
6. An imitative age
♦ They imitate speech and actions of others
7. A creative age
♦ They try to learn various skills by repeated trials and adventurous attempts. They also engage in games and modified
form of sports without toys
8. A Problem age
♦ Behavior problems are more frequent than the physical care problems. Thus, they develop distinctive personalities
and aspire for independence.
♦ They are very often obstinate, stubborn, disobedient, protesting and antagonistic.
♦ They are often bothered by daydreams at night and irrational fears during day times and suffer from jealousies.
♦ They also demand independence and are incapable of handling things.
THE PHYSICAL CHANGES IN A PRESCHOOLER

♦ The baby look has disappeared but facial features remain small. The body is more proportioned.
♦ Slower growth rate continues
♦ Weight: increases 4-6 lbs a year
♦ Height: increases 2 inches a year
♦ Birth length doubled by 4 years
♦ Head circumference has an increase by 1 inch per year
♦ Vital signs decrease slightly: pulse 90 – 100; respirations 24-25; BP 85-100 / 60-70
♦ Slimmer, taller, more of child-like proportions from previously wide-legged gait, prominent lordosis and protuberant
abdomen.
♦ Contour changes are definite that future body type- ectomorphic (slim body build) and endomorphic (large body build)
becomes apparent.
♦ Lymphatic tissues begin to increase in size particularly tonsils.
♦ Levels of IgG and IgA antibodies increase making preschool illnesses more localized.
♦ Physiologic splitting of heart sounds and innocent heart murmurs are heard for the first time. This occurs owing to the
changing heart size in reference to the thorax. The APD and TD of the chest reach adult proportions.
♦ Pulse rate decreases to about 85 bpm, BP at 100/60 mmHg.
♦ Bladder is easily palpable above the symphysis pubis, voiding is frequent (9 to 10 times a day), play is interrupted.
♦ The indeterminate longitudinal arch on the foot becomes a well-formed arch now.
♦ Can perform gymnastics because of more noticeable muscles.
♦ Many exhibit genu valgus ( knock-knees ) which disappear with skeletal growth near the end of preschool period.
♦ Have all the 20 deciduous teeth by the end of three years
♦ Rarely do new teeth erupt during the preschool period.
GROSS MOTOR FINE MOTOR DEVELOPMENT

♦ Walks up the stairs using alternate feet by 3 years ♦ Builds a tower of blocks by 3 years
♦ Rides tricycle by 3 years ♦ Hand dominance is established by 5 years
♦ Stands on 1 foot by 3 years ♦ Ties shoes by 5 years
♦ Walks down the stairs using alternate feet by 4 years ♦ Ability to draw changes over this time
♦ Hops on 1 foot by 4 years ♦ Handles scissors well by 5 years
♦ Skips and hops on alternate feet by 5 years
♦ Throws and catches ball by 5 years
Age 4 Age 5
▪ color recognition of primary colors ▪ Learns to balance
▪ Triples in height ▪ Jumps in rope
▪ Jump ▪ Eruption of permanent dentition
▪ Goes up and down in stairs ▪ Imaginative play
▪ Uses scissors perfectly ▪ Imitates the triangle
▪ Imitates square ▪ Prints letters
▪ Ties his shoe laces ▪ Draws a man
▪ Writes his name ▪ Hammers nails
▪ Draws 3 parts of the body ▪ Dresses himself/herself alone
▪ 1500 vocabularies
▪ Able to tell tales
PSYCHO SOCIAL DEVELOPMENT: INITIATIVE VS. GUILT

Initiative
♦ The child with a well-developed sense of initiative would discover that learning new things is fun.
♦ If children are criticized or punished for attempts at initiative, they develop a sense of guilt for wanting to try new
activities or have new experiences.
♦ They need exposure to a wide variety of experiences and play materials so they can learn as much about the world
as possible.
♦ They need to go places: zoo, or amusement park where they could learn more vocabularies.
♦ Encourage creative play where they could use their hands: clay, finger paints, soapy water, sand, mud, homemade
dough.
COGNITIVE DEVELOPMENT
♦ Preoperational: Intuitive thought
♦ lack sight to view themselves as others see them or put themselves in another’s place, so they feel they are always
right. This causes them to argue with forcefulness believing they are always 100% correct.
♦ They are not yet aware of the property of conservation.
Imitation
♦ Preschoolers need free rein to imitate the roles of the people around them. Hence role playing should be fun and
need not be accurate.
♦ They generally imitate activities they see their parents performing at home
♦ They learn new words by introducing the other self of the parents at work such as: photocopier, secretary, lawyer,
sales clerk and the like.
PSYCHOSEXUAL DEVELOPMENT : Phallic Stage

Oedipus/Electra Complex
♦ refers to the strong emotional attachment of a preschool boy to his mother.
Electra complex
♦ refers to the strong emotional attachment of a preschool girl to her father.
♦ Each child competes with the same-sex parent for the love and attention of the other parent. This is normal.
♦ Parents feel left out, and need help in handling feelings of jealousy and anger especially if the child is vocal in
expressing feelings: “I hate you! I only love Daddy!”
Gender Roles
♦ Preschoolers need exposure to an adult of the opposite sex so they could become familiar with the opposite
gender roles.
♦ If a child is hospitalized during the preschool period, a male nurse could help fill this role.
♦ Children’s gender-typical actions are strengthened by parents, strangers, nursery school teachers, other
family members and other children.
♦ The 3-year old child has a vocabulary of 900 words.
♦ These are used to ask questions constantly, mostly “how”, and “why”.
Examples: “Why is snow cold?”
“How do worms hear?”
“What does your tongue do?”
♦ They need simple answers, so curiosity, vocabulary building and questioning are encouraged, and also the depth of
child’s understanding is deceptive
♦ They would just follow what has been told to them but then return and ask why it was so.
♦ Preschoolers imitate language exactly, so if they hear less-than-perfect language, that is the language pattern they
adopt.
♦ They may imitate and use “bathroom language” if not corrected.
♦ Preschoolers are egocentric so they define objects in relation to themselves.
PLAY
♦ Preschoolers do not need so many toys. Their imaginations are keener than they will be at any other time in their
life, so they enjoy games that use imitation such as playing
♦ They imitate what they see parents doing: eating meals, mowing the lawn, cleaning the house, washing, ironing
arguing and so forth.
♦ They pretend to be teachers, firefighters, cowboys, store clerks. They have imaginary friends. These exist until they
formally begin schooling.
♦ Four and 5-year-olds divide their time between rough-housing and imaginative/imitative/associative play.
SOCIALIZATION
♦ Since 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do
toddlers, which is why preschool period is a sensitive and critical time for socialization.
♦ Children at age 4 are involved in arguments more than they did at age 3, especially as they become more certain of
their role in the group.
♦ Five-year-olds begin to develop “best” friendships perhaps on the basis of who they walk with to the school, or who
lives closest to them
Fantasy
♦ Preschoolers begin to differentiate cartoon characters from real
♦ Children are fond of imitating and pretending to be something ore someone else, a fantasy role: like rabbit,
batman, superman.
♦ Parents should be encouraged to support the fantasy but still reassuring the child that she/he is still herself/
himself, the difference between the child and the role.
MORAL DEVELOPMENT : Pre-conventional Level Stage 2: Individualism and Exchange

♦ Does the right thing in exchange for something
SPIRITUAL DEVELOPMENT : Intuitive projective

♦ Begin to have elemental concept of God if they have been provided some form of religious training.
♦ Belief is an outside force aids in the development of conscience (Kohlberg,1984)
CONCERNS RELATED TO GROWTH AND DEVELOPMENT

1. Preschool and kindergarten experience
♦ Transition to kindergarten should begin a year before.
♦ Practice and guidance is essential to prevent stress.
♦ Children should have preschool skills such as: being able to retell a simple story, able to recognize letters in
their names, trace the shapes of letters and numbers on paper, following simple instructions, matching
rhyming sounds, properly holding a pencil and listening to a story with a group, new social experiences like
taking turns and being in school for an entire day, interacting with new friends
2. Sex education
a. Open the door to sex education by teaching your child the proper names for his or her sex organs, perhaps
during bath time.
b. If your child points to a body part, simply tell him or her what it is. This is also a good time to talk about
which parts of the body are private.
c. When your child asks questions about his or her body — or yours, take the questions at face value, and
offer direct, age-appropriate responses.
♦ Sex education isn't a single tell-all discussion. Instead, take advantage of everyday opportunities to discuss
sex.
3. Gifted children
♦ The range for average intelligence is 85 to 115
♦ Children whose IQ scores are at least 120 to 130 are considered gifted.
♦ Some gifted children realize they're "different" from their peers. This can make them feel isolated and
withdrawn. It may also make them targets for bullying. They may begin to feel intensely frustrated because
they can think more rapidly than they can express themselves, verbally or physically.
♦ If child appears unusually angry or frustrated, consider consulting a mental health professional.
4. Aggression
♦ The preschooler is learning a lot of new skills and she can easily become frustrated with everything she is
trying to accomplish
♦ Child is tired and hungry or maybe if she feels resentful or neglected on top of everything else. She doesn’t
quite know what to do about it, so she responds by biting, hitting, or throwing a tantrum.
a. Help her realize and talk about it.

b. Let her know instantly when she’s done something wrong
c. Remove her from the situation for a brief time out for three or four minutes to connect her behavior
with the consequence that if she hits or bites, she’ll miss out on the fun.
d. Reinforce responsibility that if her aggression damages property or make a mess, she should help
make it right again.
e. Reward good behavior
5. Speech problems
a. Stuttering
♦ repeating the first sound or syllable in a word or the first word in a sentence. It is more likely to happen when
a child is tired, excited, or in a competitive situation, such as trying to express herself better or faster than
her peers.
b. Lisping
♦ make substitutions of an easy sound for one that is more challenging for them to make, such as "th" for "s,"
thus, "thand" for "sand." or "w" for "r," saying "wabbit" for "rabbit."
c. Lengthy pauses
♦ the appearance of long pauses between words or thoughts. A sign that child is groping for the correct word
or thinking about how to structure her next sentence.
Some tips
1. Talk a lot with the child to help her learn new words.
2. Point out words you see
3. Speak to the child in the language you know best.
4. Listen and respond when the child talks.
5. Encourage child to ask questions.
6. Give child time to answer questions.

