Concepts on Growth & Development

Every Day Fine Infants Enter Eager & Excited

 I. GROWTH

Growth - is generally used to denote an increase in

physical size or quantitative changes
Parameters for Growth:
1. Weight:
▪ Birthweight is 2x at 6 mos
▪ 3x at age of 1 year; and 4x at 2-2 1/2 years
▪ Toddler’s weight gain is 3 lbs/year
▪ Pre-school weight gain is 5 lbs/year
▪ School age is 5-7 lbs/year
 I. GROWTH

Parameters for Growth:

2. Height:
▪ Height gain in infant is 10 inches/ year
▪ In toddlers 3 inches/ year
▪ In pre-school 2 ½ to 3 inches/ year
▪ In school age 2 ½ to 3 inches/ year
▪ Adolescents is 3 inches in girls and 8
inches/year
 II. DEVELOPMENT

▪ It refers to increase in skills and capacity to

function.
▪ It is also known as qualitative changes.
▪ It is synonymous to maturation.
▪ Aspects of Development:
1. Personal - Social-Adaptive
2. Emotional
3. Motor
4. Cognitive
 Principles of Growth and
Development

1. Growth and development are continuous process from conception until

death.
‒ Although there are high and lows in terms of the rate at which growth
and development proceed, a child is growing new cells and learning
new task. Like an infant triples in birth weight and increases height by
50% during the first year of life, and this growth rate continues.
2. Growth and development proceed in an orderly sequence.
– Growth in height occurs in only one sequence- from smaller to larger,
and development also proceeds in a predictable order.
– Like majority of children sits before they crawl, and crawl before they
stand, stand before they walk, and walk before they run.
– Occasionally the child may skip a stage [ or pass through it so quickly in
which the parents may not observe the stage.
– Occasionally also, a child will progress in a different order, but most
children follow a predictable sequence of growth and development.
 Principles of Growth and
Development

3. Different children pass through the predictable stages at

different rates.
‒ Like two children may pass through the motor sequence
at such different rates, for example, that one begins to
walk at 9 months, where as another starts at 14 months.
They are both following the predictable sequence and
are developing normally, they are merely developing at
different rates
4. All body systems do not develop at the same rate
– Certain body tissues mature more rapidly than others.
Like neurologic tissue experiences its peak growth during
the first year of life, whereas
– genital tissue grows little until puberty.
 Principles of Growth and
Development

5. Development is “cephalocaudal” (head to tail)

– (Cephalo- means head, and caudal means tail).
so, development proceeds from head to tail.
– Newborn can lift only their head off the bed when
they lie in a prone position. By 2 months can
both lift their head and chest, at 4 months , the
head chest and abdomen , by 5 months, can turn
over, by 9 month, they can control legs enough
to crawl, and by 1 year infant can stand and
perhaps walk.
 Principles of Growth and
Development

6. Development proceeds from “proximal to distal” body

parts.
– This principle is closely related to cephalocaudal
development.
– A newborn makes a little use of the arms and hands,
except to put a thumb in the mouth, is a flailing motion.
– By age 3 or 4 months, the infant has enough arm control
to support the upper body weight on the forearms and
can coordinate the hand to scoop up objects.
– By 10 months, the infant can coordinate the arm and
thumb and index fingers to use a pincerlike grasp or to
be able to pick up an object or breakfast cereal on a tray.
 Principles of Growth and
Development

7. Development proceeds from gross to refine skills.

‒ Once children are able to control distal body parts
such as fingers, they are able to perform fine motor
skills. ( like a 3 year old colors best with a large
crayon, and a 12 year old can write with a fine pen).
8. There is an optimum time for initiation of experiences
or learning. Children can not learn tasks until their
nervous system is mature enough to allow that
particular learning.
– Children who are not given the opportunity to learn
development tasks at the appropriate or target times
may have difficulty than the usual child learning the
task later on.
 Principles of Growth and
Development

9. Neonatal reflexes must be lost before development can

proceed.
– An infant cannot grasp an item with skill until the grasp
reflex has faded nor can the infant stand steadily until the
walking reflex has faded .
– Neonatal reflexes are replaced by purposeful movement.
10. A great deal of skill and behavior is learned by practice.
– Infants practice over and over taking a first step before
they accomplish this securely.
– If children fall behind in growth and cevelopment
because of an illness, they are capable of “ catch up”
growth to bring them equal again with their age group.
 Factors Influencing Growth and
Development

1. Genetics: From the moment of conception when

a sperm and ovum fuse, the basic genetic make
up of an individual is cast.
– In addition to physical characteristics such eye
color and height potential, inheritance
determines characteristics such as learning
style.
– A child may also inherit a genetic abnormality,
which could result in disability and illness at
birth or later in life and so prevent optimal
growth.
 Factors Influencing Growth and
Development

2. Environment: This could hinder child’s growth if with:

– Inadequate nutrition, because of family’s low socio-
economic status
– Parent’s lack of child care skills, or not give enough
attention or stimulation
– A child with chronic or infectious illness and left behind
with long term disability. Illness can lower children’s
appetite, thus interfering with growth
Factors Influencing Growth and
Development

– Existing endocrine disorder to a child- directly may alter

the growth rate.
• Having a parent who abuses alcohol or other
substances ca cause such inconsistency in care that it
can affect mental health.
• Ordinal position in the family:
– First born child or only child- may generally excels
in language because conversations are only with
adults.
– Youngest children may develop language more
slowly especially if older children talk “baby talk”
with them.
 Patterns of Growth and
Development

