Chapter 20: Caring For The Developing Child

Address anticipatory guidance for each developing stage:

>**In first year, infants see a HCP at regular intervals for physical assessment and immunizations** >Important to provide teaching regarding nutrition, health promotion, safety, sleep-wake patterns, growth and development, and discipline

Identify and explain the theories of growth and development: Moral Domain of Carol Gilligan

**Helped Define Moral Development:** -Orientation of individual survival -Goodness as self-sacrifice -Shift from goodness to truth example would be breaking an unjust law to save the lives of innocent people.

Define Temperament

**Refers to those characteristics present at birth that govern the way in which the infant responds to his surroundings**

Identify and explain the theories of growth and development: Separation

3 phases of separation 1) Protest -in response to the anxiety produced by separation 2) Despair -Related to the grief and mourning caused by prolonged separation 3) Detachment -A defense against the feeling associated with despair

Describe the principles inherent in the developmental process:

> **Growth spurts tend to be followed by periods of rest because it takes energy for the growth process** >**Development proceeds from cephalocaudal direction (Head-to-toe)** >**Development proceeds proximodistally (develops from near to far and midline to periphery, example= torso develops before arms and legs, and development to the hands and feet then finger to toes)** >**Gross motor skills to fine motor skills** **(Gross motor skills such as running, jumping, or riding a bike provides foundation for fine motor developments such as eating, coloring, or buttoning a shirt)**

Erik Erikson: Autonomy vs. Shame and Doubt

> **Occurs between 1 and 3 years of age** >**Task is for child to balance independence and self-sufficiency against the predictable uncertainty and misgiving when placed in life situations** >**Time for child to establish willpower, determination, and can do attitude about self** **Example: Child wants to choose clothing and dress independently** >Struggle happens when parents allow the child to make personal choices yet expect the choices to be socially acceptable. >New profound independence is accompanied by new rules that may cause internal conflict. >Child must develop personal abilities while struggling with both fears and wishes.

Phases of Attachment: Phase 1

> Birth - 2 months Bowlby: >Orientation and signals without discrimination of figure Ainsworth: >Initial pre-attachment phase Manifestation: >The infant responds to everyone in his or her environment without discrimination

What to say----> Helping adolescent make good decisions

> Listen: -Pay close attention not only to what they are saying, but also to nonverbal cues -Try to understand their view of the world and stay open minded >Discuss W/O Judging: -Nurse can share personal understanding of the issues and various perspectives while respecting those of the adolescent >Encourage Critical Thought: -Allow the adolescent to explore and further develop their options

Box 20-5: Anticipatory Guidance for Infants

> Nutrition: -Review breast and bottle feeding guidelines -**Introduction of solid foods (4-6 months)** -Encourage self-feeding when appropriate -Finger foods -Weaning to cup (9-12 months) -Family meal time -**CHANGE TO WHOLE MILK @ 12 MONTHS!!!!!** >Health Promotion 1) Signs and Symptoms of Illness -Vomiting -Diarrhea -Fever -Dehydration -Jaundice 2) See immunization scheduling for infants pg 93 3) Recommend CPR training (review emergency procedures) 4) **Oral health- brushing with non fluoride toothpaste after eruption of the first tooth, schedule first dentist appointment** >Focus on Safety -Safety guideline for crib -Place car seat in back of car -**Have car seat in rear-facing position** -**Position baby on back to prevent SIDS** -Do not leave unattended -Install smoke detectors -**Lower crib mattress as baby becomes more mobile** -Close supervision -**Discourage use of baby-walkers** >Sleep-Wake Patterns -Expected patterns at each month of age >Cognitive and Emotional Development -Age appropriate toys and interactive games -Talk and sing to infant -Read stories -Respond to infant cries -Face-to-face time >Motor Development -Support head and neck -**Supervised "tummy time" to increase neck, arm, and torso strength** -Provide safe space for child to move about -Provide opportunities for sitting, crawling, and walking >Discipline -Discuss discipline vs punishment -Limit setting -Apply rules consistently

FOCUS ON SAFETY: PRIVACY

>**At this age, important to guard the child's privacy** >Nurse must be aware of self-conscious behavior related to physical changes occurring to the body >**Nurse must be aware of menstruation, secondary sexual characteristics, hormone imbalances, mood swings, social needs, as well as other specific areas identified by child/family members**

