Chapter 28: Developmental and Genetic Influences on Child Health Promotion

Maturation

- Increase in competence and adaptability - aging - usually used to describe qualitative change - a change in the complexity of a structure that makes it possible for that structure to begin functioning - to function at a higher level

Growth

- Increase in number and size of cells as they divide and synthesize new proteins - results in increased size and weight of the whole or any of its parts

BMR

- Basal Metabolic rate = at rest- demonstrates a distinctive change throughout childhood - BMR is highest in newborns - BMR closely relates to the proportion of SA to body mass- which changes as the body increases in size - in both sexes, the proportion decreases progressively to maturity - BMR is slightly higher in boys at all ages and further increases during pubescence over than in girls

Bone Formation when? what?

- Begins during the second month of fetal life when calcium salts are deposited in the intercellular substance matrix to form calcified cartilage fist and then true bone - differences - small bone the bone continues to form in the center, and cartilage continues to be laid down on the surfaces - long bones- the ossification begins in the diaphysis and continues to the epiphysis (central to end) --> between them is epiphyseal cartilage plate or growth plate - first centers of ossification appear in 2 month old embryos and at birth the number is 400, about half the number at maturity - new centers appear at regular intervals during growth - postnatally, the earliest centers to appear at 5 months are those of capitate and hermit bones in wrist- therefore radiographs of the hand and wrist provide most useful areas for determine skeletal age before age 6************* - these centers appear earlier in girls than boys

Separation Anxiety: Protest

- Behaviors observed during later infancy: cries, screams, searches for parent with eyes, clings to parent, avoids and rejects contact with strangers - Behaviors observed during toddlerhood: verbally attacking strangers- Go away!- physically attacking strangers- kicks, bites, attempts to escape to find parent, attempts to physically force parent to stay - behaviors may last from hours to days - protest may be continuous like crying stoping with exhaustion

Significance of Temperament

- Children who display the difficult or slow to warm up patterns are more vulnerable to the development of behavior problems in early and middle childhood - any child can develop behavior problems if dissonance between temperament and environment - most important is degree of fit between children and their environment, specifically their parents that determines the degree of vulnerability - potential for optimum development exists when environmental expectations and demand fit with the individual's style of behavior and the parents' ability to navigate this period - early recognition may help. Difficult children may be colic in infancy, active children require more vigilance to prevent injury - temperament can influence parent's self esteem, marital harmony, mood, and satisfaction as parents - studies on temperament and ability to perform a task successfully (mastery motivation) found that infants with high master and more cooperative

Body Image

- Consists of the physiologic (the perception of one's physical characteristics) psychologic (values and attitudes toward the body, abilities and ideals) and social nature of one's self image - sig others in their lives exert the most important and meaningful impact on body image - infants receive input about their bodies through self-expiration and sensory stimulation from others- as they manipulate their environment they become aware of their bodies as sport from others - toddlers identify the various parts of their bodies and are able to use symbols to recognize objects - preschoolers become aware of their bodies and discover genitalia - school age children begin to learn about internal body structure and function and become aware of differences in body size and configuration - adolescents most concerned abut the physical self

Directional Trends

- G&D proceed in regular, related directional trends - first pattern = cephalocaudal: head to tail direction- head develops first and is large and complex, lower end is small and simple and takes shape later- applies to postnatal behavior development... control heads before trunk and extremities and control of feet - second, proximodistal: near to far- applies to the midline to peripheral concept -----Early embryonic development of limb bids --> fingers and toes. In infants, shoulder control precedes mastery of the hands. The whole hand is used as a unit before the fingers can be manipulated, and CNS develops more rapidly than PNS - these are bilateral and symmetric - can have preference, like by 5 years have dominant and non-dominat hand - third trend = differentiation- describes development form simple operations to more complex activities and functions - from broad--> more specific all areas of development follow this pattern

Development

- Gradual changes and expansion - advancement from lower to more advanced stages of complexity - the emerging and expanding of the individual's capacities through growth, maturation and learning

What is considered a stable measurement of general growth?