These patterns are definite and predictable

A. Directional Pattern:
▪ Cephalocaudal (head to tail)
▪ Proximdistal (midline to peripheral)
▪ Mass to specific (differentiation)
B. Sequential Pattern:
▪ Ex: Locomotion
▪ Behaviors - (language & social skills)
C. Secular Pattern:
 Theories of Growth and
Development

Theory - a systematic statement of principles that

provides a framework for explaining a phenomenon
Developmental Tasks - is a skill or growth
responsibility arising at a particular time in an
individual’s life, the achievement of which will provide
a foundation for the accomplishment of future tasks
 Freud’s Analytic Theory

• Sigmund Freud (1856 - 1939)

– Austrian Neurologist and the founder of
psychoanalysis
– he described adult behavior as being the result
of instinctual drives that a primarily sexual nature
(libido) that arise from within the person and the
conflicts that develop between these instincts
– represented in the individual as the Id; Reality,
the Ego; and the society/conscience as
Superego.
Erikson’s Theory of Psychosocial
Development

• Erik Erikson (1902 - 1996)

– a theory that stresses the importance of culture
and society in development personality.
– he described eight developmental stages
covering the entire life span
 Piaget’s Theory of Cognitive
Development

• Jean Piaget (1896 - 1980)

– a Swiss psychologist who introduced the
concepts of cognitive development or the way
children learn and think. Piaget defined four
stages of cognitive development
 Kohlberg's Theory of Moral
Development

• Lawrence Kholberg (1927 - 1987)

‒ a psychologist
‒ studied the reasoning ability of boys and develop
a theory on the way children gain knowledge of
right and wrong or moral reasoning.
 THEORIES OF GROWTH AND DEVELOPMENT
AGE PSYCHOSEXUAL PSYCHOSOCIAL COGNITIVE
THEORY THEORY THEORY
(FREUDIAN) (ERICKSON) (PIAGET)
INFANCY Oral Stage Trust vs Mistrust Sensorimototr
“Id” stage Consistency needed for Reflexes,
development of trust Primary, secondary &
secondary reaction
Inventions of new means

All pleasure
TODDLER “Anal” stage Autonomy vs Shame and Doubt Sensorimotor

Ego stage -limit setting Preconceptual: 2-4 yr

“Egocentric”
-selfish

PRESCHOOL “Phallic stage” Initiative vs Guilt Preoperational: 2-7 yr

Super Ego
Cooperative Intuitive thought: 4-7 yr
Oedipus
Electra
 THEORIES OF GROWTH AND DEVELOPMENT
AGE PSYCHOSEXUAL PSYCHOSOCIAL COGNITIVE
THEORY THEORY THEORY
(FREUDIAN) (ERICKSON) (PIAGET)
SCHOOL AGE Laterncy stage (most Industry vs Inferiority Concrete Operations: 7-
quiet stage) 12 yrs
Strict Super Ego – (more
cooperative)
-to win friends
ADOLESCENCE Genital Stage Identity vs Role Formal operations: 13-
16y rs
-tries genital relationship

“adolescence marriage”
(crisis situation)
 Freudian Nursing Implications

• Infancy - I month – 1 year (Oral stage)

– Id Stage - All pleasures
– Provides oral stimulation
• (Do not discourage thumb sucking)
 Freudian Nursing Implications

• Toddler - 1-3 years (Anal Stage)

– Ego stage
• Egocentric (selfish)
• Help children achieve bowel and bladder control
without undue emphasis on its importance.
 Freudian Nursing Implications

• Pre-school - 3-5 years (Phallic Stage)

– Oedipus complex / Electra complex
– Accept child’s sexual interest
– Help parents answer child’s questions about
birth/sexual differences
 Freudian Nursing Implications

• School age - 6-12 years (Latency stage)

– help children have positive experiences with
learning to develop self-esteem
– Prepare the child for the conflicts of adolescence
 Freudian Nursing Implications

• Adolescence - 13- 21 years (Genital stage)

– provide opportunities for the child to relate with
opposite sex
– allow to verbalize feelings about new
relationships
 Ericson Nursing Implications

• Trust vs Mistrust – 1 month to 1 year

– Child learns to love and be loved
– Consistency needed for development of trust
– Provide experiences that may add to security
– Provide soft sound and gentle touch
– Provide visual stimulation
 Ericson Nursing Implications

• Autonomy vs Shame and Doubt - 1-3 years

– Child learns to be independent
– Provide opportunities for decision making
 Ericson Nursing Implications

• Initiative vs Guilt - 3-5 years

– Provide opportunities for exploring new places
and activities
 Ericson Nursing Implications

• Industry vs Inferiority, 6- 12 years

– Provide opportunities to allow child to assemble
or complete a short project
– Give the child recognition and reward for
accomplishments
 Ericson Nursing Implications

• Identity vs Role Diffusion - 13- 21 years

– Provide opportunities to discuss feelings about
events important for him or her
– Offer support and praise for decision making
 Piaget Nursing Implications

• Sensorimotor - 0-2 years

– Relates to senses and nerves
– Provides enjoyable and pleasant activities
 Piaget Nursing Implications

