SULTAN KUDARAT STATE UNIVERSITY

COLLEGE OF NURSING BATCH 2025

CARE OF MOTHER, CHILD & ADOLESCENT (WELL CLIENTS)- NCM 107
PROF. CRISTELA MARIE M. PELARCO, RM, RN, MAN

Growth & Development

Growth: generally used to denote an increase in physical
size (quantitative change) :
Wt = kg or lbs Height = cm or ft
Development: used to denote an increased in skill or the
ability to function (qualitative change) measured by:
1. observing the child’s ability to perform tasks
2. recording parents’ description
3. using standard tests

STAGES OF GROWTH AND DEVELOPMENT

Neonate/Newborn: Birth to 1 month
Infancy: 1 month to 1 year
Early Childhood (Toddlerhood): 1-3 years
Early Childhood (Pre-school Age): 3-6 years
Middle Childhood (School-age): 6-12 years
Late Childhood (Adolescent): 13-18 years
Middle to Late Adulthood (Elderly): 19-65 years

A. First Stage – pre-natal begins from conception to birth

B. Second stage – from birth to 12 months
1. neonatal – first 28 days or the first 4 weeks of life.
2. Infancy – 1 to 12 months
C. Third Stage – Early Childhood ( 1-6 y/o)
1. Toddler – 1-3 y/o
2. Pre- school – 3-6 y/o
D. Fourth Stage – Late Childhood
1. School age – 6-12 y/o
2. Adolescence – 13 – 18 y/o
How to measure development?
Two Parameters of Growth 1. by simply observing a child doing a specific task
● WEIGHT: most sensitive measure of growth 2. by noting the parent’s description of the child’s
○ 2x ----- 6 mos progress
○ 3x-------1 yr 3. by using the standardized test:
○ 4x--------2-2 1⁄2 yr a. DDST (Denver II Developmental Screening Test)
● HEIGHT: increases by 1 inch per month during first b. MMDST (Metro Manila Developmental Screening
6 months Test)
○ The average increase in Ht: 1st yr = 50 %
MDDST
4 Main Rated Categories of MDDST
1. Language – for communication
2. Personal- Social – ability to interact
3. Fine Motor Adaptive – pre-tensile ability (ability to
use hand movement)
4. Gross Motor Skills – the ability to use significant
body movement

DENVER II TEST
These 125 easily administered developmental test items,
with ag norm, are presented in a convenient one-page format

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a. Maturation follows a predictable, universal

timetable
b. Developmental changes occur rapidly
during the first year of life and slow during
middle and late childhood.
3. Different children pass thru the predictable stages
at different rates

MATURATION
● “maturus” = ripe): the total way in which a person
grows and develops, as dictated by inheritance
(development of traits carried by genes)
● Development that is genetically and organically
programmed

Maturation could refer to any of the following:

1. Fetal Development/Developmental biology
2. Emotional development
3. Physical maturation of any biological life form
4. The emergence of personal and behavioral
characteristics through growth processes.
5. In the final stages of the differentiation of cells,
tissues, or organs

Principles of Growth and Development (Pillitteri, 2008)

1. Growth and development are continuous
processes from conception until death.
(Principle: WOMB to TOMB

4. All body systems do not develop at the same

2. Growth and development proceed in an orderly rate
sequence: Patterns of Growth and Development

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1. Renal, digestive, circulatory, musculoskeletal they are young and not capable of coping
(childhood) with several new skills simultaneously.
2. Neurologic Tissue
- Grows rapidly during 1 – 2 years of life Why do developmental changes come out?
- Brain (achieve to its adult proportion by 5 Factors Influencing Growth and Development
years) 1. Genetics
- Central Nervous System 2. Environment
3. Lymphatic System 3. Culture
- Lymph nodes, Spleen, Thymus 4. Nutrition
- Grows rapidly during infancy and 5. Health Status
childhood (to provide protection against 6. Family (Parental Attitudes & Child- Rearing
infection) Philosophies)
- Tonsils are achieved in 5 years CRITICAL PERIOD: the specific time period during which
4. Reproductive Organ – grows rapidly during certain environmental events or stimuli have the greatest
puberty effect on a child's development.
5. Development proceeds from gross to refined
skills (Becomes Increasingly Differentiated)
- Responses become more specific and,
skillful as the child gets older.
6. There is an optimum time for the initiation of
experiences or learning
- Children have a strong drive to practice
and perfect new abilities, especially when
they are young and not capable of coping
with several new skills simultaneously.
7. Neonatal reflexes must be lost before
development can proceed
- Persistent Primitive Infantile Reflex
(suspect Cerebral Palsy)