7. Set limits for watching TV and using electronic media. Use the time for talking and reading
together.
8. Reduce child's stress.
9. Read to the child.
10. Eat dinner as a family to regularly participate in conversation with adults
6. Lying
♦ Maybe due to active imagination; They struggle to tell the difference between what’s real and what’s not. After all,
most preschoolers engage in a lot of pretend play.
♦ Maybe due to forgetfulness, the angel syndrome; A child who recognizes that his parents think he can do no
wrong starts to believe it himself
a. Encourage truth-telling.
b. Don't accuse.
♦ Couch your comments so they invite confession, not denial
c. Don't overburden your child.
♦ Don't weigh your child down with too many expectations or rules, he may feel compelled to lie to
avoid your disappointment.
d. Build trust.
e. Establish a household rule about honesty to make your expectations clear.
7. Whining
♦ the sound of a child who feels powerless and is pitching his request in higher and higher tones so someone will
pay attention to him.
♦ Toddlers often don't know how else to express what they want or when they don’t get their way
a. Acknowledge your child's need for attention
b. Show her a better way to address the problem.
c. Avoid triggers.
d. Respond consistently
e. Try a diversion
8. Stress
♦ body's reaction to a physical or emotional situation that causes imbalance in a person's life.
♦ Negative sources of stress: physical abuse, separation, rejection, and fights , parent losing a job, or the death of a
parent, grandparent, or sibling
♦ Positive sources of stress: birthday parties, new pets, and the birth of new siblings, everyday family obligations,
events, and routines
♦ Possible Signs of Stress in Young Children are: Accident proneness, Hitting, Anger, Kicking, Anxiety, Insomnia,
Appetite Loss, Stuttering, Baby Talk, Indigestion, Bed-wetting, Thumb sucking, Biting, Pounding Heart, Crying
Spells, Grinding Teeth, Detachment, Fingernail Biting, Excessive Aggressiveness, Respiratory Tract Illness,
Excessive Laziness, Tattling
a. Acknowledge their feelings so they understand what they are feeling
b. Promote a positive environment by praising children for the acceptable things that they do
c. Help children through stories
d. Make an effort to cut down on activities when you see signs of stress
e. Teach children tricks for calming themselves
f. Plan plenty of time for play to allow them to express their feelings
g. Books, art activities, puppetry, play and drawing allow children to think through and label their feelings.
h. Give children a lot of cuddles, reassurances, and familiar routines
9. Common Fears
a. Fear of darkness e. Fear of animals
b. Fear of ghosts f. Fear of mutilation
c. Fear of annihilation g. Sexual matters – castration anxiety
d. Pain
♦ Some fears are a result of concrete experiences but some is due to their developing imagination.
a. Approach the fear in steps.
b. Explain, expose, and explore.
c. Use love objects. These can offer an anxious child lasting reassurance
d. Problem-solve together.
e. Practice through pretend play
PROMOTION OF HEALTH
1. Promoting Preschooler Safety
a. Keeping Children Safe, Strong and FREE
b. Warn child never to talk to a stranger.
c. Teach child to call for help in case of emergency.
d. Describe what a police officer looks like and express that a police officer can help in emergency situation.
e. Explaining about secrets
f. Explaining that bullying behavior from other children is not to be tolerated but reported so they can receive help
managing it.
g. Wearing safety helmet when riding a bicycle
2. Nutritional Needs
♦ Would be based on the food pyramid.
♦ Caution should be made, since vitamins for this period are made in such a way that they are attractive, and
should be kept in a safe place far from children’s reach.
3. Promoting Preschoolers in Daily Activities
a. Dressing
♦ have difficulty in buttons, prefer bright and printed clothes that oftentimes mismatch.
b. Sleep
♦ Sleep 12 hours a night
♦ They don’t take a nap no matter how tired they are
♦ Are afraid of the dark
♦ Night waking from nightmares or night terrors reaches its peak.
♦ Needs a night light.
c. Exercise
♦ Active period.
♦ They receive a great deal of exercise, Rough-housing, love time-honored games.
d. Bathing
♦ Fond of taking a bath but are not paragons of neatness.
e. Care of teeth
♦ Deciduous teeth should be preserved to protect the dental arch.
f. Night grinding
♦ Bruxism
♦ grinding the teeth at night
♦ usually to release tension, “letting go”
SCHOOLER
♦ 6 – 12 YEARS OLD
CHARACTERISTICS OF A SCHOOLER
1. Troublesome Age
♦ no longer willing to do what they are told
♦ influenced by their peers

2. Sloppy Age
♦ children are careless
♦ slovenly about their appearance
♦ rooms are cluttered
3. Quarrelsome stage
♦ emotional climate of the home is far from pleasant for all family members
4. Elementary school age
♦ time to learn essential skills both curricular and co-curricular
5. Critical Period !!!
♦ formation of habit: achievers or underachievers (working above/below up to one's capacity tend to persist into
adulthood)
6. Gang Age
♦ Major concern: acceptance of peers
♦ age of conformity
BIOLOGIC DEVELOPMENT
♦ Weight: doubles over this period
♦ Height: 2 inches per year
♦ Height increases to 1-2 inches (2.5-5 cm)
♦ At age 9, both sexes - same size;
♦ Age 12, girls bigger than boys
♦ Adult vision level is achieved; hand-eye coordination develops completely
♦ IgA and IgG reach adult levels, and lymphatic tissue continues to grow up until age 9.
♦ By 10 years of age, brain growth is complete, so fine motor coordination becomes more refined.
♦ Innocent heart murmurs are heard due to extra blood crossing the heart valves.
♦ Pulse rate decreases to 70-80 bpm;
♦ Blood pressure rises to about 112/60 mmHg
PHYSICAL GROWTH
♦ Dentition
▪ loses first primary teeth at about 6 years
▪ by 12 years, has all permanent teeth except final molars
▪ Malocclusion with teeth mal alignment may result if the eruption of the permanent teeth and growth of the jaw do
not correlate with final head growth.
♦ Bone growth faster than muscle and ligament development
♦ Posture becomes more erect
MOTOR DEVELOPMENT
♦ Gross motor skills
▪ predominantly involving large muscles
▪ children are very energetic
▪ develop greater strength, coordination, and stamina
♦ Fine motor development
▪ Develops smoothness and speed in fine motor control
PSYCHOSEXUAL DEVELOPMENT : Latency Stage

♦ Energy is used to gain new skills and social relationship and knowledge.
♦ Sexual drive (libido) controlled and repressed
SPIRITUAL DEVELOPMENT : Stage 2: Mythic - Literal Faith

♦ Start sorting out the real from the make-believe.
♦ Beliefs, moral rules and attitudes are also held literally. Thus, God is an anthropomorphic (having human
characteristics) being in the sky; Heaven and hell are viewed as actual places.
♦ The person is also more able to take the perspective of another person but his view of reciprocity is also rather
literal. "If I follow the rules, God will give me a good life." "If I pray, God will grant my wish.”
MORAL DEVELOPMENT: Level II: Conventional Stage 3: Good Interpersonal Relationship: Good Boy/Girl Attitude
♦ Taking turns is fair, stealing is not.
♦ They lie to disguise that they have been involved in an action that is not nice.
♦ When asked why it is wrong to steal, “because it is not nice or fair”.
PSYCHOSOCIAL DEVELOPMENT : Industry Vs Inferiority

♦ Sense of initiative means learning how to do things.
♦ Sense of industry means learning how to do things well.
♦ The questions asked reflect curiosity by using “how”, “why” and “what”.
♦ Best type of book has many short chapters, they feel a sense of accomplishment if they finish each chapter.
♦ They like small chores that can be finished quickly and the difference is visible from the previous on.
Settings where to learn industry:
♦ Home ♦ Structured activities ♦ School ♦ Problem solving
♦ Learning to live with others.
♦ If the child doesn’t receive rewards or prevented from achieving a sense of industry he develops a feeling of inferiority.
♦ These children will have difficulty tackling new situations later in life ( new job, new school, new responsibility)
because they cannot envision how they could be successful in handling them frustrations in work and school.
COGNITIVE DEVELOPMENT : Stage 3: Concrete Operational Stage

a. Decentering
▪ ability to consider multiple aspects of a situation
b. Conservation
▪ child understands that changing the form of a substance or object does not change its amount, overall
volume, or mass
c. Accommodation
▪ altering one's existing schemas, or ideas, as a result of new information or new experiences.
d. Class inclusion
▪ Ability to classify objects as belonging to two or more categories simultaneously
SIX-YEAR OLD SEVEN-YEAR OLD