• Pre-conceptual/Pre-operational - 2-4 years

– Provide activities that requires imagination
 Piaget Nursing Implications

• Intuitive thought - 4-7 years

– The child intuitive thought process uses many
words appropriately but lacks real knowledge of
their meaning
– Provide activities that applies mathematical
counting and classifying
– Role modeling of applying words into action
 Piaget Nursing Implications

• Concrete Operations – 7- 12 years

– Uses memory to learn broad concepts and
classifications
– Expose the child to other ideas / viewpoints by
asking questions
 Piaget Nursing Implications

• Formal Operations - 13 years to adulthood

– Can solve hypothetical with scientific reasoning or
abstract reasoning
– Development of idealism
– Provide intellectual activity and sort through
attitudes and opinions
 Health Maintenance in Infancy

• Nutrition
– 1,200 calories = caloric requirement/ day
– 4-6 months = introduction of solid foods (cues to readiness
for solid foods)
• Extrusion reflex and sucking fading
– Can sit with support
– Salivary glands and intestinal enzymes that aid in
digestion are not present before 4 – 6 months
– There is a nutritional need to be met ( The fetal iron
liver stores: usually consumed by 4 – 6 months)
 Simple rules to follow when
introducing supplementary foods

• One food at a time.

• Small amount each time (1 tsp.)
• Have an interval of 4 – 7 days between new foods
• Don’t mix with formula
• Feed when newborn is hungry after a few sucks of
milk to increase patience for a new food
• Don’t force, bribe, plead, threaten
 Sequence of introducing solids

• Cereals
• Fruits
• Vegetables
• Meats
• Eggyolk
• Fish
• Whole eggs at 1 year (egg white is hyperallergenic)
 Sequence of introducing solids

• Teething foods - at 5 – 6 months

• Chopped table foods at 9 – 12 months
• Chewable foods and finger foods – toast, crackers,
fresh fruit, cheese
• Weaning:
• 6 months – from breast to bottle
• 12 months – from bottle to cup
• There should be no weaning in illness and in
stress
 Food allergies in infancy

• Food causing allergies

– Milk
– Chocolate
– egg white (albumin)
– foods (with wheat, soy, corn)
– citrus fruits
 Food allergies in infancy

• Signs of hypersensitivity to food allergies

– Vomiting
– Diarrhea
– Abdominal pain
– Urticaria
– Respiratory difficulties
• Treatment: remove the cause
 Safety/Accidents

• Leading causes of accidents in infancy

– Aspiration
– Falls
– Suffocation
– Burns
– Poison – lead
– Animal bites
– Motor vehicle
Nursing Process Overview of an
Infant

• Assessment
– Important areas to discuss include:
1. nutrition, elimination, growth patterns and
development. These indicators of growth
should be measured and plotted;
2. height, weight and head circumference
3. physical assessment and the appearance of
the infant
 Nursing Process Overview of an
Infant

• Nursing Diagnosis:
1. Ineffective breastfeeding r/t maternal fatigue
2. Disturbed sleep pattern ( maternal ) r/t baby’s need to nurse every 2
hours
3. Deficient knowledge r/t normal infant growth and development
4. Imbalanced nutrition, less tan body requirements, r/t infant’s difficulty
sucking
5. Health- seeking behaviors r/t adjusting to parenthood
6. Delayed growth and development r/t lack of stimulating
environment
7. Risk for impaired parenting r/t long hospitalization of Infant
8. Readiness for enhanced family coping r/t increased financial support
9. Social isolation ( maternal) r/t lack of adequate social support
10.Ineffective role performance r/t new responsibilities within the family
Nursing Process Overview of an
Infant

• Outcome Identification / Planning

1. Try to suggest activities that can be easily
incorporated into the family’s lifestyle.
2. Encourage parents to spend additional time
each evening reading or reciting nursery
rhymes to their baby.
3. Suggest to parent’s caretaker to talk to their
infant more.
Nursing Process Overview of an
Infant

• Implementation:
1. Teach new parents about normal growth and
development milestones
Nursing Process Overview of an
Infant

• Outcome Evaluation:
1. Mother states, she feels fatigued but able to cope up with
sleep disturbance from night waking.
2. Parents state five actions they are taking daily to
encourage bonding
3. Father states both he and spouse are adjusting to a new
role as parents.
4. parents verbalize appropriate techniques they to
stimulate infant
5. Infant demonstrates age-appropriate growth and
development.
6. Infant exhibits weight, height, and head and chest
circumference within usual norms
 Toddler (1 – 3 years)

• WEIGHT
• LENGTH
• HEAD CIRCUMFERENCE
• FONTANELLES
• TEETHING
• GROSS MOTOR SKILLS
– 15-18 months
– 2 years
– 2 ½ years
– 3 years
 Toddler (1 – 3 years)

• FINE MOTOR SKILLS

– 15-18 months
– 2 years
– 2 ½ years
– 3 years
• LANGUAGE DEVELOPMENT
 Toddler (1 – 3 years)

• PSYCHOSOCIAL SKILLS
– 5 months
– 8 months – 2 ½ years
– 2 ½ years
▪ Behavioral traits include NEGATIVISM (NO-NO STAGE)
▪ Ritualism, dawdling temper tantrums (a means of asserting
independence/autonomy)

*Bedtime represent desertion, may be attached to transitional

object or security blanket
*Territorial – possessive of own body and toys (disinterest in toys
in toddlers is a sign of illness)
 Toddler (1 – 3 years)