Erik Erikson: Initiative vs. Guilt

>**Occurs between ages 3-6** >**Child's task is to develop the resourcefulness to achieve and learn new things without receiving self-approach.** >Difficult for child to resolve the conflict between wanting to be independent and needing to stay attached to parents. >**Child's learning of new songs, games, or jokes are good examples.** >**Child feels confident to try new ideas** >**Important that parents and teachers encourage this initiative to help the child develop a sense of purpose** >**If initiative is discouraged, child may feel guilt and lack of resourcefulness**

Erik Erikson: Identity vs. Role Confusion

>**Occurs between the ages of 12-18** >**A time of forging ahead and acquiring a clear sense of self as an individual in the face of new and at times conflicting demands or desires.** >**Adolescent wants to define "What I want to be when I grow up"** >**Concentrates on goals and life plans separate from those of peers and family** >Adolescent child has the ability to think about self as well as others and proceeds accordingly >An adolescent who is unable to make decisions about possible career choices, a personal belief and value system, and sexual orientation. >Example: May develop a weak sense of self and be incapable of committing to identity. This indecision leads to role confusion.

Erik Erikson: Industry vs. Inferiority

>**Occurs between the ages of 6-12** >**Child develops a sense of confidence through mastery of tasks** >This sense of accomplishment can be counterbalanced by a sense of inadequacy or inferiority that comes from not succeeding. >**Realization that child is competent is one of the most important building blocks in development of self esteem.** >**Industry is evident when the child is able to complete homework independently and regulate social behavior.** >If child cannot complete these tasks, inferiority may result

Erik Erikson: Trust Vs. Mistrust

>**Occurs between the birth and 1 year** >**Task is for the infant to recognize that there are people, generally parents, who can be trusted to take care of basic needs** >Infant's struggle becomes evidenced in the recognition that not everyone or every situation is "safe" >Infant learns to have confidence in personal worth and well-being along with connectedness to others >Failure of this stage leaves a sense of hopelessness >**Examples: Infants with failure to thrive or with attachment disorders**

Temper Tantrums in 1-3 years

>**Temper tantrum is a normal way of working things out internally in toddler** >**Tantrums are normal** >Anticipation (tired, hungry, overwhelmed by situations) >**Avoidance** -Get tired child to rest -Feed hungry child -**When child is wailing or thrashing, IGNORE THEM** -Touching and distractions may soothe the child

Sensory Development

>**Touch is the first important sense to develop** >Ability to feel objects opens up the world of learning >**Important for the infant to experience soft, comforting, textures.** >**Ability to experience pain is a protective device** >Infant has pain experience when: -**baby reacts to pain with the whole body by quickly extending and then retracting the extremities.**

Phases of Attachment: Phase 3

>6-7 months Bowlby: >Maintenance of proximity to a discriminated figure by locomotion and signals Ainsworth: >Clear-cut attachment Manifestation >The baby attaches to his/her caretaker by crawling toward the caregiver, reaching for or cooing at the caregiver

Phases of Attachment: Phase 2

>8-12 weeks Bowlby: >Orientation and signals directed toward one or more discriminated figures Ainsworth: >Attachment in the making phase Manifestation: >The infant responds most to those significant caretakers in his/her life

CRITICAL NURSING ACTIONS: ANTICIPATORY GUIDANCE FOR ALL LEVELS

>Anticipatory guidance provides info about expectations to next developmental stage

Phases of Attachment: Phase 4

>Around age 3 Bowlby: >**Implications of the partnership for the organization of attachment behavior during the preschool years** Ainsworth: >Goal-corrected partnership Manifestation >**The preschool child begins to develop an understanding of the caregiver's goals. The child knows that a tantrum might get mother to fulfill demands**

FOCUS ON SAFETY: REFLEXES

>As the nurse performs an assessment, it is imperative to note important infant reflexes >Rooting -Infant's head turns and he begins to suck when his cheek or lower lip is stroked >Sucking -Sucking motion of lips, mouth, and tongue allows the infant to take in food/drinks/nourishment >Moro -Startle response with sudden jarring causes extension of the head. The arms abduct and move upward. Hands form a "C" >Grasping -This is noted when the palms of the hands or soles of the feet are stroked causing fingers or toes to curl inward >Babinski -This is the turning in of the foot and fanning out of the toes when the sole of the foot is stroked

Identify and explain the theories of growth and development: Sigmund Freud, Psychosexual