Physical: Physical
♦ A year of constant motion ♦ Central incisors erupt
♦ skipping is a new skill ♦ difference between sexes becomes apparent in
♦ first molar erupts play (video games vs dolls)
Cognitive ♦ spends time in quiet play
♦ First grade teacher becomes authority figure Psychosocial
♦ adjustment to all day school may be difficult and ♦ A quiet year
lead to nervous manifestations of fingernail ♦ striving for perfection leads to this year being
biting.,etc. called an eraser year.
♦ Defines words by their use Cognitive
♦ Conservation is learned
♦ can tell time
♦ can make simple change
EIGHTH-YEAR OLD NINE-YEAR OLD

Physical Physical
♦ Coordination definitely improved ♦ all activities done with gang
♦ playing with gang becomes important Psychosocial
♦ eyes becomes fully developed ♦ Gang age: a 9 year old club is formed to spite
Psychosocial someone
♦ “Best friends” develop ♦ has secret codes
♦ whispering and giggling begin ♦ is all boy or all girl
Cognitive ♦ gangs disband and reform quickly
♦ Can write as well as print
♦ understand concepts of past, present and future.
TEN-YEAR OLD ELEVEN-YEAR OLD
Physical Physical
♦ coordination improves ♦ Active but awkward and ungainly
Psychosocial Psychosocial
♦ ready to camp away from home ♦ Insecure with members of opposite sex
♦ collecting age ♦ repeats off- color jokes
♦ likes rules
♦ ready for competitive games
TWELVE-YEAR OLD
Physical
♦ coordination improves
Psychosocial
♦ A sense of humor is present
♦ is social and cooperative
SOCIAL DEVELOPMENT
♦ Daily relationship with age-mates provides the most important social interaction of school- aged children.
♦ They practice or mimic adult roles.
♦ Explore the social environment.
♦ They have sense of initiative.
♦ They learn to share, & discover,
♦ Learning is fun and adventure,
♦ Doing things is more rewarding than watching things being done.
♦ Children become increasingly sensitive to social norms and pressure of the peer groups.
♦ Interaction to peers lead to the formation of intimate friendships with same sex peers
AT SIX YR OLD AT SEVEN YR OLD

♦ talk in full sentences, using language easily and ♦ they can tell time in hours, but have trouble with
with meaning. concepts such as half past and quarter to
♦ They still define objects by their use. especially with digital clocks and watches.
♦ They know the months of the year and can name
the months in which holidays fall.
SEVEN TO NINE-YEAR OLD NINE TO TWELFTH-YEAR OLD
♦ They know simple arithmetic. ♦ They have short period of intense fascination with
♦ They can add and subtract and make simple bathroom language, as they did during preschool
change, so they can go to the store and make years.
simple purchases ♦ By 12 years of age, sense of humor is apparent .

♦ At 9, when they discover dirty jokes, they like to tell ♦ They can carry on an adult conversation, although
them to friends and try to understand those told stories are limited because of their lack of
by adults. experience.
♦ They use swear words to express anger or just to
show to other children they are growing-up.
EMOTIONAL DEVELOPMENT
1. Children enter this period with the ability to trust others and with a sense of respect for their own worth.
2. There’s sense of autonomy
♦ Can accomplish small tasks independently.
♦ They practice or mimic adult roles.
♦ Explore the social environment.
3. They have sense of initiative.
♦ They learn to share
♦ Discover learning is fun and adventure
♦ Doing things is more rewarding than watching things being done.
Seven-year old boy

♦ Children require more props for play than when they were younger.
♦ Start of the decline in imaginative play.
Seven-year old girl
♦ Girls prefer teenage dolls
♦ with good coordination to button the miniature dresses and pull on the tiny boots.
Seven-year old
♦ They develop an interest in collecting items such as baseball cards, dolls, rocks, marbles.
♦ The type is not as important as the quantity.
♦ They start to sort out by age 8.
Eighth-year old
♦ They like table games but hate to lose, so they tend to avoid competitive games.
♦ They change the rules in the middle of the games to keep from losing.
Eighth to ninth-year old
♦ They enter a phase of reading comic books. These can be read quickly, so they accomplish a sense of industry.
♦ If parents forbid, they read under the covers at night or read them at other children’s houses.
Nine-year old
♦ Children play hard.
♦ They squeeze in some activity before going to school, and plan something the moment they arrive home.
♦ They have difficulty in going to bed at night because they want to play just one more game.
♦ Play is rough and not interested in perfecting skills.
♦ Conflict arises when parents expect perfection.
♦ Talent for music or art becomes evident.
♦ Children do well if others in their group are taking similar lessons.
Ten-year old
♦ Children spend most of their time paying handheld or television-remote controlled games.
♦ Boys and girls play separately although interest in the opposite sex becomes apparent.
♦ Boys show off as girls pass their group, while girls talk loudly or giggle at the site of a familiar boy.
♦ Girls become more interested in the way they look and dress.
♦ Slumber parties and camp-outs become increasingly popular.
♦ The children talk, giggle, rough-house in the middle of the night.
♦ Children are interested in rules and fairness.
♦ They strictly enforce rules.

♦ Club activities become structured with a president, a secretary, and rules of order.
Eleven to Twelfth-year old
♦ Children enjoy dancing to popular music and playing table games and are accommodating enough to be able
to play with younger siblings who need the rules modified to their advantage.
♦ Time with friends is often spent just talking.
♦ They use their bedroom to meet with friends.
♦ They like to do jobs for money.
♦ They feel that they are on the verge of something great and anxiously wait to become a teenager.
CONCERNS OF SCHOOL AGE CHILDREN

1. School experience
♦ School serves as an agent for transmitting societal values and a setting for many peer relationships and
therefore exerts influence on the social development of children
a. Anticipatory socialization
♦ refers to someone adopting the standards, values and social norms of a group they are not a part of to
gain acceptance.
b. Role of the teacher

♦ acts as parental surrogate
c. Role of the parents
2. Limit setting and discipline
3. Coping with stress
a. Fears
b. Latchkey children
♦ a child who returns from school to an empty home because their parent or parents are away at work, or
a child who is often left at home with little parental supervision.
HEALTH PROMOTION DURING SCHOOL-AGE PERIOD

1. Health Behaviors
2. Nutritional Health
a. Prepare healthy snacks and meals, but do not demand that your child eat a certain amount of food at one
sitting.
b. Limit high-calorie, high-fat, and sugary snacks. These foods lack essential nutrients and will diminish your
child's desire to eat at mealtime.
c. Make mealtime environment fun and relaxing, and allow your child to eat at his/her own pace.
d. Limit distractions and stressful situations during mealtimes, such as television, family arguments, and
discipline.
e. Allow your child to help prepare snacks and meals.
f. Constantly encourage your child to try new foods and continue to make available those foods that are not well-
liked. Begin the meal by serving your child's least favorite foods.
g. Keep your child's food idiosyncracies in mind when preparing meals.
h. Avoid using food to reward or punish your child. This practice serves only to firmly establish these foods as
desirable to your child.
Establishing healthy eating patterns

Protein
♦ important for growth, strength and muscle maintenance.
♦ Children ages 4 to 8 need at least 19 grams of protein, kids ages 9 to 13 require 34 grams of protein, teen girls
ages 14 to 18 need 46 grams and teen boys ages 14 to 18 require at least 52 grams of protein every day.
♦ High-protein foods include lean red meat, chicken, turkey, seafood, eggs, dairy foods, peanut butter, soy
products, legumes, nuts and seeds.
Carbohydrates
♦ the main source of energy.
♦ Children ages 1 and older consume at least 130 grams of carbohydrates every day.
♦ Choose carbohydrates from whole grains, milk products, fruits, vegetables and legumes instead of refined
grains and added sugars
Fats, especially omega-3 fatty acids
♦ are important for child’s cognitive development.
♦ Children ages 4 and older consume 25 to 35 percent of their daily calorie intake from fats, especially mono-
and poly unsaturated fats found in vegetable oils, avocados, peanut butter, hummus, nuts and seeds. Foods
high in omega-3 fatty acids include purified fish oils, canola oil, walnut oil, walnuts, soybeans, soybean oil,
algal oil, flaxseeds, flaxseed oil and pumpkin seeds.
Calcium
♦ found in dairy products and dairy-free calcium-fortified beverages, iron in meats and iron-fortified grains,
vitamin A found in fruits, vegetables and dairy products, vitamin D in fish and dairy products and iodine,
which is abundant in seafood, dairy products, enriched grains and iodized salt.
Recommended daily dietary allowances

Girls
♦ Ages 4 to 8 need 1,200 to 1,800 calories
♦ Ages 9 to 13 require 1,400 to 2,200 calories
♦ Ages 14 to 18 need about 1,800 to 2,400 calories each day.
Boys
♦ Ages 4 to 8 require 1,200 to 2,000 calories
♦ Ages 9 to 13 need 1,600 to 2,600
♦ Ages 14 to 18 need about 2,000 to 3,200 calories per day
Promoting Nutritional Health with a Vegetarian Diet