COGNITIVE SKILLS
▪ Sensorimotor
18 months ▪ attained object permanence
▪ early signs of memory development
▪ identities geometric shape
▪ points to body parts
▪ active experimentation to achieve goals

18 mos. - 2 yrs ▪ can infer cause from observing event

▪ symbolic imitation “make believe”
▪ object permanence
▪ “magical thinking” begins
▪ egocentric thinking and behavior
 Toddler (1 – 3 years)

• COGNITIVE SKILLS
– Preoperational Stage: Preconceptual (2-4 yrs)
• Symbolism with increase use of language
• Animistic thought (giving animal or human traits to inanimate objects)
• Increasing of prepositions (over, inside, under, etc)
• Egocentrism continues
• Field dependency; all aspects of situation important and interrelated
• Increasing attention span
• Discipline right away after a wrongdoing
 Health Maintenance in
Toddlerhood

• Nutrition
– Caloric requirement: 1300 calories/day
– Physical Anorexia

*Effects
- prone to iron deficiency anemia
 Health Maintenance in
Toddlerhood

• Management for refusal to eat

– Do not force
– Allow child to join others at the table
– Let child feed himself
– Let child decide in order to eat food
– Recognize ritualistic behavior: same chair, plate, spoon and fork,
drinking glass
– Give small portions
– Do not give bottles as a substitute for solids; give solids before or
with a milk
– Do not use food as a reward (may contribute to obesity)
– Let him drink from cup
– Self feeds by 18 months
– Finger foods
– Vitamin supplements, with iron if necessary
 Health Maintenance in
Toddlerhood

• Dentition/Dental Care
– brush and floss daily (w/ parents help) twice daily
– 2 ½ - 3 yrs = as soon as all deciduous teeth are
out, he can have the FIRST DENTAL VISIT
– If water is not fluorinated, give supplements: 0.25
– 5 mg/day
– Limit concentrated sweets
– Do not allow child a bottle of milk or juice to bed
since it produces “MOUTH CARIES”
 Health Maintenance in
Toddlerhood

• TOILET TRAINING
– This is a MAJOR TASK of toddlerhood. May use
to toileting to control others and self.
– Requisites to Toilet Training:
– Physiological Readiness - ***sphincter control
– Psychologic Readiness
– Desire to please the Mother
 Health Maintenance in
Toddlerhood

• TOILET TRAINING
– SCHEDULE/TIMING OF TOILET TRAINING
• 15-18 months
• 18 months-2 yrs
• 2-3 yrs
• 3-4 yrs
– PRINCIPLES OF TOILET TRAINING
• Consistency
• Firm but not strict
• Positive maternal attitude
 Health Maintenance in
Toddlerhood

• PLAY
– the toddler’s “work; language of the child
– Parallel play
– Games
– Toys
– Safety precautions
 Health Maintenance in
Toddlerhood

• DISCIPLINE and SETTING LIMITS

– Principles
• Immediately after a wrongdoing
• Consistency and firmness
• Disapprove of the behavior and NOT of the child
• Positive approach
• Allow the child to explain; explain the reason for your
disciplining him
• Safety in disciplining
• Provide physical care after, so that DOUBT will be erased,
and instead AUTONOMY reinforced
• Withdraw privileges and NOT BASIC NEEDS (i.e. not
sending the child to sleep without dinner
 Health Maintenance in
Toddlerhood

• DISCIPLINE and SETTING LIMITS

– Forms of Discipline
• Ignoring (the best for temper tantrums)
• Redirecting the child’s attention
• Time – out
• Corporal punishment (controversial) “palo” system
(Phils.)
• Explaining and reasoning, reprimanding, and loss of
privileges for older children
 Health Maintenance in
Toddlerhood

• DISCIPLINE and SETTING LIMITS

– Effect of Good Discipline
• (3 S’s of Good Discipline)
• SECURITY
• SELF - CONTROL
• SOCIALLY APPROPRIATE/ACCEPTANCE
BEHAVIOR
 Health Maintenance in
Toddlerhood

• ACCIDENT PREVENTION
*Accident - the leading cause of death in 1-5
years
– Falls
– Poisoning
– Burns
– Drowning
– Cuts and Stabs
Overview of the Nursing Process
(Toddler)

• Assessment
1. Careful health history about:
▪ Child’s developmental progress
▪ Toddler’s ability to carry out activities of
daily living
2. Careful observation of child’s behavior
Overview of the Nursing Process
(Toddler)

• Nursing Diagnosis
1. Health - seeking behaviors r/t normal toddler
development
2. Deficient knowledge r/t best method of toilet training
3. Risk for injury r/t impulsiveness of the toddler
4. Interrupted family process r/t the need for close supervision of a
2 year old
5. Readiness for enhanced family coping r/t the parent’s ability to
adjust to the new needs of the child
6. Risk for imbalanced nutrition, more than body, r/t fast food
choices
7. Disturbed sleep pattern r/t lack of bedtime routine
Overview of the Nursing Process
(Toddler)

• Outcome Identification / Planning

– Urge the parents to establish realistic goals and
outcomes, so they can meet the rapidly changing
needs of their toddler and learn to cope with
typical toddler behaviors.
Overview of the Nursing Process
(Toddler)