- Height - linear growth or height is almost entirely a result of skeletal growth - not uniform throughout life but ceases when maturation of skeleton is complete - maximum rate of growth in length occurs before birth but newborns continue to grow at a rapid but slower rate

The Difficult Child

- Highly active, irritable, irregular with habits - negative withdrawal - require more structured environment - adapt slowly to new routines, people - intense mood expressions, usually negative - frequent periods of crying and frustration 10% of children

Self Concept

- How an individual describes himself or herself - includes all notions, beliefs and convictions that constitute an individual's self-knowledge and influence his or her relationship with others - not present at birth develops gradually - in infancy self-concept is primarily an awareness of one's independence existence learned in part with social contacts and experiences - process becomes more active in toddlerhood - school age children are more aware of differences among people, more sensitive to social pressure and more preoccupied with self criticism and evaluation - during adolescence focus more on physical and emotional changes - is crystallized during later adolescence as young people organize their self concept around a set of values, goals and competencies acquired throughout childhood

Seperation Anxiety: Detachment

- Observed behaviors: shows increased interest in surroundings, interacts with strangers o familiar caregivers, forms new but superficial relationships, appears happy - this usually occurs after prolonged seperation from parent, it is rarely seen in hospitalized children - behaviors represent superficial adjustment to loss

Cognitive Development

- Piaget - cognitive development consists of age-related changes that occur in mental activities - he says intelligence enables individuals to make adaptations to the environment that increase the probability of survival - and to establish and maintain equilibrium with the environment - 3 stages of reasoning 1. Intuitive 2. Concrete operational 3. Formal operational - when enter concrete operational (7 years) they are able to make logical inferences, classify and deal with quantitive relatioships about concrete things - not until adolescent are they able to reason abstractly with any degree of competence

Nutrition

- Prob the single most important influence n growth - dietary factors regulate growth at all stages of development - Durin rapid prenatal growth period poor nutrition may influence development form time of implantation to birth - during infancy, protein and caloric requirements are higher than at any period of postnatal development - growth is uneven, plates and growth spurts- therefore appetites fluctuate

Stages of Development Notes

- Remember they do NOT take into account individual differences, cannot be applied to all with precision Developmental Age Periods 1. Prenatal Period- Conception to Birth 2. Infancy Period- Birth to 12 months 3. Early Childhood 1-6 years 4. Middle Childhood 6-11/12 years 5. Later Chipdood 11-19 years

Functions of Play

- Sensorimotor development - intellectual development- learn colors, shapes, textures, numbers, up, down, under, over, puzzles - socialization - creativity - self-awareness - therapeutic value- express emotions, experiment and test fearful situations, communication - Morality- interaction with pears contributes to moral training- learn that their peers are less tolerant of violations than are adults and to maintain play group they must conform to the standards of the group

Synthetic Convention

- Stage 3 Fowler, spiritual - approach adolescence become more aware spirituality - recognize that prayers are not always answer on their own terms and may abandon or modify religious practice - begin to reason and question some of established parental views

External Proportions

- Variations in the growth rate of different tissues and organ systems produce sig changes in body proportions during childhood - cephalocaudal trend of development is most evident in total body growth indicated by these changes - 2 months gestation, head is 50% of body length - during infancy growth of the trunk predominates, legs are most rapidly growing during childhood etc.