♦ Vegetarian diets tend to be high in fiber and polyunsaturated fat, and low in cholesterol and calories.
♦ Consume insufficient amounts of calcium and vitamin D if they remove milk products from their diet.
♦ Lack of meat products, vegetarians have inadequate iron intake.
♦ Insufficient amounts of vitamin B-12, zinc, and other minerals
♦ Extremely low caloric intake, cause a delay in normal growth and weight gain.
♦ Lack of adequate protein sources. Thus, ensure child receives a good balance of essential amino acids.
3. Health in daily activities
3.a. Sleep and rest - 10 and 11 hours of sleep per night
How to help your school-aged child sleep well
a. Develop a regular sleep schedule.
b. Maintain a consistent bedtime routine.
c. Set up a soothing sleep environment. Child’s bedroom should be comfortable, dark, cool, and quiet.
Nightlight is fine; a television is not.
d. Set limits. (time lights off; how many bedtime stories)
e. Turn off televisions, computers, and radios.
f. Avoid caffeine (found in sodas, coffee-based products, iced tea)
3.b. Exercise and Physical activity
♦ At least 60 minutes of physical activity every day from moderate activity (such as cycling and playground
activities), to vigorous activity (such as running and tennis)
3.c. Dental health
1. Most bottled water does not contain enough fluoride to prevent tooth decay
2. Help child brush their teeth with fluoride toothpaste twice a day
3. Serve healthy meals and snacks
4. Take your child to the dentist for regular cleanings and check-ups.
5. Ask your dentist about dental sealants
3.d. Hygiene
1. Teach handwashing
2. Use handkerchief when sneezing and coughing
♦ Germs travel far and wide. A sneeze travels up to 100 miles per hour and can send 100,000 germs
into the air.
3. Remind child not to touch their eyes or pick their nose.
♦ Germs are easily transmitted into the body through the mucous membranes in the eyes, the nose,
and the mouth.
4. Dental Hygiene
♦ Get the child into the habit of flossing and brushing the tongue, the insides of the cheeks and roof of
mouth
3.e. Bath Time
♦ Many parents find that evening baths are the best way to relax a child before bed.
3.f. Grooming their fingernails

♦ Fingernails are a breeding ground for bacteria
3.g. Dress
♦ This is the right age to teach children the importance of caring for their own belongings.
♦ Have definite opinion about clothing styles.
4. School health
♦ Classroom teaching on the subject of health/ hygiene
♦ Health education attempts to close the gap between what is known about optimum health practice and that
which is actually practiced
5. Injury prevention
a. Use seatbelts and bicycle safety around cars.
b. Risk taking behavior
♦ They want new experiences
♦ They need to explore their own limits and abilities, as well as the boundaries set.
♦ They need to express themselves as individuals. It’s all part of their path to becoming independent young
adults, with their own identities.
♦ Examples of risk taking behaviors are: fighting, truancy (the action of staying away from school without
good reason), unprotected sexual activity, tobacco smoking, alcohol use and binge-drinking, illegal
substance use, dangerous driving, illegal activities like trespassing or vandalism.
c. Motor vehicle prevention and other vehicle related injuries
d. Injuries at school
e. Sexual abuse is an unfortunate and all-too-common hazard for children.
Teaching Points To Help Children Avoid Sexual Abuse

a. Your body is your property and you can decide who looks at it or touches it.
b. Secrets are fun things to keep.
c. Don’t go anywhere with stranger.
d. Being touched by someone you like is a good feeling
e. A “private part is the part of you a bathing suit touches.
f. If the person you tell doesn’t believe you, keep telling people until someone believes you.
COMMON HEALTH PROBLEMS

1. Dental Caries
♦ Drinking carbonated soft drinks regularly can contribute to the erosion of tooth enamel.
♦ Enamel breakdown leads to cavities.
♦ Foods that are high in carbohydrates, as well as some fruits, juices and sodas, peanut butter, crackers and
potato chips are culprits.
Factors that cause tooth decay:
a. the frequency in which the foods are eaten
b. the time they remain as particles in the mouth.
2. Malocclusion (poor bite)
♦ caused by thumb-sucking, finger-sucking, and pacifier use in young children. But when a child stops the
sucking habit, the teeth naturally begin moving back to their normal positions.
♦ thumb and finger-sucking and pacifier use for more than 4 to 6 hours in 24 hours can eventually:
a. Push the upper front teeth (incisors) outward and the lower incisors inward (overjet).
b. Prevent the incisors from coming in (erupting) completely (open bite).
c. Cause the top molars to bite inside the lower molars (cross bite).
3. Language Problem
♦ Articulation - difficulty in pronouncing s, z, th, l, r and w
There are three kinds of language disorders:

a. Receptive language issues involve difficulty understanding what others are saying and could also have
difficulty following simple directions and organizing information they hear.
b. Expressive language issues involve difficulty expressing thoughts and ideas and may be late to start talking
and not speak until age 2. At age 3, they may be talking but hard to understand.
c. Mixed receptive-expressive language issues involve difficulty understanding and using spoken language.
4. Fear and Anxieties
a. Anxiety related to beginning of school e. Sex Education i. Violence or terrorism
b. Recreational Drug Use f. School Phobia j. Stealing
c. Children of alcoholic parents g. Bullying k. Home schooling
d. Latchkey children h. Obesity
ADOLESCENT
♦ 12 to 18 years old
PUBERTY
♦ a transitional period between the juvenile state and adulthood during which a growth spurt occurs
♦ secondary sexual characteristics appear, fertility is achieved, and psychological changes take place
♦ A girl has entered this period when she begins to menstruate, and a boy when he begins to produce spermatozoa
♦ These events occur between 11 and 14 years
♦ Follows same pattern for all races and cultures
♦ Related to hormonal changes
CHARACTERISTICS OF PUBESCENT STAGE

1. An overlapping period
♦ it encompasses the closing years of childhood and the beginning years of adolescence
2. A short period
♦ lasts for only 2 to 4 years
♦ children who pass through puberty in 2 years or less are regarded as “rapid maturers” while those who require
3 to 4 years are regarded as “slow maturers”
3. Puberty is divided into stages
Stages of Puberty
1. Pre-pubescent (“Maturing”)
♦ overlaps the closing year or two of childhood
♦ one who is no longer a child but not yet an adolescent
♦ secondary sex characteristics begin to appear but the reproductive organs are not yet fully developed
2. Pubescent (“mature”)
♦ occurs at the dividing line between childhood and adolescence
♦ criteria of sexual maturity appear - menarche in girls and first nocturnal emission in boys
♦ secondary sex characteristics continue to develop and cells are produced in the sex organs
3. Post pubescent
♦ overlaps the first year or two of adolescence
♦ secondary sex characteristics become well developed and the sex organs begin to function in a
mature manner
4. A time of rapid growth and change
♦ “adolescent growth spurt” rapid changes lead to confusion, feelings of inadequacy and insecurity, and in many
cases to unfavorable behavior
5. A negative phase
♦ negative attitudes and behavior are characteristic mainly of the early part of puberty and the worst of the
negative phase is over when the individual becomes sexually mature
Major Milestones of Development
♦ Onset of puberty and the cessation of body growth; Physiologic growth and development of adult coordination occur.
♦ Initially, the gain in physical growth is mostly in weight, leading to stocky appearance of prepubescence, è thin, gangly
appearance of late adolescence.
♦ Fast period of growth
♦ Results in change in body structure, development of secondary sex characteristics, and reproductive maturity
♦ Girls: height increases approximately 3 inches/yr; slows at menarche; stops around age 16
♦ Vital signs approach adult norms
SEXUAL MATURATION
♦ At a set point in brain maturity, the hypothalamus transmits an enzyme to the anterior pituitary gland to begin
production of gonadotropic hormones, which activate changes in testes and ovaries and produce puberty.
♦ Time of the onset of puberty varies widely, between 10-14 years of age.
♦ Sexual maturation in girls occurs between 12 and 18 years old
♦ Sexual maturation in boys, between 14 and 20 years old.
CHRONOLOGICAL DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS

AGE BOYS GIRLS
9 - 11 ♦ Prepubertal weight gain occurs ♦ Breast: elevation of papilla with breast bud formation;
♦ Areolar diameter enlarges
11 - 12 ♦ Sparse growth of straight ,downy, slightly ♦ Straight along the labia. vaginal epithelium becomes
pigmented hair at the base of the penis cornified
♦ Scrotum becoming textured ; growth of ♦ pH of vaginal secretions acid; slight mucous vaginal
penis and testes begins discharge present
♦ Sebaceous gland secretion increases ♦ Sebaceous gland secretion increases
♦ Perspiration increases ♦ Perspiration increases
♦ Dramatic growth spurt
12 - 13 ♦ Pubic hair present across pubis ♦ Pubic hair grows darker; spreads over entire pubis
♦ Penis lengthens. ♦ Breast enlarge, still no protrusion of nipples.
♦ Dramatic linear growth spurt ♦ Axillary hair present. Menarche occurs
♦ Breast enlargement occurs
ADOLESCENCE
♦ A period of rapid growth and development.
♦ A period of intense physical, physiologic, and psychosocial changes usually beginning and ending in the second
decade of life.
Substages of adolescence
1. Early Adolescence – 10 to 14 years
♦ aware of their rapidly changing bodies and start to worry about their physical appearance.
♦ They might experience shyness, blushing, modesty, and a greater interest in privacy.
♦ May feel invincible and start to engage in risky behaviors such as smoking and alcohol use.
♦ Characterized by sexual curiosity, usually expressed through admiration of celebrities, teen idols, and
musicians.
2. Middle Adolescence - 15 to 17 tears
♦ extremely concerned with how they look, and they think others are concerned too.
♦ They spend a large amount of time grooming, exercising, and modifying their physical appearance.
3. Late Adolescence - 18 to 21 years

