GnD Ladewig

Maternal & Child Nursing Care, 2/eBy London / Ladewig / Ball / Bindler

© 2007 by Pearson Education, Inc.Pearson Prentice Hall

Upper Saddle River, New Jersey 07458

Maternal & Child Nursing Care

Second Edition

Lecture NotesChapter 33

Growth and Development

Marcia L. LondonPatricia W. Ladewig

Jane W. BallRuth C. Bindler




Developmental Theory: Freud

• Early childhood experiences form unconscious motivation for action later in life

• Sexual energy is centered in specific parts of the body at certain ages

• Unresolved conflict at a certain stage leads to a fixation of development at that stage




Freud’s Stages of Development

• Oral (birth to 1 year): Derives pleasure from mouth

• Anal (1 to 3 years): Control over body secretions• Phallic (3 to 6 years): Works out relationships

with parents• Latency (6 to 12 years): Sexual energy is at rest• Genital (12 years to adulthood): Mature sexuality




Developmental Theory: Erikson

• Eight periods of psychosocial development• Occur from birth through old age• Two possible outcomes

Healthy: Move on to next stage Unhealthy: Problem with future relationships




Erikson’s Stages of Development (Pediatric)

• Trust versus mistrust (birth to 1 year)• Autonomy versus shame and doubt (1 to 3

years)• Initiative versus guilt (3 to 6 years)• Industry versus inferiority (6 to 12 years)• Identity versus role confusion (12 to 18

years)




Developmental Theory: Piaget

• Child’s view of the world is largely influenced by

Age Experience Maturational ability

• Focuses on cognitive (or intellectual) development




Piaget’s Stages of Development

• Sensorimotor (birth to 2 years)• Preoperational (2 to 7 years)• Concrete operational (7 to 11 years)• Formal operational (11 years to adulthood)




Developmental Theory: Kohlberg

• Examines moral development• Three levels of moral reasoning• Described age guidelines - many people

never reach highest stage




Kohlberg’s Stages of Moral Development

• Preconventional (4 to 7 years)• Conventional (7 to 12 years)• Postconventional (12 years and older)




Social Learning Theorists

• Children learn attitudes, beliefs, and customs through social contact

• Children imitate behaviors they see• If positively rewarded, they repeat

behaviors• Concept of self-efficacy - expectation that

someone can produce desired event




Behaviorism Theories

• Applied ideas of Pavlov and Skinner to children

• Can elicit behaviors through positive reinforcement

• Can extinguish behaviors through negative reinforcement




Nursing Interventions: Infants

• Encourage parents to hold and stay with infant

• Provide opportunities for sucking• Provide toys that give comfort or stimulate

interest• Pain control (trust)




Nursing Interventions: Toddlers

• Toilet-training procedures Do not begin toilet-training in hospital Accept regression during hospitalization

• Encourage independent behaviors - feeding, hygiene, dressing self

• Give short explanations• Reward appropriate behavior




Nursing Interventions: Preschoolers

• Encourage parental involvement• Provide safe versions of medical

equipment for play• Give clear explanations about illness -

explain that child is not responsible for the illness

• Allow child to draw




Nursing Interventions: School-Age

• Provide gowns, covers, and underwear• Explain treatments and procedures• Encourage school work• Encourage hobbies, favorite activities




Nursing Interventions: Adolescents

• Provide privacy• Interview separately from parents when

possible• Encourage participation in care and

decision-making• Encourage peer visitation• Provide information on sexuality




Ecologic Theory (Bronfenbrenner)

• Each child is unique• Emphasizes presence of mutual

interactions between child and various settings

• Neither nature nor nurture is more important

• Levels and systems




Temperament Theory

• Focuses on wide spectrum of behaviors in children

• How children respond to daily events• Based on New York Longitudinal Study

(1956 to present)




TABLE 33–5 Nine Parameters of Personality




TABLE 33–6 Patterns of Temperament




Resilience: Basic Ideas

• Resilience: Ability to function with healthy responses, even when faced with stress and adversity

• Protective factors Provide strength Examples

• Risk factors Contribute to the challenge Examples




Resiliency Theory

• All individuals experience crises that lead to adaptation and development of inner strengths

• Increases ability to handle future crises




Development During Infancy

• Time of rapid growth and change• Birth weight

Doubles by 5 months Triples by 1 year

• Begins to understand meanings of sounds and words

• By 1 year, able to feed self




Major Developmental Milestones During Infancy

• Rolls over• Sits up• Stands• Able to say 1 or 2 words• Uses pincer grasp well




Development: Toddlers

• Typically independent and negative• Proud of new accomplishments• Rate of growth and food intake slows• Birth weight quadruples by 2 years• At 2 years, child is one-half of adult height




Major Developmental Milestones: Toddlers

• Walks up and down stairs• Undresses self• Scribbles on paper• Kicks a ball• Has a vocabulary of 1,000 words - uses

short sentences




Development: Preschoolers

• Most children in daycare or school• Increased social activities and contacts• Language skills well-developed• Writing ability improved• Physical skills developed




Major Developmental Milestones: Preschoolers

• Uses scissors• Rides bicycle with training wheels• Throws a ball• Holds a bat• Writes a few letters• All parts of speech are well-developed




Development: School-Age Children

• Very industrious• Find activities they enjoy and excel in• Contributes to sense of achievement, self

esteem• Peers becoming more important




Major Developmental Milestones: School-Age Children

• Possesses reading ability• Rides a two-wheeled bike• Jumps rope• Plays organized sports• Mature use of language




Development: Adolescents

• Transition: End of childhood and beginning of adulthood

• Identity formation: “Who am I?”• Puberty and rapid growth changes• New activities• Less dependent on parents for

transportation• Peers are important




Major Developmental Milestones: Adolescence

• Fine motor skills well-developed• Gross motor skills improve due to growth

spurts• Able to apply abstract thought and analysis




Assessing Growth and Development

• Use combination of developmental theories and assessments

• Holistic approach• Categories of Assessment

Physical growth Cognitive development Psychosocial development Personality and temperament Communication Sexuality




Children at Play

• Play is the “work of childhood”• Play contributes to:

Cognitive growth Physical development: Gross motor skills and

fine motor skills Social interaction




Infants at Play

• Primarily enjoy solitary play• Others may teach infants how to play with

new objects• Progress from reacting to objects (rattle) to

manipulating them• Once they become mobile, sphere of play

enlarges




Toddlers at Play

• Increased motor skills allow new types of toys and play

• Play becomes more social, often with other toddlers - parallel play

• Imitates behavior• Manipulating objects helps them to learn

about their qualities (Example: Square block will not fit in round hole)




Preschoolers at Play

• Interacts with others during play• Enjoys large motor activities• Increased manual dexterity• Fantasy play




School-Age Children at Play

• Increased physical abilities allow for wide variety of play

• Understanding of rules of a game - like for rules to be followed during play

• Cooperative play




Adolescents at Play

• Increased maturity leads to new activities and ways to play

• Peer group becomes focus of activities• Less reliant on parents for transportation• Social interactions important




Nursing Interventions and Development

• Assess growth and development - holistic approach

• Tailor nursing interventions based on this data




General Principles: Interventions and Development

• Discuss proper nutrition and feeding techniques

• Conduct health teachings and screenings based on child’s age

• Encourage family to discover child’s personality and temperament

• Instruct parents about expected language skills




General Principles: Interventions and Development

• Give parents information about normal sexual behavior of children

• Instruct school-age children about expected changes of puberty

• Give adolescents information about Birth control Sexually transmitted diseases

Documents

GnD Ladewig