>Believed that development was most influenced by biological instincts >Child progresses through developmental stages based on resolution of conflicts surrounding urges and rules Three aspects of human personality: >THE ID -emotional part of the personality -ID is present at birth -infant cries, laughs, or coos without a thought -relies solely on instinct >THE EGO -**Develops during the babies first year** -provides balance between completing ID and reality -**Provides a sense of identity separate from others and promotes the ability of the child to function individually** >THE SUPEREGO -**Develops between 3-6, a super ego which serves to regulate behavior** -**Develops cognitively and learns about rules and the needs for others** -**Functions not only on the center of conscious, but a sense of what and how the child perceives self. ** -**Example: A young child obeying the parents rules by picking up the toys even though the child would rather continue playing.** -**Child learns difference between right and wrong and child is not "center of universe"**

Discipline Strategies for 1-3 years:

>Distraction -provide toy to divert attention >Time out -move child to a cooling off place where child can calm down >Removal of privileges -withhold a favorite toy until behavior is appropriate >Verbal Reprimands -given spoken warning such as "bad" >Corporal Punishment -spanking, swatting, grabbing is NOT RECOMMENDED

Identify and explain the theories of growth and development: Erik Erikson

>Erikson focused on the influence of social interaction >Developed 7 stages, mastery of each stage requires that the individual achieve a balance between two tasks (conflicting variables).

LEGAL ALERT--->>> INCLUDE ADOLESCENT IN INFORMED CONSENT PROCESS

>Informed Consent -Elicits permission that is given freely that protects a person's right to autonomy and self-determination -Informed consent is given when the person understands the procedures, rationales, and associated risks >Children under 18 can give informed consent when: - Minor parents of the child patient -Seeking birth control -Counseling -Help for substance abuse -Self-supporting (emancipated)

Anticipatory Guidance (3-6 years old)

>Nutrition -Family meal times should be pleasant -Provide 3 meals and 2 nutritious snacks/day -Allow child to make nutritious choices >Health Promotion 1) Signs and Symptoms of illness -Vomiting -Diarrhea -Fever -Dehydration -Immunizations -CPR training -Oral health--> brushing, routine cleanings >Focus on Safety -Car seat -Update home childproofing -Secure: (guns, matches, outlets, medications, poisons) -Sunscreen -Bike helmet -Water & playground safety -Teach about stranger safety -Continue close supervision >Sleep-Wake Patterns -Dreams & nightmares are evident -Naps start to disappear -Maintain bedtime routine >Cognitive and Emotional Development -Offer praise -Show affection -Expect fantasy play as child tries new roles -Address fears as they occur -Read, sing, and talk to child to develop language skills -Creative toys -Expose child to various places within the community -Encourage assertiveness NOT aggression -Teach how to solve conflicts -Encourage self-expression -Expect sexual exploration and answer questions -Assign simple chores -Encourage self-care/toileting/dressing >Motor Development -Encourage peer play and physical activities -May want to join organized sport -Bike/Water safety >Discipline -Continue with consistent rules -Teach right from wrong -Teach respect for authority -Continue with Time-outs

Anticipatory Guidance for 1-3 years:

>Nutrition -Family meals -**Allow toddler to self feed and cup drink** -Provide 2-3 healthy snacks/day -Do not force feed >Health Promotion 1) Signs and Symptoms of illness -Vomiting -Diarrhea -Fever -Dehydration -Immunizations (see schedule) -Recommend CPR -**Heimlich maneuver training** -Oral health (brush and routine cleanings) >Focus on safety: -Lower crib mattress -Transition to toddler bed by age 3 -Toddler car seat -Lock windows, secure curtains and mini-blind cords to prevent asphyxiation -Secure doors -Update childproofing home -Use of bike helmet -Water safety -Check smoke detectors -Supervised play -Sunscreen >Sleep wake pattern -Continue night time rituals -Consistent bedtime -Expect nightmares and strategies to deal with them >Cognitive and Emotional Development -Read short stories daily -Provide simple explanations -Respond to child's verbalization -Praise accomplishments -Schedule play dates -Teach child how to express feelings -Expect child to test limits -Encourage self expression/self-care -Limit TV 1-2 hours/day >Motor Development -Promote fine motor skills, crayons, blocks, provide outdoor play with balls, push and pull toys with toddler >Discipline -Apply rules and consequences consistently -Brief time-outs

Anticipatory Guidance for School-Age Children (6-12)