8. A great deal of skill and behavior is learned by

practice (Becomes Increasingly Integrated and
Complex)
- As new skills are gained, more complex tasks are
learned. THEORIES OF DEVELOPMENT
9. Play is the universal language of a child.
10. Behavior is a most comprehensive indicator of Freud, Sigmunnd Psychosexual development
developmental status
Piaget, Jean Cognitive development
11. Development Is Unique
- Every child has a unique timetable for Erikson, Erik Psychosocial development
physiological, psychosocial, cognitive, and
moral development Kohlberg, Lawrence Moral development
12. Development Is Interrelated
- Physiological, psychosocial, cognitive, and
moral aspects of development affect and
are affected by one another.
13. Children are Competent
- They possess qualities and abilities
ensuring their survival and promote their
development.
14. New Skills Predominate
- Children have a strong drive to practice
and perfect new abilities, especially when

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Temperamental Qualities:
1. Activity level
2. Sensitivity and reactions to external stimuli
3. Adaptability
4. Level of Intensity
5. Distractibility
6. Approach/Avoidance & Withdrawal
7. Persistence
8. Regularity & organization
9. Mood

Type of Temperament:
A. Easy Child
B. Difficult Child
C. Slow-to-Warm-Up Child
SPIRITUAL DEVELOPMENT: FOWLER’S THEORY
● Stage ‘0’: Undifferentiated
● Stage ‘1’: Intuitive Projective
● Stage ‘2’: Mythical Literal
● Stage ‘3’: Synthetic Convention
● Stage ‘4’: Individuating Reflexive

Nursing Process for Normal Growth &

Development
NURSING PROCESS
ASSESSMENT- Physical Assessment, History taking,
Observation, Nutrition
DIAGNOSIS- Vary depending on age level and nursing
problems identified
PLANNING- Consider ALL aspects of the child’s health
(holistic care)

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INTERVENTION- Encourage age-appropriate self- 1. An infant’s smile in response to a parent’s touch

care, toys/ activities, Role modeling 2. a toddler’s aggressive attack on a playmate
EVALUATION- For specific milestones, early detection of 3. a school-age child’s development of
various problems assertiveness
4. an adolescent’s joy at the senior prom
STAGES OF GROWTH AND DEVELOPMENT 5. the affection of an elderly couple
● Neonate: Birth to 1 month
● Infancy: 1 month to 1 year ● HUMAN DEVELOPMENT: a field of study that
● Early Childhood (Toddler): 1-3 years includes all changes human beings experience
● Early Childhood (Pre-school): 3-6 years throughout the life span
● Middle Childhood (School-age): 6-12 years ● CHILD DEVELOPMENT: a field of study devoted to
● Late Childhood (Adolescent): 13-18 years understanding all aspects of human growth from
● Middle Adulthood to Late Adulthood (Elderly) conception to adolescence

Developmental Assessment
● Early detection of deviation in child’s pattern of
development
BIOLOGICAL PROCESSES ● Simple and time efficient mechanism to ensure
- produce changes in an individual’s physical nature. adequate surveillance of developmental progress
EXAMPLES: ● Domains assessed:
1. Genes Inherited From Parents – Cognitive
2. The Development Of The Brain – Motor
3. Height And Weight Gains – Language, Social / Behavioral
4. Changes In Motor Skills – Adaptive
5. Nutrition
6. Exercise
7. Hormonal Changes Of Puberty
8. Cardiovascular Decline

COGNITIVE PROCESSES
● Cognitive processes refer to changes in the
individual’s thought, intelligence, and language.
EXAMPLES:
1. Watching a colorful mobile swinging above the
crib,
2. putting together a two-word sentence,
3. memorizing a poem
4. imagining what it would be like to be a movie star,
5. solving a crossword puzzle involves cognitive
processes.