♦ period when young adults become more comfortable with their body images and sexuality, become more self-
reliant and focus less on the opinions of peers.
♦ the time when goals for the future become defined.
CHARACTERISTICS OF ADOLESCENT STAGE

1. An important period
♦ Adolescence is one of the periods when both the immediate effects and long term effects on attitude and
behavior are important.
♦ It is also important for their physical and for their psychological effects.
♦ gives rise to the need for mental adjustments and the necessity for establishing new attitudes, values and
interests
2. A transitional period
♦ Transition means a passage from one stage of development to another which means what has happened
before will leave its mark on what happens now and in future.
3. A time of unrealism
♦ have a tendency to look at life through rose – tinted glasses.
♦ They see themselves and others as they would like them to be rather than as they are.
4. A period of change
♦ Heightened emotionality, rapid changes that accompany sexual maturing, changes in their bodies, their
interests and in the roles the social group expects them to play, interests and behaviour pattern change, so
do values.
♦ Most adolescents are ambivalent about changes.
♦ While they want and demand independence, they often dread the responsibilities that go with independence
5. A problem age
♦ Throughout childhood, their problems were met and solved in part at least by parents and teachers.
♦ Because adolescents want to feel that they are independent, they demand the right of coping with their own
problems, rebuffing attempts on the part of the parents and teachers to help them.
6. A time of search for identity
♦ The ambiguous status of the adolescents in the American culture of today presents a dilemma that greatly
contributes to the adolescent “identity crises‟ or the problem of ego-identity.
7. The threshold of adulthood
♦ As adolescents approach legal maturity, they are anxious to shed the stereotype of teenagers and to create
the impression that they are near adults.
♦ Dressing and acting like adults is not always enough so they begin to concentrate on behaviour associated
with adult status – smoking, drinking, using drugs, and engaging in sex are some examples. They believe
that this behavior will create the image they desire.
8. A dreaded age
♦ adolescent teenagers being sloppy, unreliable individuals who are inclined towards destructiveness and
antisocial behaviour has led many adults who must guide and supervise the lives of young adolescents to
dread this responsibility and to be unsympathetic in their attitudes towards adolescents.
♦ it creates much friction with their parents and places a barrier between them and their parents which prevents
them from turning to their parents for help in solving their problems.
9. Late adolescence is also a gang age
♦ Group standards is far more important to older children than individuality eg:- in dress, speech and behaviour
older children want to be as nearly like their gang mates as possible.
According to the World Health Organization (WHO)
♦ Adolescent age ranges from 10 to 19 years of age.
♦ Young people range from 10 to 24 years of age.
♦ Youth encompasses ages 15 to 24 years
PHYSICAL GROWTH
♦ Most girls are 1 to 2 inches (2.4 – 5 cm) taller than boys coming into adolescence and generally stop growing within
3 years from menarche. Thus, those girls menstruating at 10 years of age may reach their adult height by age 13.
♦ Boys: growth spurt starts around age 13; height increases 4 inch/yr, slows in late teens
♦ Boys double weight between 12 and 18, related to increased muscle mass
♦ Body shape changes
Girls Boys
Weight 13 – 55 lb ( 7 – 25 kg) 15 – 65 lb (7 – 30 kg)
Height 2 – 8 in ( 5 – 20 cm) 4 – 12 in (10 – 30 cm)
Age ( years) 16 or 17 18 - 20
♦ Apocrine glands cause increased body odor

♦ Increased production of sebum, and plugging of sebaceous ducts causes acne.
♦ Increase in body size does not occur in all organ system at the same rate.
Example: Skeletal system: muscle
Muscle mass : heart
♦ Both sexes lack coordination
♦ Blood flow and oxygen availability is reduced because the lungs and heart increase more slowly than the
rest of the body.
♦ Pulse rate and respiratory rate decrease slightly (to 70bpm and 20 breaths / min.)
♦ BP increases slightly to 120/70mmHg reaching adult levels by late adolescence.
SEXUAL DEVELOPMENT (GIRLS)

♦ Development of secondary sex characteristics, sex organs and function under hormonal control
♦ Menarche
♦ Menstrual cycle: controlled by complex interaction of hormones
♦ Breast development is first sign puberty
SEXUAL DEVELOPMENT (BOYS)

♦ Enlargement of testes is first sign of sexual maturation; occurs at approximately age 13, about 1 year before growth
spurt
♦ Scrotum and penis increase in size until age 18
♦ Reaches reproductive maturity about age 17, w/ viable sperm
♦ Nocturnal emission
♦ Masturbation increases
♦ Pubic hair continues to grow and spread until mid 20’s
♦ Facial hair appears
♦ Voice changes due to growth of laryngeal cartilage
♦ Gynecomastia
Early Adolescence (12 – 14)

♦ Starts with puberty
♦ Physical body changes result in an altered self-concept
♦ Tends to compare own body to others
♦ Early and late developers have anxiety regarding fear of rejection
♦ Fantasy life, daydreams, crushes are all normal, help in role play of varying social situations
♦ Is prone to mood swings
♦ Needs limits and consistent discipline
Middle Adolescence (15-16)

♦ Separate from parents (except financially)
♦ Can identify own values
♦ Can define self (self-concept, strengths and weaknesses)
♦ Partakes in peer group; conforms to values/fads
♦ Has increased heterosexual interest; communicates with opposite sex; may form “love” relationship
♦ Sex education continues
Late adolescence (17-19)

♦ Achieves greater independence
♦ Chooses a vocation
♦ Participates in society
♦ Finds an identity
♦ Finds a mate
♦ Develops own morality
♦ Completes physical and emotional maturity
PSYCHOSOCIAL DEVELOPMENT: Identity vs Role Confusion
COGNITIVE DEVELOPMENT: Formal Operational Stage

♦ Develops abstract thinking abilities
♦ Is often unrealistic
♦ Is capable of scientific reasoning and formal logic
♦ Enjoys intellectual abilities
♦ Is able to view problems comprehensively
SPIRITUAL DEVELOPMENT: Stage 3: Synthetic Conventional

♦ Choices come from community’s norms
♦ Choices not done reflectively / critically
PSYCHOSEXUAL DEVELOPMENT: Genital Stage
MORAL DEVELOPMENT: Stage 5: Social Contract and Individual Rights
CONCERNS OF ADOLESCENCE
1. Sexuality and Sexual Activity
2. Hazing
3. Substance Abuse
PROMOTION OF HEALTH DURING ADOLESCENCE

1. Promoting adolescent safety
a. Motor vehicle accidents d. Proper use of equipment
b. Sports injuries e. Risk taking behavior
c. Firearms accidents f. Drug and alcohol use
SAFETY ISSUES
♦ Accidents are leading cause of death: motor vehicle accidents, sports injuries, firearms accidents
♦ Safety measures include education about proper use of equipment and caution concerning risk taking
♦ Drug and alcohol use may be a serious problem
♦ Adolescent characteristics of poor impulse control and recklessness make prevention complex
NUTRITIONAL NEEDS
♦ Nutritional requirements peak during years of maximum growth: age 10 – 12 in girls, 2 years later in boys
▪ Boys require an average of 2,800 calories per day.
▪ Girls require an average of 2,200 calories per day.
♦ Appetite increases
♦ Inadequate diet can retard growth and delay sexual maturation
♦ Food intake needs to be balanced with energy expenditure
♦ Increased needs include calcium for skeletal growth;
iron for increased muscle mass and blood cell development;
zinc for development of skeletal and muscle tissue and sexual maturation
PROMOTING DEVELOPMENT IN DAILY ACTIVITIES

♦ Dress and hygiene ♦ Sleep ♦ Care of teeth ♦ Exercise
COMMON PROBLEMS
a. Hypertension d. Body piercing & Tattoos g. Gender discrimination j. Acne
b. Poor Posture e. Rebellion h. Dealing with peer pressure k. Obesity
c. Fatigue f. Menstrual Irregularities i. Suicides
REPRODUCTIVE RIGHTS OF THE ADOLESCENT

Adolescent Reproductive Health
♦ is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity, in
all matters relating to the reproductive system of people between the ages of 10 and 19.
a. Right to health
b. Right to access reproductive health services and facilities
c. Right to non-discrimination
d. Right to education and information
e. Right to be protected from all forms of physical and mental abuse and from all forms of sexual exploitation
Adulthood (18 years and above)