>Nutrition -Family meals -3 healthy meals, 2-3 nutritious snacks/day -Teach child to make nutritious choices -Avoid high fat/"Fast-foods" -Manage weight through exercise and healthy nutrition >Health Promotion -Immunizations -Heimlich maneuver -Oral Health--> Brushing, routine cleanings -Be alert to mood changes/Stress -Discuss smoking and substance abuse -Sexual feelings and how to say "no" to sex >Focus on Safety: -Seat belt and car safety -Safe environment -Secure (Matches, guns, bike helmet, water, sports, playground safety, check smoke detectors, protective equipment for sports, review rules for being home alone >Sleep-Wake Patterns -Require 8-12 hours of sleep/night -Night tremors may occur >Physical Development -Discuss physical changes r/t secondary sex characteristics in later childhood -Body odor -Some girls may start menstruation late in childhood >Cognitive and Emotional Development -Stimulate thinking -Praise academic achievement -Provide regular time and spacing for homework -Teach organizational skills -Encourage problem-solving skills -Implement goal setting through charts/calendars -Assign regular chores -Provide for family centered activities/trips -Assist child to handle new emotions -Demonstrate acceptance -Love -Concern for the child -Support participation in hobbies, clubs, and extra activities -Discuss ways to handle peer pressure -Taking on new responsibilities >Motor Development -Daily regular exercise -Support participation in sports >Discipline -Clearly defined limits -Restriction of priveleges

Anticipatory Guidance for Adolescents (12-18)

>Nutrition -Provide 3 healthy meals and 2-3 healthy snacks/day -Avoid fast foods /high fat foods -Maintain weight through exercise and healthy nutrition >Health Promotion -Immunizations -Oral health -Discuss sex -Sexual feelings -Protection against STI -Abstinence the best way to avoid pregnancy & STI -Discuss smoking/substance abuse -Symptoms of stress and how to deal with it >Focus on Safety -Seat Belts -Driving Safety -Sports and Water Safety -Sunscreen -Avoid Tanning Salons >Sleep Wake Patterns -**Require 8-10 hrs/night ** >Physical Development -Explain development of secondary sex characteristics -For females, explain menstruation and masturbation -For males, explain masturbation and nocturnal emissions (involuntary ejaculations during sleep) >Cognitive and Emotional Development -Praise academic success -Monitor for academic struggles -Encourage new challenges -Model respect for differing opinions -Model conflict resolution -Expect increasing independence from family -Peer groups and activities with peers are important -Provide some privacy @ home -Development of intimate relationships -Teach to balance school/work/peer group participation -Begin planning for the future >Motor Development -Daily regular exercise -Support Participation in sports >Discipline -Increase levels of responsibility at home to foster movement to adulthood -Restriction of privileges

Developmental Milestones of Adolescent (12-18)

>Physical Growth Variable: A) Girls: -Weight: Increases 15-55 lbs -Height: Increases 2-8 inches B) Boys -Weight: Increases 15-66 lbs -Height: Increases 4-12 inches **Both genders develop secondary sex characteristics** >Gross Motor Skills -Begins to develop endurance -Increases speed, accuracy, and coordination -Develops the necessary skills for an identified interest (sports/hobbies) >Fine Motor Skills -Manipulates complicated objects -High skill level playing video games and using computer -Good finger dexterity for writing and other intricate tasks -Precise hand to eye coordination >Cognitive, Sensory & Learning -Abstract thought well developed -Uses logic to solve problems -Projects thoughts over long-term to develop future plans -Increased concentration so can follow complicated instructions -Senses tied into body image -Develops adult preferences based on senses -Language: Continues to develop and refine with increased vocab up to 50,000 words; Improved communication skills, converses with increasing abstract thoughts and analysis >Psychosocial & Play -**Peer group primary social environment** -**Desires parent involvement yet pushes parent away at same time** -Begins to explore romantic relationships -Concentrates on goals and life plans >Play: -**Cooperative play continues within peer groups, team sports, school or community activities, and dating; enjoys solitary time**

Developmental Milestones of Toddlers (1-3 years)

>Physical Growth -**Weight: 3-5 pounds per year** -Height: 3 inches per year >Gross Motor Skills -Stands without support -Walks independently -**Walks backwards** -Creeps upstairs -Pulls toys while walking -Runs with wide stance -**Jumps in place with both feet** -Throws/kicks the ball -**Rides a tricycle by 3 years of stage** -Begins to stand on one foot momentarily -**Can walk up and down stairs with alternate feet** -Blows kisses >Fine Motor Skills -**Holds pencil/large crayon** -Make artwork more representative of an object -**Copies a circle and cross by age 3** -Knows colors -**Feeds self with spoon and drinks from a cup** -Constantly throws objects on the floor -Builds tower of 3-4 cubes, eventually building 7-8 -**Screws/Unscrews** -Turns pages in book 1 page @ a time -Turns knobs -**Removes shoes/socks, learns to undress self** -**Begins toilet training around 3 yrs of age** >Cognitive, Sensory & Language -Experiments and learns new behaviors -Begins to learn cause & effect -Imitates behaviors of caretakers -Well-developed vision -**Can identify geometric objects** -Intense interest in picture books/ stories -Distinguishes food preferences based on senses -**Languages: Single words and phrases : "I do", "Want drink" by 15 months knows 15 words; 20 words by 2 years; follows simple instructions** >Psychosocial and Play -Increases control of self and environment -Explores and learns about safety and boundaries, but may test them -Shows affection -**Play: Parallel play (alongside of another child**). Activities include: Matching games, simple puzzles, blowing bubbles, bean bag toss, catching fireflies, ring around the rosy, London bridge, Duck-duck goose, Hide and seek, coloring, and drawing