Skill Play

- after infants develop ability to grasp/manipulate --> skill play and repeating over and over gain - practicing a new ability summits products pain and frustration

Developmental Pace

- although precise order, does NOT progress at same rate/pace - some accelerated growth areas some slow - when a spurt occurs in one area like gross motor, minimal advances may take place in language or fine motor - rapid growth before birth, levels off throughout early childhood- slow during middle, than increases rapidly at beginning of adolescnce --> developmental milestones

Weight vs. Height at birth

- at birth, weight varies more than height and is more so a reflection of the intrauterine environment - average newborn weights 7-7.5 lbs or 3175-3400 grams - generally, BW doubles by 4-7 months and triples by end of the first year - 2-2.5 years its 4x BW- after this point the normal rate of weight gain assumes a steady annual increase of 4.4-6lbs 2-2.75 kg per year until adolescent growth spurt

Temperature

- body temperature (reflecting metabolism) decreases over development - thermoregulation is one of most important adaptation responses of infants during transition from intrauterine to extrauterine life - in neonates hypothermia can --> hypoglycemia, elevated bilirubin levels, metabolic acidosis - skin to skin care= effective way to prevent neonatal hypothermia - after the unstable regulatory ability in the neonatal period, heat production steadily declines as the infant grows into childhood - individual differences 0.5-1F are normal, and occasionally a child normally displays an unusually high or low temperature - age 12 girls temp= stable - boys temp at age 12 needs more time, falls for a few more years *In relation to body weight, an infant produces more heat per unit than an adolescence- therefore during play or when heavily clothed, an infant is more likely to become overheated

Nursing Considerations Bones

- bone fractures occurring at the growth plate may be difficult to discover and may sig addict growth and development - factors that influence skeletal muscle injury rates and types in children and adolescent are - less protective sport equipment - less emphasis on conditioning and flexibility - fractures more common in adolescence that ligamentous ruptures because rapid growth of the physeal zone of hypertrophy

Language Development general

- children born with mechanism and capacity to develop speech, but do not spontanesouly - need right environment - speech requires intact physiologic structure and function, intelligence, need to communicate and stimulation - rate varies - gesture precedes speech, as speech develops gesture recess but never entirely - research suggests infants can learn sign language before voice and may enhance development of voice language - at ALL stages children comprehensive vocab (what they understand) is greater than expressed (what they can say) - reflects continuing process of modification- acquisition of new words and expanding and refining of word meanings previously learned - by the time they begin to walk, they area able to attach names to objects

Solitary play

- children play alone with toys different from those used by other children in the same area - they enjoy the presence of other children but machine effort to get close or speak to them 0-1

Parallel play

- children play independently but among other children - they play with toys similar to those that the children around them are using but neither influencing or being influenced by other children - each play beside but not with other children - no group association - characteristic of toddlers but may occur in any age Toddler 1-3

Associative play

- children play together and are engaged in a similar or even identical activity but there is NO organization division of labor, leadership -- children borrow and lend play materials like wagons, tricycles sometimes attempt to control who or who may not play in the group - each child acts according to his own wishes there is NO group goal example- 2 children play with dolls, borrowing clotting from one another engaging in similar conversation but neither directs the others' actions or establishes rules regarding play 3-6

Onlooker Play

- children watch what other children are doing but make no attempt to enter into the play activity - there is an active interest in observing but no movement towards participating example- watching older sibling bounce a ball

Patterns of Growth and Development

- definitive predictable patterns - directional trends - Sequential Trends - Developmental Pace - Sensitive Periods

The rate of metabolism determines

- determine the caloric requirements of the child - basal energy requirements of infants is about 108kcal/kg and decreases to 40-45kcal/kg at maturity - energy requirement to build tissue steadily decreases with age following the general growth curve BUT energy needs vary with individual child- for strenuous exercise and illness may be very high

RF that increase children's vulnerability to stresses of hospitalization

- difficult temperament - lack of fit between child and parent - age especially 6months- 5 years - male gender - below average intelligence - multiple and continuing stressers

The Easy Child

- even tempered - regular and predictable in habits - positive approach to new stimuli - open and adaptable to change - mild to moderately intense mood that is usually positive 40% of children

Applying and Integrating Genetic into Nursing

- family health history is e important should collect info within a minimum of 3 generations- takes 20-30 minutes - best to include both parents in the interview to elect information

Games as play

- games alone and with others - very young participate in simple games like peek a boo - preschool learn formal games- ring around a rosy and London Bridge - with exception of simple boardgames, preschool children do not engage in competitive games- they hate to lose, try to cheat - school age and adolescents enjoy competitive games