• Implementation
1. teach parents that a good rule is to think of a toddler as a
visitor from a foreign land, who wants to participate in
everything the family is doing, but doesn’t know the custom or
the language.
2. teach parents not only how to approach a current problem, but
also how to learn adequate methods for resolving similar
situations that are sure to arise in the future.
3. health visits provide opportunities to help parents learn
healthier coping techniques as well as time to demonstrate
effective communication skills so parents can improve their
interactions with their child.
Overview of the Nursing Process
(Toddler)

• Outcome evaluation
1. parents state the child maintain a consistent
bedtime routine within the next two weeks.
2. parents state they have childproofed their home
by putting a lock on kitchen cupboards by the
next clinic visit
3. grandmother states she has modified usual
activities to conserve strength to care for
toddler granddaughter by one week’s time.
 The Preschooler
(3 – 6 years old)
• GROSS MOTOR SKILLS
• WEIGHT
3 years ▪ rides a tricycle
▪ climbs up steps alternating feet
• HEIGHT ▪ walks backwards
• TEETHING ▪ stands on one foot (2 – 3 inches)
▪ catches ball with some misses
4 years ▪ walks down stairs alternating feet (can walk up &
down stairs like an adult)
▪ balances on one foot (5 seconds)
▪ hops and skips on one foot
▪ catches ball without missing
5 years ▪ skips; hops alternating feet
▪ jumps rope, roller skates
▪ backward heel to toe walking
▪ throws and catches ball well
▪ stand on one foot ( 10 seconds) with eyes closed
 The Preschooler
(3 – 6 years old)
• FINE MOTOR SKILLS: with Hand Dominance
3 years ▪ undresses self; dresses with help
▪ copies circle; imitates cross
▪ builds tower of 9 – 10 blocks
▪ washes hands & feet
▪ makes face in circle

4 years ▪ buttons clothes; laces shoes without bow

▪ copies a square
▪ draws a man with 3 parts
▪ brushes teeth
▪ draws two geometric shapes
▪ dresses self without help (except handling lace & slippers)

5 years ▪ dresses self totally

▪ ties shoelaces
▪ copies rectangle & triangle; diamond at 5 – 6 years old
▪ uses scissors well – to cut outline
▪ prints letters, numbers, words, first name
▪ draws 6 – 9 part stick man with hand preference
 The Preschooler
(3 – 6 years old)

• LANGUAGE DEVELOPMENT
•BOWEL & BLADDER CONTROL
3 years ▪ 960 words
• 4 years old ▪ 3-4 word

• 5 years old
4 years ▪ 1500 word vocabulary
▪ 4 – 5 word sentences
▪ asks “why?” questions; VERY INQUISITIVE; has sexual curiosity
(start sex education)
▪ counts to 5

5 years ▪ 2000 – 2100 word vocabulary

▪ 6 word sentences (adult length sentences)
▪ last year for normal STUTTERING (dysfluency)
▪ Counts to 10
 The Preschooler
(3 – 6 years old)

• PSYCHOSOCIAL SKILLS
1. Decreasing egocentricity with sharing
2. Imitates others; like to pay “dress up” games
3. With gender-specific behavior at 5 years
4. Aggressiveness & impatience
5. Derives satisfaction from accomplishment
6. Needs opportunities to explore different people,
things and events
7. Child views parents as who does no wrong &
giving them security
 The Preschooler
(3 – 6 years old)

• COGNITIVE SKILLS
– Stage of Preparational (2-7years)
• Preconceptual (2-4 years)
• Intuitive thought (4-7 years)
– Centration – focuses on parts not whole; focuses on
one thing at a time
– Magical Fantasy thinking continues
– Increasing concept of time & space; time correlates
with events (i.e. after breakfast, this afternoon, after
nap; uses time-oriented words at 5 years)
– Accepts words in their literal sense
 The Preschooler
(3 – 6 years old)

• PLAY
1. Cooperative Play
▪ These play activities allow education/teaching on
social rules. Sharing & playing small groups, simple
games & rules.
▪ The preschooler’s play & game may be DRAMATIC,
CREATIVE, IMITATIVE & IMAGINATIVE
▪ Toys
▪ Imaginative
▪ Creative
▪ Dramatic/Imitative
▪ Active Games
 Health maintenance in the
preschool age
• NUTRITION
▪ Calories – 1700 calories/day
▪ With food likes (preference) and dislikes
▪ Self-feeder; less picky; feeds self at 4 years; can
set table; can pour from pitcher
 Health Maintenance in the
Preschool Age
• SAFETY AND ACCIDENTS
– Motor Vehicle accident – leading cause
a) Teach safety on streets
b) Motor vehicles safety; USE SEAT BELTS
c) Parents should set “good” examples; they learn best by
imitation
d) Be less reckless, less prone to accidents
e) Other causes of injuries
– Burns
– Drowning
f) General Safety
 Health Maintenance in the
Preschool Age

• SLEEP PATTERNS
a) Has the most amount of sleep disturbances
because of real or imaginative/illogical fears
b) May have fears of the DARK, GHIST,
INANIMATE objects
c) Requires 9-12 hours of night sleep; may give
up nap
d) Resists bedtime
 Health Maintenance in the
Preschool Age