Developmental Milestones of the infant: 9-12 months

>Physical Growth -**Weight: Triple the birth weight** -Height: increases 1 in/month -Head and chest circumference: Same at 1 year of age >Gross Motor Skills -**Creeps on hands and knees** -Pulls self to standing position -Stands while holding onto furniture and begins to cruise -**Stands alone** -Changes from prone to sitting position -Can reach backwards while sitting -Can sit down down from standing position alone -**Begins to walk holding hand and then independently, takes first step** >Fine motor skills -**Uses pincer grasp** -Hand dominance now evident -Releases and rescues and object -When sitting, purposely reaches around back to get object -Can randomly turn pages in a book -**Can make a simple mark on paper** -**Waves bye-bye and plays patty-cake** -**Begins to feed self finger foods** >Cognitive, Sensory & Language -Increasing depth perception -Moves toward sound -Thoroughly explores and experiences objects -Points at simple objects -**Language: Says "mama", "dada", "uh-oh", Understands a few words, responds to own name, exhibits stranger anxiety, begins to distinguish colors, increasing ability to see things in the distance** >Psychosocial & Play -**Completes Erikson's stages of trust vs. mistrust, ability to calm self** Play: Solitary play stimulates sensorimotor development with simple imitative games; interaction with parents and caregivers through games such as: Patty-cake, peek-a-boo, songs, finger painting, ball rolling, high chair fishing

Developmental Milestones Of Early Childhood (3-6 years):

>Physical Growth -Weight increases 5 lbs/yr -Height increases 2.5-3 inches/yr >Gross motor Skills -Dresses self -Throws and catches ball -Pedals tricycle -Kicks ball forward -Stands on one foot for 5-10 seconds -Walks down steps with alternate feet -Jumps on bottom step -Balances on alternate feet with eyes closed >Fine motor Skills -Moves around in more balanced fashion -Builds tower 9-10 cubes -Draw stick figures with 6 parts -**Uses scissors to cut outline of picture** -Copies and traces geometric patterns -**Ties shoelaces** -Uses fork, spoon, and knife with supervision -Colors, prints letters -Mostly independent toileting/dressing >Cognitive, Sensory & Language -Focuses on self -Uses language to convey concepts -Concrete thinking -Well developed senses -Preferences based on senses -Learns address & phone number Languages: **Recognizes most letters, vocabulary has increased from 1,500-2,000 words, eventually speaks in full sentences with increasing fluency, sings songs, enjoys silly word rhymes, asks many "why" questions** >Psychosocial & Play -Begins to regulate own behavior -Learns about rules -Increases confidence to try new things -Knows difference between boys/girls -Play: Associate play helps children learn how to share, play in small groups, and learn simple games with rules, concepts of language, and social rules Activities include: -Memory -Chutes and ladders -Candyland -Hokey pokey -Hot letters -Alphabet games -Color games -Checkers -Make believe play

Developmental Milestones of The School Age Child (6-12 years)

>Physical Growth -Weight: Increases 4-6 pounds/year -Height: Increases 2 inches per year >Gross & Motor Skills -**Gradual decrease in dexterity and becomes limber** -Improves coordination, strength, balance, and rhythm -Climbs, bikes, skips, jumps rope and swings -Learns to swim, dance, somersaults, and skate >Fine Motor Skills -Good eye-hand coordination -Balance improves -**Can sew, draw, make arts, crafts, builds models, play video games** -Handwriting improves -Prints and Writes -**Likes activity that promotes dexterity such as playing musical instrument and building models** >Cognitive, Sensory & Language -Increased logical thinking leads child to be able to solve problems -Wants to know "how" things work -Understands actions=consequences -Aware of own thinking and how conclusions were reached -**20/20 visual acuity** -Color discrimination fully developed -Mature sense of smell -Hearing deficits may be distinguished as language develops -Language: Accelerated vocabulary expands to 8,000-15,000 words as comprehension expands children engage in long conversations on a variety of topics >Psychosocial & Play -Increases peer group involvement -**Same sex friends** -**Masters skills** -**Increases confidence/self-esteem** Play: Cooperative play teaches children how to bargain, cooperate, and **compromise to develop logical reasoning, which increases social skills**; Activities include: -Baseball -Soccer -Gymnastics -Swimming -Dodgeball -Board Games -Simple card games -Computer games -Video games -Puzzles -Crosswords -Word search puzzles