SOCIO-EMOTIONAL PROCESSES
● Socio-emotional processes involve changes in
the individual’s relationships with other people,
changes in emotions, and changes in
personality.
EXAMPLES:

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SOCIAL DEVELOPMENT
It refers to the ability to interact with people and the
environment. It is dependent on cultural and environmental
factors. Here is a table of social milestones:

INFANT
● Solo, mom interactive
● Facilitate motor & sensory dev’t
● Fear of infancy: Stranger anxiety begins at 6-7
months; PEAKS at 8 months
○ Diminished by 9 months
● Communicate:
– Respond to non-verbal
– Slow approach
– Use calm, soothing voice
– Be responsive to cries
– Allow security object ( blanket or pacifier)

COGNITIVE DEVELOPMENT
This domain talks about thinking, memory, learning,
and problem-solving. By evaluating problem-solving and
language milestones, infant intelligence can be estimated.
There is a poor correlation between gross motor skills and
cognitive potential.

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SPEECH MILESTONES
● 1-2 months: coos
● 2-6 months: laughs and squeals
● 8-9 months: babbles mama/dada as sounds
● 10-12 months: mama/dada specific
● 18-20 months: 20 to 30 words – 50% understood by
strangers
● 22-24 months: two-word sentences, >50 words,
75% understood by strangers
● 30-36 months: almost all speech understood by
strangers

HEARING
● BAER hearing test done at birth
● Ability to hear correlates with ability to enunciate
INFANT DAILY CARE words properly
● Bathing ● Always ask about history of otitis media – ear
● Diaper care infection, placement of PET – tubes in ear
● Care of teeth ● Early referral to MD to assess for possible fluid in
● Dressing ears (effusion)
● Sleep: 16-20hrs/day; ● Repeat hearing screening test
● 6 mons: 1-2 naps, with 12h at night ● Speech therapist as needed
● 12 mons old: 1 nap with 12h at night
● Exercise

RED FLAGS in Infant Development

1. Unable to sit alone by age 9 months
2. Unable to transfer objects from hand to hand by age
1 year
3. Abnormal pincer grip or grasp by age 15 months
4. Unable to walk alone by 18 months
5. Failure to speak recognizable words by 2 years

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Computation of Weight: Infant & Children TODDLERS

● < 6 MONTHS : Age (mos) X 600 + BW (g) Communication:
● 6-12 months : age (mos) X 500 + BW (g) ● Approach cautiously
● 1-6 years old : Age (yrs) X 2 + 8 ● Accept verbal communication literally
● 7-12 yrs old : Age (yrs) x 7 -5/2 ● Learn the toddler words for the common item and
○ # of deciduous teeth = age in month - 6 use them in conversations.
● Use short & concrete terms
● Repeat explanation and description
● Use play for demonstration
● Use visual aids
● Explain and allow to handle equipment to use
● Encourage to use of comfortable object

TODDLERS: Fears & Characteristics

Fear: Separation Anxiety
● don’t prolong good bye
● tell when you will be back
Characteristic trait
● Negativistic “NO” – way to search for independence
● Rigid, ritualistic and stereotype
● Love rough tumbling play
● Loves toilet training
● Temper tantrums- head banging, screaming,
stamping feet, hold breath –Ignore behavior
-in order to control self & others. Mx: IGNORE THE
BEHAVIOR or direct them to activities they can
master.(When things are rearranged or are strange;
or when persons or places are unfamiliar)
● Accidents because they are naturally active,
mobile & curious –(set limits & exert external
control) .
● LOVE & CONSISTENCY are the 2 most important
concepts in child-rearing.
● EGOCENTRIC – uses “ MINE “ for everything

Issues in parenting - toddlers

● Stranger anxiety – should dissipate by age 2 1⁄2 to
3 years
● Temper tantrums: occur weekly in 50 to 80% of
children – peak incidence 18 months – most
disappear by age 3
● Sibling rivalry: aggressive behavior towards new
infant: peak between 1 to 2 years but may be
prolonged indefinitely
○ Thumb sucking
○ Toilet Training

TOILET TRAINING
a. Sphincter control: most important
b. Ability to stand and walk to the bathroom
c. Understand the act of elimination
d. Can express the need to eliminate
e. Desire to please the mother (positive maternal
attitude and not “strictness” is important to success
in toilet training