• SEXUAL ACTIVITY
o Aware of sexual differences at age 3
o Curious about anatomical differences & sneaks to investigate
o Imitates “mommy” and “daddy” roles
o Masturbation is normal & especially common in this stage
▪ Management:
• gives substitute toy to play
• do not punish or verbally reprimand
• explanation of privacy of the act & its meaning should be
done by the parents
o Guidelines for Parents/Caregivers
▪ Assess what the child already knows when he asks question
▪ Give answers simply, honestly, matter-of-fact
Overview of the Nursing Process
(Preschool Age)

• Assessment
– Regular Assessment of a preschool includes:
1. obtaining a health history
2. performing both physical and developmental
evaluation at healthcare visits
3. assess child’s weight, height and body mass
index according to standard growth chart.
4. assess child for general appearance
Overview of the Nursing Process
(Preschool Age)
• Nursing Diagnosis
1. health-seeking behaviors r/t developmental
expectations.
2. risk for injury r/t increased independence outside
the home.
3. delayed growth and development r/t frequent
illness.
4. risk for imbalanced nutrition, more than body
requirements, r/t fast food choices
5. risk for poisoning r/t maturational age of the child
6. parental anxiety r/t lack of understanding of
childhood development.
Overview of the Nursing Process
(Preschool Age)

• Outcome Identification / Planning

1. establishing a schedule for discussing normal
preschool development with the parents
2. planning for unintentional injury prevention
3. plan opportunities for adventurous activities
and interaction with other children
Overview of the Nursing Process
(Preschool Age)

• Implementation
1. role playing a mood or attitude you would
like a child to learn
2. unintentional injury prevention - for role
modeling
Overview of the Nursing Process
(Preschool Age)
• Outcome Evaluation
1. child states importance of holding parent’s
hands while crossing streets
2. parents state realistic expectations of 3 year
old child’s motor ability by next visit
3. mother reports she has prepared her 4 year
old for new baby by next visit
 School Age Child
(6-10 years old)

• Annual average: weight gain: 3 to 5 lb.

(1.3 to 2.2 kg.)
• Height: 1- 2 inches ( 2.5 to 5 cm )
• 10 years - brain growth is complete
 School Age Child
(6-10 years old)

• Concerns: Prepubertal Girls

– Taller by about 2 inches (5 cm) or more than
preadolescent boys.
– Conscious of breast development- may wear loose
clothing to hide breast development. Breast development
is not always symmetrical . Super numenary nipples is
normal as an effect of hormones.
– Early preparation for menstruation - important
preparation for future child- bearing and for the girl’s
concept of herself as a woman.
– Vaginal secretions will begin to be present - need to be
explained because a girl might be feared of having an
infection.
 School Age Child
(6-10 years old)
• Concern of Boys
– Increasing genital size - men tend to measure their
manliness by penis size. So a boy who develops late may
feel inferior
– Hypertrophy of breast tissue (gynecomastia) - can occur in
prepuberty, most often in stocky or heavy boys. A
transitory phenomenon and will fade as soon as male
hormones becomes more mature and stable.
– Nocturnal Emissions - a seminal fluid is produced and
begin to notice ejaculation during sleep.
– Pubic hair, but no growth of beard or chest hair - pubic hair
normally appears first and the chest and facial hair may
not grow until several years later.
 School Age Child
(6-10 years old)

• Teeth
– The average child gains 28 teeth between 6 to
12 years old:
• The central and lateral incisors
• First, second and third cuspids
• First and second molars
 School Age Child
(6-10 years old)
Gross Motor Development
6 years old ▪ Endlessly jump, tumble, skip, and hop
▪ Enough coordination to walk a straight line
▪ Many can ride a bicycle.
7 years old ▪ Gender differences usually begin to manifest in play; girl
games and boy games
8 years old ▪ More graceful. They ride a bicycle well and enjoy sports
9 years old ▪ On the go constantly with deadlines to meet
▪ Enough eye-hand coordination to play sports game
10 years old ▪ They are more interested in perfecting their athletic skills than
they were previously.
11 years old ▪ May feel awkward because of their growth spurt
▪ They may channel their energy into constant motion
12 years old ▪ Plunge into activities with intensity and concentration
▪ They often enjoy participating in sports for charities
▪ They may be refreshingly cooperative around the house, able
to handle responsibility and compete given tasks
 School Age Child
(6-10 years old)
Fine Motor Development
6 years old ▪ Can easily tie their shoes
▪ Can cut, paste well, print and draw with good detail

7 years old ▪ Concentrate on fine motor skills more

▪ Can be called an “eraser year “ - because children are never
quite content with what they have done. They set too high
standard for themselves and have difficulty performing at that
level.

8 years old ▪ Eyes are developed enough and can read regular size type.
▪ Can make reading a greater pleasure and school more
enjoyable.
▪ Learn to write script rather than print

9 years old ▪ Their writing begins to look mature and less awkward
 School Age Child
(6-10 years old)
Play
6 years old ▪ Continues to be roughed but begins to spend quite some time
reading
▪ Many children spend hours to an activity that can either foster a
healthy sense of completion or create isolation from others.
7 years old ▪ Require more props for play - which indicates the start of a
decline in imaginative play .
▪ Develop an interest in collecting items.
8 years old ▪ Collection may become increasing structured as children
develop skills for sorting and cataloging
9 years old ▪ Competitive behaviors can develop and cause children to
change the rules in the middle of the game.
10 years old ▪ Become very interested in rules and fairness in competitive play
situations.
▪ Begin discovering the internet and internet searching
▪ Learning to music, artistic expressions and popular dances take
the place of earlier simple games
 School Age Child
(6-10 years old)
Language Development
6 years old ▪ Talk in full sentences, using language easily and with meaning
▪ Still define objects by their use (A key is to unlock the door)