Developmental Milestones of the infant: Birth to 1 month

>Physical Growth -height: 19-21 inches -**weight: 7.5 lbs** -**Head: 13-14 inches** -**Chest : 12-13 inches** >Gross motor skills -**Reflexes are absent** -**Absence of head control** -**Momentarily hold head at midline** -**Head lag when newborn is pulled from lying to sitting position** -**Assumes flexed position** -**When supine assumes, tonic neck flex position** -Kicks legs and waves arms -Rounded back when sitting -Rolls over accidentally >Fine motor skills -**Hands predominately closed** -**Strong palmar and plantar grasp reflexes** >Cognitive, Sensory & Language -**Touch: First sense to develop** -Smell: Recognizes mother and has a taste preference for sweets -**Hearing: well developed** -Becomes quiet when hears a familiar voice -**Limited visual acuity, 20/100, fascinated with faces, follows moving objects, contrasting colors (black & white)** -**Language: Cries to express unmet needs,Smiles during sleep** >Psychosocial & Play -**Learns to relieve anxiety through oral sensations (breastfeeding, sucking on fist) begins to learn to trust caregivers** -Play: interaction with parents and caregivers; mobiles

Developmental Milestones of the infant: 1-2 months

>Physical Growth -Weight increases 1.5 lbs / month -Height: increases 1 inch/month -Head: increases 0.5 inches/month >Gross motor skills -Less head lag when pulled to sitting position -**When prone, can slightly lift head off floor** -**Improved head control** -**Turns and lifts head from side to side when prone** -**Some head control when upright** >Fine motor skills -**Holds hands open** -**Grasp reflex absent** -**Can pull at clothes and blanket** -Bats at object >Cognitive, Sensory & Language - When supine, follows dangling toys -Visually searches for sounds -When crying, can be consoled easily by being held or spoken to -Turns head to sound -Language: Coos has social smile >Psychosocial -Learns to calm self Play:** Solitary play stimulates sensorimotor development with simple imitative games; interaction with parents and caregivers through games such as: Patty-cake; peek-a-boo**

Developmental Milestones of the infant: 3-6 months

>Physical growth -**Weight: Double the birth weight by 6 months** -**Height: increases by 1 in/month** >Gross motor skills -**Can hold head more erect when sitting, still some bobbing, by 6 months sturdy head control** -Only slight head lag, by 6 months no head lag -**Raises head 45-90 degrees off floor** -In sitting position (tripod) back is straight and balances head well, sits alone by 8 months -When held in standing position can bear some weight, by 8 months, readily bears weight -**Rolls from back to side and then abdomen to back** -When supine, puts feet to mouth -**Begins to creep on hands and knees** >Fine motor skills -Plays with toes -Clutches own hands -Inspects and plays with hands -Pulls blanket over face -Rakes objects -**Grasps objects with both hands (palmar grasp)** -**Shakes, rattles, and holds bottle** -**Eventually able to put objects in container and bang them together** -**Carries objects to mouth** -**Transfers objects from hand to hand** -Reaches and bangs toys on table -Like mirror images >Cognitive, Sensory & Language -Follows object 180 degrees -Develops binocular vision -Locates sound by turning head -Beginning hand-eye-coordination -Purses dropped objects visually -Sees small objects -Responds to name -Recognizes parents voice and touch by 6 months; differentiates between parents -**Language: Coos, babbles, laughs; by 6 months may say "mama" & "dada" and "baba"; begins to distinguish emotion based on tone of voice** >Psychosocial & Play -Same as previous card -Play: Solitary play stimulates sensorimotor development with simple imitative games; Interaction with parents and caregivers through games such as: Patty-cake, peek-a-boo, songs

Identify and explain the theories of growth and development: Attachment Theories

>Refers to the bond or emotional and physical connection that develops between an infant and caregiver that tends to endure. John Bowlby & Mary Ainsworth >Healthy mother infant relationship is contingent on the characteristic value of communication between them **>Infant develops an attachment to the mother or mother substitute as a means of surviving the vulnerability of infancy**. **>Mother is considered as home-base**