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encouraging rooming-in. To help the toddler deal

with frustration & loss of autonomy, the nurse
should provide the toddler with a POUNDING
BOARD or PUNCHING BAG.
3. SECURITY OBJECT – something a toddler
becomes strongly attached to like doll, stuffed
animal, pillow or blanket; if separated from the
security object, the toddler usually reacts with
extreme frustration & anxiety.
4. The DENVER DEVELOPMENT SCREENING
TEST is used to screen the development of
toddlers. ( ex. Most toddlers can remove their own
NUTRITION for TODDLERS
clothes between 12 & 18 mos. And put on their own
● Decrease in appetite because
clothes between 19-24 mos.
of the slow growth rate
5. Turn pot handles in when on stovetop.
● Picky eaters, dawdling with
6. Poisoning: most common in 2-year-olds
meals
● 1, 300 kcal/day
OTHER CONSIDERATIONS:
● Allow self-feeding
● Consider every nonfood substance a hazard and
● Allow choice between 2 types
place it out of the child’s sight/ reach.
of food
● Keep all medications, cleaning materials, etc. in
● Offer finger foods, the appetite
clearly marked containers in locked cabinets.
of 3-year-olds is more
● Provide a barrier on open windows to prevent falls.
capricious than that of
1-year-olds
RED FLAGS: 3 years old
● Risk of aspiration
● Can’t work simple toys (such as pegboards, simple
puzzles, turning handles)
DAILY CARE OF TODDLERS
● Doesn’t engage in pretend play
● Dressing: can put on socks, underpants, undershirt
● Doesn’t make eye contact
● Sleep: 12-14H/night w/ 1 nap; dependency on
● Doesn’t speak in full sentences
security object (transitional toy)
● Doesn’t understand simple instructions
-may ask to sleep with bottle
● Doesn’t want to play with other children or with toys
-may rebel against going to sleep
● Drools or has very unclear speech
● Bathing
● Falls down a lot or has trouble with stairs
● Care of teeth: since all 20 deciduous teeth are out
● Loses skills they once had
by 2 1⁄2 yrs, start teaching brushing of teeth; first
dental check-up should be bet. 12-18 mos.

REACTION TO ILLNESS and NURSING INTERVENTIONS

● Regressive behaviors: reassurance
● Nutrition: Allow finger food
● Dressing changes: Allow to pull off tape
● Medications: Allow choices of “chaser” after oral
medication (eg. juices, milk, etc.)

REACTION TO ILLNESS and NURSING INTERVENTIONS

● Hygiene – allow a choice of bath time toy, allow to
put toothpaste
● Pain – allow to express pain
● Stimulation
● Elimination – continue potty training
● Rest – allow a choice of toy at bedtime

PROBLEMS AND HEALTH ISSUES OF TODDLERS

1. Accidents are the chief cause of death in
toddlers. Most accidental deaths in children under
the age of 3 years are related to MOTOR VEHICLE
ACCIDENTS.
2. When caring for a toddler in the hospital, the nurse
should prevent SEPARATION ANXIETY by

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PRESCHOOLER: BEHAVIORAL PROBLEM

● Telling Tall tales: over imagination
● Imaginary friend: to release tension and anxiety
● Sibling rivalry: jealousy to new baby
● Regression: going back to early stage
○ Thumb sucking
○ Baby talk
○ Bed wetting
○ Fetal position
● Masturbation: sign of boredom
○ Divert attention by offering toy.

NUTRITION OF PRE-SCHOOLERS
● Slow/Steady growth
● Decreased appetite
● Offer small servings
● Healthy snack food

DAILY CARE OF PRE-SCHOOLERS

● Accidents: bicycle safety, seat belts
● Dressing: choose own clothes
● Sleep: resist taking naps
● Exercise: very active
● Bathing: can wash and dry hands; need supervision
● Care of teeth: independent brushing

RED FLAGS: PRESCHOOL

1. Inability to perform self-care tasks, hand washing
simple dressing, daytime toileting
2. Lack of socialization
3. Unable to play with other children
4. Ability to follow directions during exam
5. Performance evaluation of preschool teacher for
kindergarten readiness