7-8 years old ▪ Can tell the time in hours, but they may have trouble with
concepts such as; half past and quarter to.
▪ Can add and subtract and make simple change (can go to store
for an errand and make simple purchases.)
9-10 years old ▪ Discover dirty jokes and tend to tell them to friends
▪ Short period of intense fascination with ‘bathroom language’,
that parents should avoid from using in their child’s presence
 School Age Child
(6-10 years old)
• Emotional Development
– Developmental Task: Industry Versus Inferiority
– In the early school years, children attempt to master
another developmental step, that is learning the
sense of industry or accomplishment.
– Gaining a sense of industry is learning how to do
things well.
– If children are prevented from achieving a sense of
industry or do not receive rewards for
accomplishment, they can develop a feeling of “
Inferiority “ or become convinced they cannot do
things they actually can do.
 School Age Child
(6-10 years old)
Emotional Development

6 years old ▪ Children play In group, but when they are tired or stressed, they
prefer a one to one contact.
▪ Participate actively in class for a few minutes for attention

7 years old ▪ Increasingly aware of family roles and responsibility

▪ Promises must be kept - because they view them as definite,
firm commitment.
▪ They tattles - because they have a strong sense of justice and
may dissolve quickly as he plays with group.

8 years old ▪ Actively seek the company of other children.

▪ Girls to girls and boys to boys, girls begin to whisper among
themselves which are annoying to both parents and teachers
 School Age Child
(6-10 years old)
Emotional Development
9 years old ▪ Take the values of their peer group very seriously
▪ Interested in how other children dress than in what their
parents want them to wear.
▪ Consider as “ gang “ age - usually children form clubs.
▪ Ready for activities away from home - can take care of their own
needs and are mature enough to be separated from their
parents.
10 years old ▪ Enjoy groups, but also needs to have privacy and space.
▪ The best gift is a “ box that locks “.
 School Age Child
(6-10 years old)
Cognitive Development
5- 7 years old ▪ A transitional stage - a shift from preoperational thought they
used as a preschoolers to concrete operational thought – or the
ability to reason through any problem they can visualize.
 School Age Child
(6-10 years old)
• Cognitive Development
– Children can use Concrete Operational Thought
because they learn several new concepts:
• Decentering - The ability to project oneself into
other people’s situations and sees the world from
their viewpoint rather than focusing only on their
own.
• Accommodation - the ability to adapt thought
processes to fit what is perceived such as
understanding that there can be more than one
reason for other people’s actions. ( school age
child can understand that different nurses work
different shifts.
 School Age Child
(6-10 years old)
• Cognitive Development
– Children can use Concrete Operational Thought – because
they learn several new concepts:
• Conservation - the ability to appreciate that a change in
shape does not necessarily mean a change in size. (30 ml
of med syrup from a thin glass into a wide one), the school
age child will say both glasses hold an equal amount.
• Class Inclusion - the ability to understand that objects
can belong to more than one classification ( A preschooler
can categorize items only in one way, such as stone and
shells are found at the beach; a school age child can
categorize them in many ways like shells and stones are
both found at the beach, but are made of different
materials, and are different in sizes ).
 School Age Child
(6-10 years old)

• Cognitive Development
– The Cognitive Development Lead to some Typical Changes
and Characteristics of the School age.
• Decentering - enables the child to feel compassion with
others
• Accommodation - leads to understanding other people
• Conservation - Sibling and peer argument in shares are
lessened
• Class Inclusion - leads to collecting activities (cards,
holens, pictures, elastic bands ).
• Necessary for learning math and reading- that categorize
numbers and words.
 School Age Child
(6-10 years old)

• Moral and Spiritual Development

– Preconventional Reasoning (Kohlberg) begin to mature
in terms of moral development
– Concentrate on niceness or fairness and can’t see yet
that stealing hurts their neighbor
• the highest level of moral reasoning
• if ask why is it wrong to steal, school age child may
answer “police says it’s wrong” or you’ll go to jail
– Begin to learn the rituals and meaning behind their
religious practices ( the distinction between right and
wrong becomes more important to them
 School Age Child
(6-10 years old)

• Moral and Spiritual Development

– Rule oriented ( when they pray, they may expect their
god to follow also )- if you are good and pray for
something, you should received it, ( this makes them
confused if prayer is not immediately answered .
– Interpret something right, if it is good for them, not
because it is right for humanity as a whole
 School Age Child
(6-10 years old)
Health Promotion
1. Safety for:
Motor Vehicle ▪ Use of seat belts
Accidents ▪ Health instructions for crossing streets, bicycle riding, parking
lot and school bus safety and wearing of helmet
Community ▪ Avoid unsafe areas, do not go with strangers
▪ Should say no to anyone who touches them - it maybe a form
of sexual abuse.
▪ For late school age, teach rules for safer sex.
Burns ▪ Teach safety with candles, matches, campfires
▪ Safety with beginning cooking skills, sun exposure
▪ Do not climb electric poles
Falls ▪ Avoid climbing on roofs, rough housing fences
▪ Teach skateboard, scooter and skating safety
 School Age Child
(6-10 years old)
Health Promotion
1. Safety for:
Sports Injuries ▪ Wearing appropriate equipment for sports
▪ Stress not to play to a point of exhaustion or joining an activity
beyond physical capability- and it should be adult supervision.
Drowning ▪ Teach how to swim. Do not swim beyond limits of capabilities

Drugs ▪ Avoid all recreational drugs and take prescribed meds only.
Avoid cigarettes and alcohol.