Discuss the components for each developmental stage: Reflexes and Neurological Development

>Reflexes controlled by the lower brain centers >**Reflexes present at birth naturally disappear by 9 months**

What to say---Tips for Effective Discipline

>Speak to child as you would want to be spoken to >Never resort to name-calling, yelling, or disrespect >Be clear about what you mean >Be firm and specific

CRITICAL NURSING ACTION: ANTICIPATORY GUIDANCE

>Way of providing caregivers with information and examples about what to expect in the future regarding their child's next developmental stage (discipline, nutrition, safety, schooling, elimination, immunization, or play) > **It is important to teach parents that infants do not misbehave on purpose** >**Exploration and crying is normal for an infant** >Purpose of discipline at this stage is to keep the child safe >**Parents can use a firm tone of voice or facial expression while telling the child "NO" OR "STOP" as infant reaches for stove** >Infant can then be directed to a similar experience, such as reaching instead for a toy off a countertop

Identify and explain the theories of growth and development: Family Domain/ E.R. Duvall

Family Development: >Marriage -Tasks of couples in this stage is to establish themselves as a pair and to prepare for parenting >Family with infants -Child is born and family adjusts to its new structure >Family with preschool children -As oldest child enters stage of early childhood, family functions to socialize the children helping them to cope with separation >Family with school children -Children develop friendships and launch socially outside the family >Family with adolescent -Oldest child launches toward independence **>Family launching young adult** -Oldest child leaves home >Middle age family -Family continues to focus on reinvesting the couples relationship >Aging family -Family copes with process of, and losses involved in, retirement and aging

Identify and explain the theories of growth and development: Learning Theories of Urie Bronfenbrenner

Ecological definition of Development >**Microsystem (refers to system where child is actively involved)** >**Mesosystem ( interaction between 2 microsystems such as the interplay between a child's home and school)** >**Exosystem ( Refers to those systems that have an impact on the child, but which the child is not intimately involved-----for instance, the parent's work. The parent's work affects the child's life, yet the child is not directly involved in it**

Identify and explain the theories of growth and development: Learning Theories of Ivan Pavlov/ J.B Watson/ B.F. Skinner

Ivan Pavlov >Classical conditioning J.B. Watson >Observable behavior B.F. Skinner >Stimulus-Response

Identify and explain the theories of growth and development: Learning Theories of Lev Vygotsky

Levels of Development: >**Personal (intrapsychological)** >**Social (interpsychological)** >**Zone of proximal development ( one learns much more successfully when assisted by another person)** >**Vygotsky emphasized that culture and certain factors within the child's environment have a dramatic impact on language and development.**

Identify and explain the theories of growth and development: Moral Domain of Lawrence Kohlberg

Moral Development: >Preconventional Morality -Obedience & punishment -Individualism and exchange (child thinks it might be okay to do something if good comes with it, "the end justifies the means" >Conventional Morality -Good Interpersonal relationships -Maintaining social order >Postconventional Morality -Social contract and individual rights -Universal principles

Identify and explain the theories of growth and development: Intelligent Domain of Howard Gardner (basically learning)

Multiple intelligences: >Bodily Kinesthetic -dancing, running, jumping, building, touching -need role play, drama, sports, physical games, hands-on learning >Interpersonal -bouncing ideas of other people -leading, organizing, relating, manipulating -group activities, social events >Intrapersonal -In relation to their feelings, needs, and goals -setting goals, meditating, learning, reflecting -secret places, time alone, self-paced projects >Linguistic -reading, writing, telling stories, playing word games -books, tapes, writing tools, paper, diaries, discussion, debate >Logical Mathematical -Experimenting, questioning, puzzles, calculating -Materials to experiment with, science materials, trips to museums and planetariums >Musical -singing, whistling, humming, tapping feet and hands -sing along time, trips to concerts, playing music @ home & school >Naturalistic -playing with pets, gardening, investigating nature, raising animals, caring for planet Earth -access to nature, magnifying glasses, binoculars >Spatial -designing, drawing, visualization, doodling -art, LEGOS, videos, movies, slides, imagination games, mazes, puzzles, illustrated books

What to say when a parent inquires about the development of her child?