♦ longest period in the total lifespan of a person.
♦ Encompasses the years from the end of adolescence to death.
♦ A balance of growth in intellectual, psychomotor and emotional state.
Adult
♦ is an individual who has completed his/her growth and is ready to assume his/her status in the society along with other
adults.
♦ has attained full size and strength
♦ grown up, matured
Stages of Adulthood
A. Early adulthood – 18 to 45 years old
B. Middle adulthood – 45 to 65 years old
C. Late adulthood – 65 and above
CHARACTERISTICS OF AN EARLY ADULT

1. The age of settling down
♦ settling down with the line of work or career and settling down to a partner who have the qualities they want for a
lifelong spouse
2. The reproductive age
♦ for some, the last decade of early adulthood is the reproductive age
3. Period of emotional tension
4. Time of commitments
♦ as adolescents change their role from that of student and dependent to that of an independent adult, they establish
new patterns of living, assume new responsibilities, and make new commitments
5. The problem age
♦ very few young people have had any preparation for meeting the types of problems they are expected to cope with
as adults;
♦ trying to learn two or more skills simultaneously usually results in not learning any one of them well, so trying to
adjust to two or more new roles simultaneously results in poor adjustment to all of them;
♦ young adults do not have the help in meeting and solving problems that they had when they were younger.
♦ Most of them are too proud of their new status to admit that they cannot cope with it
6. Time of adjustment to new lifestyle
7. A Creative age
♦ some find a creative outlet in hobbies while others choose vocations in which they can express their creativity
8. Period of social isolation
♦ with the end of formal education and the entrance into the adult life pattern of work and marriage, associations with
the peer groups wane and with them, opportunities for social contacts outside the home.
♦ Isolation is intensified by a competitive spirit and a strong desire to rise on the vocational ladder.
♦ They must also devote most of their effort and time to their work, thus, little time for socialization
9. Period of dependency
♦ some young adults are partially or totally dependent on others for varying lengths of time.
♦ Dependent maybe on parents and on the educational institution they attend
10. Time of value change
♦ many of the values developed during the early stages of the life span change as experience and social contact with
people from all walks of life broaden and as values are considered from a more mature standpoint
PHYSICAL APPEARANCE/PHYSIOLOGICAL
♦ Musculo-Skeletal System
♦ At 19 – 30, maximum physiologic and motor function and stamina is reached.
♦ At 25, skeletal growth is completed
♦ At 30, loss of strength is 10% especially back and leg muscles.

♦ Vertebral column continuous to grow until 30
♦ At 40, bone has lost some mass and density.
Integumentary system
♦ Skin is smooth and taut, later becomes dry and wrinkled, lose moisture and with smile lines
Cardio-Vascular System
♦ HR = 72beats /min; BP = 100/60 – 120/80 mmHg
♦ Heart and blood vessels are fully matured, arteries less elastic
♦ Heart weighs at an average of 10 oz. for males and 8 oz for females
♦ Maximum cardiac output is achieved between 20 and 30 years old
♦ Changes occur gradually depending on exercise and diet patterns
Respiratory System
♦ RR = 12 – 20 breath/min
♦ Breathing is slower and deeper
♦ Maximum breathing capacity decreases between 20 – 40 years
Gastro-Intestinal System
♦ Ptyalin decreases after 20 years and digestive juices after 30
♦ Dental maturity is achieved in early 20’s with the emergence of the last 4 molars
Nervous System
♦ Brain reaches maximum weight during adulthood
♦ Mature patterns of brainwave activity occur after age 20 and continues to mature until 30
Visual and Auditory perception
♦ Lens of the eye lose elasticity gradually and begin to have difficulty changing shape and focusing on close objects.
Endocrine system
♦ BMR decreases gradually thus there is decrease in muscle mass
♦ Plasma cortisol levels remain constant therefore good response to stress is maintained.
♦ There is gradual decrease in thyroid hormone to adjust to progressively slower rate at which it is broken down and
removed from the blood.
♦ T4 (Thyroxine) blood level falls 15% over the adult lifespan
♦ T3 ( Triiodothyroxine), the active thyroid hormone declines only when the person is ill and not eating.
♦ Adrenal secretion of cortisol (hydrocortisone) decreases by 30% over the entire adult lifespan
PSYCHOSOCIAL DEVELOPMENT: Intimacy vs Isolation (18 to 45 years old)

♦ ability to relate deeply with other persons, members of the opposite sex ( heterosexual relationship), with one’s own
sex ( homosexual) as well to form long lasting friendships, a cause, institution, or creative effort of strong sense of
identity is needed before intimacy can occur.
Isolation or self Absorption
♦ Inability to be intimate, spontaneous, or close with another, thus becoming withdrawn, lonely and conceited and
behaving in a stereotype manner.
Factors influencing social participation

a. Socio-economic status d. Length of residence in the community g. Birth order
b. Social class e. Church affiliations h. Gender
c. Environment f. Age of sexual maturity
♦ They face a number of experiences & changes in lifestyle as they progress towards maturity.
♦ Remaining single is becoming the lifestyle of more & more adults.
♦ The multiple roles of adulthood may also create stress as a result of role conflict.
NURSING SIGNIFICANCE: Encourage mutual relationship and responsible sexual behavior.

COGNITIVE DEVELOPMENT: Formal operational

♦ Able to comprehend existing conditions
♦ Forms new concepts and do problem solving
♦ Applies mature reasoning or thought process
♦ Logical reasoning and imagination
♦ Differentiates among many perspectives and is objective, realistic and less egocentric
MORAL DEVELOPMENT: Postconventional level : Stage 6: Universal Principles: Principled conscience

♦ Separates self from the expectations and rules of others
♦ Defines morality in terms of principled reasoning
Men use “ethic of justice” ( according to rule and rights)
Women use “ethic of care” ( obligations to care and avoid hurt)
SPIRITUAL DEVELOPMENT : Stage 4 Individuative – Reflective stage

♦ Focuses on reality
♦ Asks philosophic questions regarding spirituality and maybe self-conscious about spiritual matters
♦ Begins to see the conflicting truths of her beliefs but does not get to see how they interrelate.
PSYCHOSEXUAL DEVELOPMENT : Genital Stage

Sexuality
♦ a deep pervasive aspect of the total person.
♦ the sum total of one’s feelings and behavior as a male or female
♦ the expression of which goes beyond genital response.
Gender Identity
♦ sense of self as male, female, bisexual ( feeling comfortable with both sexes), homosexual or ambivalent (transexual).
Gender Role
♦ what the person does overtly to indicate to self and others maleness, femaleness, bisexuality or ambivalence.
Basic Values Towards Sexuality

a. Absolutist Position – sexuality exists for the purpose of reproduction
b. Hedonistic View – pleasure and pursuit is the central value and is interested in ultimate fulfillment of human
sexual potential.
c. Relativistic Position – acts should be judged on the basis of their effects, you will have your private set of values
but you must recognize that other’s values may be valid as yours.
Sexual patterns in Early Adulthood

a. Heterosexuality - Attracted to, and having sex with opposite sex
b. Bisexuality - Attracted to, and having sex with both sexes
c. Homosexuality - Attracted to, and having sex with the same sex
d. Masturbation - is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually
to the point of orgasm
e. Abstinence - or sexual restraint is the practice of refraining from some or all aspects of sexual activity for medical,
psychological, legal, social, financial, philosophical, moral or religious reasons
DIEKELMANN’S THEORY : Young adult experiences five developmental tasks

a. Young adults achieve independence from parental controls.
b. He begins to develop strong friendships & intimate relationship outside the family
c. He establishes a personal set of values some of which he obtains from his parents and peer groups.
d. He develops a personal sense of identity
e. He prepares for his life work & develops the capacity for intimacy
Conditions Affecting Stability of Marriage

a. Number of children e. Social class h. Economic status
b. Time of Marriage f. Reason for Marriage i. Time at which the couple becomes parents
c. Parental model g. Similarity of background j. Ordinal position in childhood family
d. Maintenance of identity
PROMOTING HEALTH OF THE EARLY ADULT

1. Nutrition
♦ Caloric intake should be based on the following:
a. Occupation & amount of physical activity & mental effort e. Age
b. Emotional state f. Body size
c. Individual metabolism g. Climate
d. Presence of disease
♦ Male – 56 kg and 162.5 cm in height = 40 Kcal/kg or 2,580 Kcal/day
♦ Female – 48 kg and 151.7 cm in height = 40 Kcal/kg or 1,920 Kcal/day
♦ Nutrients needed:
CHO– 50 -60 % of Total Kcal Proteins – 1.12 gm/KBW Iron – 8 mg/day
Fats – 20 – 30% Calcium – 500 mgs/day Water – 6 -8 glasses /day
Vit D– to metabolize calcium Vit B6 – Catalyzes synthesis of heme portion ofheme molecule
Vit C - to increase iron absorption Thiamin – counteracts poor appetite and regulate normal nerve
Vit E – for solubility of RBC function
Vit C & E – Retard cellular aging Vit B12 and Folacin – for normal blood formation
Copper – Facilitates hemoglobin formation Zinc – improves taste acuity and wound healing
2. Rest and Sleep
Rest - to cease activity, taking a break, usually the person is awake through that time.
Nap - to sleep briefly. Anywhere from 5 minutes to 2 hrs.
Sleep - eyes closed and not conscious of goings on around you this can last a few moments to many hours.
♦ During this time body, mind and energy are rejuvenated through this version of relaxation.
♦ Young adults should have 5 or 7 – 8 hours of sleep
Factors that determine need for rest and sleep:
a. Emotional and physical status
b. Occupation and amount of physical activity
Stages of sleep
1. REM (Rapid Eye Movement) sleep
♦ when dreaming occurs
♦ occur in 79 -90 min cycle that increases as the night progresses
2. NREM – Non Rapid Eye Movement
Stage 1 - transition from wakefulness to sleep in 5 min.
♦ drowsy and relaxed with fleeting thoughts, somewhat aware of the environment, can be easily
awakened and may think he has been awake .
Stage 2 – beginning of deeper sleep; ( 40 – 50% of total sleep time)
♦ more relaxed but easily awakened.
Stage3–period of progressively deeper sleep begins 30- 40 mins after sleep onset
♦ muscles more relaxed, difficult to awaken
Stage 4 - very deep sleep; ( occurs 40 min after stage 1)
♦ rests and restores body physically
♦ very relaxed, seldom moves, difficult to arouse
♦ responds slowly if awakened
♦ sleep-walking and enuresis may occur
3. Work, Exercise and Leisure