Firearms ▪ Avoid firearms use. Keep firearms locked in the cabinet with
bullets separate from gun
 School Age Child
(6-10 years old)

• Note:
– A School age children should informed adults
regarding where they are and what they are
doing
– Be aware that frequency of accidents increases
when parents are under stress and therefore
less attentive .
– Children are more active, curious and impulsive-
therefore more vulnerable to accidents.
 School Age Child
(6-10 years old)
• Health Promotion
2. Nutrition:
– Boys – More calories needed for increased demand of energy
– Boys and girls require more iron, calcium and fluoride - to
ensure good teeth and bone growth
– Fond of sugary foods - parents are urge to make meals
nutritious
3. Daily Activities:
– Can fully dress themselves- but not good at taking care of their
clothes - teach children the importance of caring for their own
belongings.
– School children have definite opinions about clothing styles-
often based on the likes of their friends or a popular sports or
fashion rather than the preferences of their parents.
 School Age Child
(6-10 years old)
• Health Promotion
4. Sleep:
– May vary from individual children.
– Younger school age requires 10-12 hours of sleep / night
– Older ones require about 8-10 hours of sleep / night
– Nightmares may continue and may increase as a child
reacts to the stress of beginning school.
– At about 9 years old, may give up pre-bed time talks/
stories - prefer to call or text messaging.
5. Exercise:
– Needs a daily exercise - because school is a sit down
activity and those who are driven for school and back
home.
 School Age Child
(6-10 years old)

• Health Promotion
6. Hygiene:
– 6-7 years old still need help in regulating bath
water temp.; in cleaning their ears and
fingernails.
– 8 years old - Capable of bathing themselves -
but may not do it well because they do not find
bathing as important as to their parents
– Both boys and girls become interested in bathing
/ showering a they approach their teens.
 School- Age Child: ( 6- 10 years
old )

• Health Promotion
7. Care of teeth - children may develop fear of
dentist and if realized it’s painful, they may not
visit at all.- should encourage to visit the dentist
to monitor the development of dental caries.
Overview of the Nursing Process
(School Age Child)

• Assessment
1. obtaining a health history
2. performing both physical & developmental
evaluation at healthcare visits.
3. assess a child’s weight, height, and body mass
index according to the standard growth chart.
4. assess child’s general appearance
Overview of the Nursing Process
(School Age Child)

• Nursing Diagnosis
1. Health - seeking behaviors r/t normal school-
age growth and development
2. Readiness for enhanced parenting r/t
improved family living conditions.
3. Anxiety r/t slow growth pattern of the child
4. Risk for injury r/t deficient parental
knowledge about safety precautions for a
school- age child.
Overview of the Nursing Process
(School Age Child)

• Outcome Identification / Planning

1. keep in mind that school - age children tend to
enjoy small or short term projects rather than
long, involved ones
2. behavior problems need to be well – defined
before outcomes are identified and
interventions planned
Overview of the Nursing Process
(School Age Child)

• Implementation
1. school-age children are interested in learning
about adult roles
2. when giving care, keep in mind that children this
age feel more comfortable if they know the
‘’hows’’ and ‘’whys’’ of actions.
Overview of the Nursing Process
(School Age Child)

• Outcome Evaluation
1. parents states that he permits the child to make
his own age - related decisions
2. child identifies books he has read together with
parents in the past two weeks
3. child states he understand the variations of
growth as related to growth chart
4. child does not sustain injuries from sports
activities.
Overview of the Nursing Process
(Adolescent)

• Assessment
1. Health history
2. Physical examination
 Overview of the Nursing Process
(Adolescent)
• Nursing Diagnosis
1. Health - seeking behaviors r/t normal growth
and development
2. low self- esteem r/t facial acne
3. anxiety r/t concerns about normal growth and
development
4. risk for injury r/t peer pressure to use alcohol
and drugs
5. risk for disease r/t sexual activity
6. readiness for enhanced parenting r/t increased
knowledge of teen-age years
Overview of the Nursing Process
(Adolescent)
• Outcome Identification / Planning
1. respect the fact that they have strong desire to
exert independence or do things their own
way
2. establishing a contract, such as asking an
adolescent to agree to take a medication,
maybe the most effective means to reach a
mutual understanding.
3. adolescent are very oriented to the present - so
a program that provides immediate results will
usually be carried out well.
Overview of the Nursing Process
(Adolescent)

• Implementation
1. integrating the adolescents in their plan of care
2. adolescents have little patience with adults
who don’t demonstrate the behavior they are
asked to achieve
3. Evaluate how an intervention appears from
adolescent’s standpoint before beginning
teaching
Overview of the Nursing Process
(Adolescent)

• Outcome Evaluation
1. patient states she feels good about herself
even though she is the shortest girl in her class
2. patient states he has not consumed alcohol in
two weeks
3. parents state they feel more confident about
their ability to parent an adolescent
4. patient states she feels high self-esteem
despite persistent facial acne