PRE-SCHOOLER AGE: CHARACTERISTIC TRAITS

● Curious, creative, imaginative & imitative
● Favorite word: “WHY”, “HOW”
● Complexes: word identification to the parent of PRESCHOOL AGE: COMMUNICATION
same-sex and attachment of parent of the opposite ● Offer choices
sex. ● Speak in simple sentences
– Oedipal complex: boy to mom ● Be concise and limit the length of explanation
– Electra complex: girl to dad ● Allow asking questions
– Cause marital discord ● Described procedure about to be performed
● Concept of Death: SLEEP ONLY ● Use play to explain procedure & activities
1. They love to watch adults & imitate their behavior: ● Allow handling equipment
Oedipus and electra complex
2. Gender roles: need exposure to parents of opposite REACTIONS/CONCERNS IN ILLNESS AND NURSING
sex INTERVENTIONS
3. Socialization: capable of sharing ● Fear of the dark: allow dim light and parent to sit
4. Discipline: “time out” beside child
5. Common fears: dark, mutilation, separation ● Fear of body mutilation: Prepare for and explain
6. Telling “lies”, bragging & boast in order to impress procedure; reassure
others ● Fear of injury, pain and the unknown: Encourage
7. Imaginary friends & playmates are common expressive play/medical play

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● Fear of separation/ abandonment: relate time and ● Fine motor is refined

space to familiar situations ● Fine motor with more focus on:
1. Nutrition: food in animal/alphabet shapes – Building: models (legos)
2. Dressing change: allow to measure, cut tape, see – Sewing
incision site – Musical instrument
3. Medication: allow to choose “chaser” – Painting/ Drawing
4. Hygiene: allow a choice of toys, wash hands and – Typing skills
face – Technology: computers
5. Pain: allow pain expression, handle syringe,
analgesic SCHOOL PERFORMANCE
6. Stimulation ● Ask about favorite subject
● How they are doing in school
● Do they like school
● By parent report: any learning difficulties, attention
problems, homework
● Parental expectations

SCHOOL AGE: COGNITIVE DEVELOPMENT

● Greater ability to concentrate and participate in
self-initiating quiet activities that challenge cognitive
skills, such as reading, playing computer and board
games.

SCHOOL AGE: COMMUNICATION

● Establish limits
● Provide reassurance to help in alleviating fears and
anxieties
● Engage in conversations that encourage thinking.
● Use medical play techniques
SCHOOL AGE: FINE MOTOR
● Use photographs, books, doll and videos to explain
● Writing skills improve
procedures

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● Explain in clear terms REACTION TO ILLNESS AND NURSING INTERVENTIONS

● Allow time for composure & privacy. 1. Death and disability: still need comfort
2. Unknown events & procedures: Allow to help w/
SCHOOL-AGE: CHARACTERISTIC TRAITS care & treatment
● Authority figure: Teacher 3. Loss of control & independence: Give choice
● Fears: 4. Loss of contact w/ peers: Allow visits
○ School phobia 5. Disruption of school: Talk about interests
○ Displacement from school 6. Nutrition: allow choices
○ Loss of privacy 7. Dressing Change: ask opinions on the bulk of
○ Fear of death ( 7-9 y ) permanent dressing and where to apply tape
● Industrious 8. Medicine: teach name and action, allow to choose
● Modest form if possible
● Can’t bear to lose – will cheat 9. Pain: Allow expression of pain, explain the source
● Love collections: eg. stamps, toys, etc. and cause
10. Stimulation
RED FLAGS: SCHOOL AGE
● School failure
● Lack of friends
● Social isolation
● Aggressive behavior: fights, fire setting, animal
abuse

ADOLESCENT: 13-21 years old

● Androgen ↑ sebaceous gland activity resulting in
acne
● Apocrine glands ↑ activity
● 13 yo: 2nd molars complete
● PUBERTY: capable of sexual reproduction
SCHOOL-AGE: DAILY CARE
● Secondary sexual characteristics
1. Dressing: influenced by peers (latest fashion)
● 32 permanent teeth should be present by age 18-21
2. Sleep: 8-12 hrs; no naps
yrs
3. Exercise: games, bike riding, walking
4. Hygiene: 8 yo – capable of bathing alone
ADOLESCENT: CHARACTERISTICS
5. Care of teeth: 2x yearly visit to the dentist; brush
● As teenagers gain independence, they begin to
daily
challenge values
6. Safety: bicycle, school bus safety, prevention of falls
● Critical of adult authority
and sports injuries
● Relies on peer relationship
● Mood swings especially in early adolescents
SCHOOL-AGE: HEALTH PROBLEMS & CONCERNS
1. Problems w/ articulation – disappears 9 yo
ADOLESCENT BEHAVIORAL PROBLEMS
2. School anxiety and phobia
● Anorexia
3. Sex education
● Attention deficit
4. Stealing: 7 yo – the importance of money
● Anger issues
5. Violence/terrorism: education; reassurance
● Suicide
6. Bullying
7. Recreational drug and alcohol use
ADOLESCENT: HEALTH TEACHINGS
8. Likes to stay up late: slumber parties
● Relationships
9. Nightmares common
● Sexuality – STD’s / AIDS
10. It Awakens early in the morning
● Substance use and abuse
● Gang activity