Work
♦ women enter the work force due to necessity, to maintain occupational skills, self-esteem
and independence.
Burn out
♦ a feeling of worthlessness because of not being appreciated, a sense of hopelessness or loss of creativity;
a stress response; inadequate emotional and physical energy for tasks, responsibility and roles.
Physical activity
♦ movement that involves contraction of muscles; housework, gardening, walking, climbing stairs, etc
Exercise
♦ planned, purposeful physical activity performed with the intention of acquiring fitness or other health benefits;
Working out at a health club, swimming, cycling, running, and sports, like golf and tennis
Physical Fitness
♦ a combination of strength, endurance, flexibility, balance speed, ability and power.
♦ reflects ability to work for a sustained period with vigor and pleasure without undue fatigue and with
energy left for enjoying hobbies and recreational activities and for meeting emergencies basic to fitness
are the following:
1. Regular physical exercise
2. proper nutrition
3. adequate rest and relaxation
4. conscientious health practices
5. good mental and dental care
Leisure
♦ activities that people engage in during their free time; activities that we engage in for reasons as varied as
relaxation, competition, or growth and may include reading for pleasure, meditating, painting, and
participating in sports.
Factors influencing the use of leisure time:
Gender Time Amount of family, home, work, or community responsibilities
Health Marital status Income and socio-economic class
Past interests Mental status Social acceptance
4. Stable Marriage
a. Conditions affecting stability of marriage e. Reason for Marriage i. Social class
b. Time at which the couple becomes parents f. Maintenance of identity j. Economic status
c. Ordinal position in childhood family g. Number of children k. Parental model
d. Similarity of background h. Time of Marriage
MIDDLE ADULT
♦ 45 years to 65 years
CHARACTERISTICS OF MIDDLE ADULTHOOD
1. A dreaded period
♦ unfavorable stereotypes, traditional beliefs concerning mental and physical deterioration, emphasis on youth
2. A time of transition
♦ change in virility (male), change in fertility (women), changed roles, physical condition, interests
♦ Crisis: parenthood crisis, dealing with aging parents, death of a spouse
3. A time of stress
♦ somatic due to physical evidence of aging, cultural due to high value placed on youth, vigor and success,
economic due to financial burden of educating children & providing status symbols for family members,
psychological due to death of spouse, departure of children, boredom with marriage, sense of lost hope and
approaching death
4. A “dangerous age”
♦ (men) “middle age revolt”; promiscuous act, alcoholism; (women) hormonal upset due to menopause; physical
breakdown: overwork, overworry, careless living; mental illness, suicides; alcoholism, substance abuse
5. An “awkward age”
♦ “no longer young nor are they yet old”; stands between the younger “Rebel generation” and the “Senior citizen
Generation”; have no recognized place in society → inconspicuous; psychological – death of spouse;
departure of children; boredom with marriage; sense of lost hope and approaching death
6. A time of achievement
♦ time for financial and social success, authority and prestige; “Command Generation”- Norm bearers, decision
makers, lives in a youth oriented society controlled by the middle-aged
7. A time of evaluation
♦ evaluate accomplishments in light of earlier aspirations and the expectations of others; coming to terms of ones
fantasies
8. Evaluated by a double standard
♦ standard for men and standard for women; physical changes: men- distinguished, women – middle age spread;
approve way for the two sexes to age: stay young and active, “grow old gracefully”- “rocking chair philosophy”
9. A time of “empty nest”
♦ children no longer live under parental roof; Crises: family centered home → pair-centered home; more traumatic
for women
10. Time of boredom
♦ one of the unhappy periods of life
BIOLOGICAL DEVELOPMENT OF A MIDDLE ADULT

Weight gain Loss & graying of hair Eyes look less bright
Body sag Coarse & wrinkled skin Teeth becomes yellow
Joint problems Soft and flabby muscles Oftentimes with dentures
PHYSIOLOGIC DEVELOPMENT OF A MIDDLE ADULT

1. Menopause
♦ occurs between 45 – 60
♦ permanent cessation of menstruation preceded by a gradually decreasing menstrual flow.
2. Andropause
♦ occurs in late 40’s or early 50’s
♦ decreased level of androgens
♦ penile erection is less firm, ejaculation is less frequent, and the refractory period is longer
COGNITIVE DEVELOPMENT : Formal operational stage

♦ changes are rare except in the presence of illness or trauma
♦ able to continue learning skills and information
♦ can reflect on the past & current experience and can imagine, anticipate, plan and hope
PSYCHOSOCIAL DEVELOPMENT : Generativity vs. Stagnation

♦ changes may be related to career transition, sexuality, marital changes, family transition, and care of the aging
parent
♦ Contributes to the next generation by performing meaningful work as they extend their concern to the
community and the world.
COMMON CONDITIONS MILITATING AGAINST GOOD SOCIAL ADJUSTMENTS IN MIDDLE AGE

a. The “Rocking Chair “ Philosophy e. Unattractive appearance
b. Lack of social skills f. Preference for family contacts
c. Financial problems g. Family pressures
d. Desire for popularity h. Social mobility
PSYCHOSEXUAL DEVELOPMENT : Genital Stage

♦ The woman may desire more sexual activity because pregnancy is no longer a possibility, on the other hand,
she may feel less sexually attractive and may not participate in regular sexual intercourse or may feel less in
her sexual relationship.
♦ The man may notice changes in the strength of his erection and a decrease in his ability to experience repeated
orgasms.
The Male Climacteric Syndrome
a. Decline in the functioning of the sex organs f. Decline in sexual desire
b. Decline in masculine appearance g. Decline in strength and endurance
c. Loss of virility h. Decline in gonadal activity
d. Physical discomforts i. Personality changes
e. Impotence j. Less pronounced secondary sex characteristics
The Menopausal Syndrome
a. Cessation of menstruation e. Generalized atrophy of the reproductive system
b. Decline in feminine appearance f. Less pronounced secondary sex characteristics
c. Physical discomforts g. Personality changes
d. Weight gain h. Knobbiness- painful joints
MORAL DEVELOPMENT : Post-conventional level : Stage 6. Universal Principles (Principled conscience)

♦ Rights of others take precedence and they take steps to support another’s rights
♦ For women, morality is being responsible in behavior and exercising care with and avoiding hurt to others
♦ For men, morality is general practice and fairness
SPIRITUAL DEVELOPMENT : Stage 5 – Conjunctive (middle adult)

♦ This stage is when the struggles and questioning of stage four give way to a more comfortable place.
Some answers have been found and the person at this stage is comfortable knowing that all the answers
might not be easily found.
♦ In this stage, the strong need for individual self-reflection gives way to a sense of the importance of community
in faith development.
♦ People at this stage are also much more open to other people's faith perspectives. This is not because they are
moving away from their faith but because they have a realization that other people's faiths might inform and
deepen their own.
♦ Awareness of truths from a variety of viewpoints
CONCERNS OF A MIDDLE-AGED ADULT

1. Nutrition
♦ High fiber, protein, minerals, vitamins, fluids
♦ Low cholesterol, calories, salt
Calcium
♦ Men = 1000 mgs/day
♦ Women = 1200 mgs – 1500 mgs/day
♦ Post menopausal= 2000 mgs/day
Nursing responsibilities:
a. Chew food well
b. Eat smaller portions
c. Eat in a pleasant & unhurried atmosphere
d. Avoid eating when overtired
2. Rest, sleep, exercise for better maintenance & to modify and retard aging process
PROMOTION OF HEALTH
1. Regular physical examination 5. Work through emotional & family concerns related to middle age
2. Pursuit of leisure activity 6. Affirm the worth of self as a middle and aged Person
3. Use of relaxation technique 7. Prepare for possible accidents/illness
4. Prepare for the later years 8. Confront developmental tasks
HEALTH PROBLEMS
a. Obesity c. Substance abuse
b. Chronic diseases d. Cancer
THE LATE ADULT