Nurses can respond by: > It is important to note that your child may not have reached the appropriate developmental stage based on chronological age alone. There may be events or variables that delay your child's attempts to move forward such as illness

Freud's Stages of Psychosexual Development:

Oral (birth - 1 year) >Infant is fixated on oral curiousity (breasts, fingers, pacifier, teething ring) Anal Stage (1-3 years) >Kid ready to control elimination >" Big Kid Potty" >"Terrible Two's" >Child escapes boundaries and runs down the street is an examples Phallic Stage (3-6 years) >Sexual difference is discovered >Comparison of body parts between female and male is done **Latency Stage (6-12 years)** > Child "Takes a break" During this psychosexual development stage >**Child hangs with same sex friends, excelling in video games/sports, ** >Child has little interest in sexuality Genital Stage (12-18 years) >By the time the child reaches puberty, sexuality and relationships are the focus. >This is a time for exploring relationships and developing a sense of romanticism.

Describe the principles inherent in the developmental process: T Barry Brazelton Touchpoints Birth to 3 years

Pregnancy to 7 months: >Parents are concerned with who the child will be. Choice time to develop a rapport with parents before the child is born Newborn: >Soon after birth the newborn is assessed for his ability to habituate, or remain calm in a chaotic environment. 3 weeks: >Infant starts to learn to self-calm. Parents debate use of pacifiers vs thumb 6-8 weeks: >Infant reacts differently to each parent through facial expression and physical movements 4 Months: >Infant cycles through light and deep sleep several times a night as he learns to sleep through the night. Important to avoid sleeping problems 7 months: >Naps and bedtime are interrupted by the constant practice of new physical skills such as sitting and crawling 9 months: >Increasing independence (crawling, cruising) makes the infant more dependent as separation anxiety takes hold 12 months: >All foods become finger food. Parents must often give up on the idea of a "rounded diet" because the child now controls what is eaten and when 15 months: >The word "no" becomes prevalent. Toddlers demonstrate frustration at not being able to talk 18 months: >The child tests the limits of parents and caregivers and learns appropriate behavior through consistent self limiting consequences 2 years: > The child has now developed gender identity and behaves accordingly 3 years: >Learning to handle anger and aggression is paramount. Children may regress and exhibit temper tantrums as they process these emotions.

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Types of Attachment:

Secure attachment -Baby cries when the mother leaves and is happy when mother returns Avoidant Attachment: -Baby rarely cries when the mother leaves and avoids the mother upon return Ambivalent Attachment: -Baby becomes anxious prior to the mother leaving; is very upset when the mother leaves, and seeks contact with her while pushing her away on return

Identify and explain the theories of growth and development: Learning Theories of Albert Bandura

Social Context of Learning (observation & modeling: >**Approximation** -reproduction of an action increases the child's perception of personal effectiveness, which then contributes to the development of new social skills >**Self Efficacy** -They are mastery (being successful), modeling by others (imitation), social persuasion (pairing situations in which success is likely to occur after positive feedback), and being able to decrease the perception of stress and threat

Identify and explain the theories of growth and development: Spiritual Domain of James Fowler

Spirituality Stages: >Stage 0: Undifferentiated (infancy) -Infant is learning "fundamentals" of basic trust and the relational experience of mutuality with the one(s) providing primary love and care > Stage 1: Intuitive-projective (2-7) -Corresponds with the child's imaginative period in which beliefs and faith are unquestioning. Time of fantasy and magical thinking >Stage 2: Mythical-Literal (6-12) -Child retells spiritual stories and takes them literal and concretely. >Stage 3: Synthetic-Convention (typically begins around 12-13) -Young person begins to personalize beliefs -Youth looks beyond family to include values encountered in relationships, in school, and in society in general. Sometimes adults remain in this stage >Stage 4: Individuating-reflexive (may begin in late adolescence or early adulthood or not at all) -Individual takes responsibility for personal beliefs and commitments. -Invests personal energy in what spirituality makes sense, regardless of what others believe

Identify and explain the theories of growth and development: Cognitive Domain of Jean Piaget

Stages of Cognitive Development >Sensorimotor (birth-2 years) -primary means of cognition is through the senses -child takes in and processes information strictly on a physiological or emotional level -use of reflexes -primary circular reactions -secondary circular reactions -coordination of secondary schemes -mental combinations >Pre-operational (2-7 years) -begins to use cognitive processes to respond to the world physically -Takes into account the development of motor skills and is divided into to substages (pre-conceptual and intuitive) -Child is still not capable of logical thinking, but because of an increased ability to use words and actions together, the child is increasingly able to connect cognitively with the world >Concrete operational stage(7-11) -Child is able to organize thoughts in a logical order. -Child is able to categorize and label objects -Possible to solve concrete problems at this stage >Formal operational stage (11-15) -Child uses abstract reasoning to handle difficult concepts and can analyze both sides of an issue