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● Driving 6. Growth of axillary hair = Pubarche

7. Vaginal secretion

GROWTH AND DEVELOPMENTAL MILESTONES

● 13 yo: plays sports SECONDARY SEX CHARACTERISTICS IN MALE
● 15 yo: enjoys privacy; stays in room, not to be 1. Increase in weight
disturbed 2. Growth of testes
● 16 yo - part time job; charitable causes 3. Growth of facial & axillary hair
4. Voice changes
5. Penile growth
6. Increase in height
7. Sperm production = Spermatogenesis

REACTION TO ILLNESS AND NURSING INTERVENTION

● Main issue: Body image – educate and Allow
participation in tx decisions; compassionate
understanding
● Fears loss of control and independence: Respect
privacy and confidentiality
● Fears injury and pain: Provide opportunities for self
expression
● Separation from peers and lack of emotional
SECONDARY SEX CHARACTERISTICS IN FEMALE (IN support: Approach w/ caring and understanding,
ORDER) age compatible roommate, Phone at bedside
1. Growth spurt
2. Increase in diameter of the pelvis
3. Breast dev”t. = Thelarche
4. Growth of pubic hair: Pubarche
5. Onset of menstruation = Menarche

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DEVELOPMENTAL STAGES
Hospitalized Pediatric patients INTERVENTION:
● Encourage rooming-in
INFANT & TODDLERS ( 0-3 Y ) ● Become involved with his own care
● Separation Anxiety ● Accept regression but encourage independence
○ Protest – crying, screaming, kicking, verbal ● Provide choices
attack ● Acknowledge fear and concerns
○ Despair- withdrawn, depressed ● Allow expression of feeling verbally & non- verbally
○ Detachment-only after lengthy separation ● Explain all procedures
● Fear of injury and pain ● Allow to wear underpants
○ Affected by previous experience, ● Contact friends
separation from parents ● Provide educational need
● Loss of control- toddler has its own rituals; result
to regression ADOLESCENCE (13-21 y.o.)
A. Separation anxiety
INTERVENTION: - Source : separation from friends
● Provide swaddling & soft talking to the infant B. Fear of injury & pain
● Provide for oral stimulation like pacifier – Being different from others
● Provides routine & rituals – May give impression they are not afraid though
● Provide choices to toddlers they
● Allow toddler to express feeling of protest are terrified
● Encourage to talk – Become guarded when any areas R/T to sexual
● Allow as much mobility as possible development are examined
● Anticipate temper tantrum C. Loss Of Control
● Maintain pain reduction – Seek help and reject

PRESCHOOLER (3-6 Y) INTERVENTION

A. Separation anxiety – less serious ● Encourage question
– Protest ● Explore feelings
– Despair ● May wear own clothes
– Detachment ● Allow privacy
B. Fear of injury & pain ● Use body diagram to prepare for procedure
– Invasive procedure & mutilation ● maintain contact with peers
– Imagine worst thing can happen ● Identify formation of future plans
– Believe they did something wrong ● Help develop positive coping mechanism
C. loss of control

INTERVENTION:
● Provide a safe & secure environment
● Communication
● Allow to express anger
● Accept aggressive behavior
● Leave favorite toy
● Allow mobility, provide play and diversional
● Place in the room with same age
● Explain procedure simply on their level
● Allow wearing underpants

SCHOOL AGED (6-12 Y)

A. Separation anxiety
– Accustomed to period of separation from the
parents
– More concerned of missing school & friends
B. Fear of injury & pain
– Bodily injury & pain
– Death
– Uncomfortable in any sexual examination
C. loss of control

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