♦ 65 years old and above
Geriatrics ♦ the branch of medicine concerned with the diagnosis, treatment and prevention of disease in older people
and the problems specific to aging
Gerontology ♦ from the Greek word geron, "old man" and logy, "study of"
♦ the study of the social, psychological and biological aspects of aging
Senescence ♦ from the Latin word senex, meaning old man, old age, or advanced in age
♦ the process of becoming old
Aging ♦ the organic process of growing older and showing the effects of increasing age
Old Age ♦ the last period of human life, now often considered to be the years after 65
CHARACTERISTICS OF OLD AGE

1. A Period of Decline
♦ Old age is one marked by decline' both of physical and mental activities.
♦ Changes are involutional, involving a regression to the earlier stage swhich is a natural accompaniment
of aging.
2. Desire for Rejuvenation:
♦ People had been trying to stay young from time immemorial. Witchcraft, potions etc. were used for this end in
the ancient time. Today the elderly tries to remain young using medicines.
♦ The desire for remaining young is a general characteristic of the elderly
THEORIES OF THE AGING PROCESS

A. Genetic Theories
♦ states that life span of a human is programmed within the genes, thus for short or long life.
1. Random error theory (Progeria)
2. Gene regulation theory (2 types of genes)
3. Somatic mutation Theory (Mutations in organs other than repro)
4. DNA damage theory (mutation/apoptosis)
B. Non-Genetic Theories
♦ Suggest that changes occur in the cellular proteins after their formation.
1. Free Radical theory (Oxidation)
2. Cross- Linking theory (Collagen)
3. Accumulation theory
4. Deprivation theory
5. Wear-and- Tear theory
C. Physiologic Theories
♦ Explains aging on the basis of a breakdown of an organ system or impairment in neuroendocrine
or physiologic control mechanism
1. Biological Clock theory
2. Immune theory
D. Psychosocial Theories
♦ Lifestyle, personality and environmental factors also influence longevity
1. Continuity theory
2. Activity theory
3. Symbolic Interaction theory
4. Disengagement theory
PSYCHOSEXUAL DEVELOPMENT : The Genital Stage (Puberty to Death)

♦ Erogenous Zone: Maturing Sexual Interests
PSYCHOSOCIAL DEVELOPMENT : Ego Integrity vs. Despair

♦ To review one’s life & derive meaning from both positive & negative events, while achieving a positive sense of self.
♦ Those who feel proud of their accomplishments will feel a sense of integrity.
♦ Successfully completing this phase means looking back with few regrets and a general feeling of satisfaction.
COGNITIVE DEVELOPMENT : Formal operational stage (11 yrs to adulthood)
MORAL DEVELOPMENT : Stage 7: Transcendental Morality or Morality of Cosmic Orientation

♦ Kohlberg's theory centers on the notion that justice and values are the essential characteristic of moral reasoning
♦ Justice itself relies heavily upon the notion of sound reasoning based on principles:
a. Men use the “ethic of justice” (according to rules and rights)
b. Women use the ethic of care (obligation to care and not to hurt)
FAITH DEVELOPMENT : Stage 6: Universalizing Faith

♦ Becomes an incarnation of the principles of love and justice
♦ Person loves with God’s love
“Enlightenment”
♦ The individual would treat any person with compassion and with universal principles of love and justice
♦ They are able to sacrifice their own well-being to that of their cause; risk their own safety in order to help the
helpless in unexpected ways.
♦ Reached only by the very, very few. Examples are: Gandhi, Martin Luther King, Jr. and Mother Teresa
CONCERNS OF OLD AGE

1. AGEISM
♦ the practice of treating older people as helpless, unproductive and powerless.
2. Polypharmacy
♦ the simultaneous use of multiple drugs to treat a single ailment or condition.
3. Risk for Falls
4. Visual and hearing impairment
5. Malnutrition
6. Social disengagement
7. Elderly Abuse
a. Powerlessness
♦ characterized by feelings of no control or a sense that one’s actions will have no significant impact on an
outcome
b. Hopelessness
♦ A subjective state in which an individual sees limited or unavailable alternatives or personal choices and is
unable to mobilize energy on own behalf
8. Sensory deprivation
9. Sleeplessness
Melatonin
♦ important to regulate normal sleep cycles
♦ noted to induce sedation and lower core body temperature
AREAS OF PREPARATION
CHRONIC ILLNESS
FOR OLD AGE
1. Alzeimer’s 5. Cardiovascular Diseases 1. Health
2. Arthritis a. Hypertension 2. Retirement
3. Osteoporosis b. Coronary Artery Disease (Angina; MI) 3. Use of leisure time
4. Respiratory Diseases c. Congestive Heart Failure 4. Financial independence
a. Pneumonia d. Cerebro Vascular Disease (CVA) 5. Social contacts
b. Tuberculosis e. Peripheral Vascular Disease 6. Role changes
7. Life patterns
References:
Hockenberry, Wilson. Wong’s Nursing Care for Infants and Children. 8th ed. Elsevier Pte Ltd. 2010
Pilliteri, Adelle. Maternal and Child Health Nursing. 5th ed. Lippincott Williams and Wilkins. 2010
Kozier and Erbs. Fundamentals of Nursing. 8th ed. Pearson Prentice Hall. 2010
Wilson, David. Wong’s Clinical Manual of Pediatric Nursing. 8 th ed. St. Louis, Mo.Mosby. 2012
Wong’s Nursing Care of Infants and Children. 9th ed. St. Louis, Mo.Mosby. 2011
Cantrell, Mary Ann. Pediatric Nursing. New York: McGraw-Hill. 2011
Pilliteri, Adele. Maternal and Health Nursing: Care of the Childbearing and Childrearing Family. 6 th ed. Philadelphia: Wolters
Kluwer Health. Lippincott Williams & Wilkins. 2010
Grading System:
Quiz ----------------------- 40 %
Requirements ---------- 20 %
Concept Exams ------- 40 %
100 %
Prepared by :
ELIZABETH FERNANDEZ-HACIÑAS, RN, MAN, RM, Ed.D.
Lecturer
Cp # 09178197345
Consultation day : Th-F : 2:00 pm-4:00pm
Room : Consultation Room

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Far Eastern University

Course Code : NCM 101

Pre-Requisite : FNP, Health Assessment, Anatomy and Physiology

Co-requisite : Microbiology and Parasitology

Placement : 2nd year, 1st semester

Ways to measure development:

Five Main Areas of Development:

PRINCIPLES OF GROWTH AND DEVELOPMENT

3. All aspects of development are interrelated

Major Factors Influencing Growth and Development

Reaction Patterns That Determine Temperament

STAGES OF GROWTH AND DEVELOPMENT

Development of mental function & personality development

Factors Affecting Personality development:

PSYCHOSEXUAL DEVELOPMENT THEORY (SIGMUND FREUD)

Birth to 1 Year – Oral Stage

Anal Retentive Personality

PSYCHOSOCIAL DEVELOPMENT THEORY (ERIK ERIKSON)

0–1 yr - Trust vs Mistrust 11-18 yrs - Identity vs Role Confusion

How to develop Trust

♦ Maladaptation/Malignancy: Overextension and rejectivity

C. COGNITIVE DEVELOPMENT THEORY (JEAN PIAGET)

DEVELOPMENT OF BODY IMAGE

DEVELOPMENT OF SELF CONCEPT

JEAN PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

Stage Age Description

Stage Age Description

Stage Age Description

Stage Age Description

Stage Age Description

Stage Age Description

Stage Age Description

MORAL DEVELOPMENT THEORY (LAWRENCE KOHLBERG)

LAWRENCE KOHLBERG’S STAGES OF MORAL DEVELOPMENT

STAGE AGE DESCRIPTION

STAGE AGE DESCRIPTION

STAGE AGE DESCRIPTION

STAGES OF FAITH DEVELOPMENT (JAMES FOWLERS)

JAMES FOWLER’S SEVEN STAGES OF FAITH

STAGE AGE DESCRIPTION

STAGE AGE DESCRIPTION

DANIEL LEVINSON’S FOUR ERAS OF LIFE OR SEASONS OF THE LIFE CYCLE

I. Childhood and adolescence: birth to 20 III. Middle adulthood: 40 - 65

STEPHEN JAY GOULD’S SEVEN STAGES OF ADULT DEVELOPMENT

ROBERT PECK’S THEORY ON ADULT DEVELOPMENT

Stage 3: Ego transcendence vs Ego preoccupation

ROBERT HAVIGHURST – DEVELOPMENTAL TASKS

HAVIGHURST’S DEVELOPMENTAL TASKS

DEVELOPMENTAL STAGE DEVELOPMENTAL TASK

DEVELOPMENTAL STAGE DEVELOPMENTAL TASK

Characteristics of Infancy stage:

3. Infancy is the time of radical adjustments.

GROWTH & DEVELOPMENT OF THE INFANT

Neonatal period Six months

STAGES OF LANGUAGE DEVELOPMENT

PSYCHOSOCIAL DEVELOPMENT (ERIK ERIKSON) : Developmental task: Trust versus Mistrust

♦ Personal-social behavior includes the child’s personal responses to the environment

PSYCHOSEXUAL DEVELOPMENT: ORAL PHASE (SIGMUND FREUD)

DEVELOPMENT OF BODY IMAGE:

CONCERNS OF THE INFANT

PROMOTION OF HEALTH DURING INFANCY

Problems related to nutrition:

PROMOTING INFANT DEVELOPMENT IN DAILY ACTIVITIES