Foundations of Growth and Development

- growth - development - maturation - differentiation - all of these are interrelated, simultaneous and ongoing

Sequential Trends

- in all dimensions of g&d there is definite, predictable sequence - crawl before creep, before stand before walk

Separation Anxiety

- major stress from middle infancy through preschool years especially for ages 6-30 months = separation anxiety aka anaclitic depression - stages: protest, despair, detachment (denial) - in protest, children react aggressively to the seperation from their parent- cry, scream, refuse attention of anyone else, inconsolable - in despair- crying stops and depression is evident- uninterested in play, or food, withdraws - detachment- aka denial- uncommon- superficial it appears child has finally adjusted to the loss- becomes more interested in surroundings, plus with others BUT this behavior is the result of resignation and NOT a sign of contentment- child detaches from the parent in an effort to escape the emotional pain from desiring the parent's presence and copes by forming shallow relatioships with others--> self centered, and attaching primary importance to material objects

Separation misconceptions

- may perceive crying in protest as negative and "adjustment" in despair as positive but that is WRONG

Neurologic Maturation

- nervous system grows MORE rapidly beforee birth (unlike other body tissues) - two periods of rapid brain cell growth occur during fetal life 1. dramatic increase in # of neurons between 15-20 weeks gestation 2. another increase at 30 weeks- extends to 1 year - rapid growth of infancy continues till early childhood and slows more gradual during later and adolescent - postnatal growth consists of increasing amount of cytoplasm around nuclei of cells, increasing number and intricacy of communications with there cells, and advancing their peripheral axons to keep pace with expanding body dimensions --- allows for increasingly complex movement and behavior - also provide foundation for language, learning and behavior development

Sense-Pleasure Play

- nonsocial stimulate experiences that originates from without - objects in the environment- light, color, tastes, odors, textures- attract children's attention, stimulate their senses and give pleasure - pleasurable experiences are derived from handling raw materials- water, sand food, - body motion- swinging, touching and others senses- smelling

Dramatic/Pretend Play

- one of vital elements of children's process of identification = this aka symbolic play or pretend - begins in late infancy 11-13 months - predominate form of play in preschool children - practices roles in society

Cooperative Play

- organized and children play in group WITH other children - discuss ad plan activities with purpose of accomplishing something at the end - marked sense of belonging or not - division of labor and role playing - the leader follower relationship is identified and established and the activity is controlled by one or two members who assign roles to others - organized 6-12

Sensitive Periods

- periods termed critical, sensitive, vulnerable and optimal are the times in the lifetime of an organism when it is more susceptible to positive or negative influences - quality of interactions during the periods determines whether the effect on the organism will be beneficial or harmful - first 3 months of prenatal life are sensitive periods for physical growth of fetuses= example - psychologic development also has sensitive periods

Social- Affective Play

- play begins with this - infants take pleasure in relationships with people - as adults talk, touch, nuzzle and in various ways elect responses from an infant, the infant soon learns to prove parental emotions and responses with smiling, cooking etc.

Hospitalization- primary nursing goal

- prevent separation especially in children younger than 5 --> family centered care -if detachment behaviors are evident, the nurse maintains the child's contact with the parents by talking about them frequently, encouraging the child to remember them and stressing the sig of their visits, calls or letters

Differentiation

- processes by which early cells and structures are systematically modified and altered to achieve specific characteristic physical and chemical properties - sometimes used to describe the trend of mass to specific - development from simple to more complex activities and functions

Water requirements

- remain approx. 1.5mL/calorie throughout life

Seperation Anxiety- Early Childhood hospital

- separatin anxiety is the greatest stress imposed by hospitalization during early childhood - if separation is avoided, young children have a tremendous capacity to withstand any other stress** - children in the toddler stage demonstrate more goal-directed behaviors- ma plead with parents to stay and physically try to keep the parents with them or try to find parents who left, the may demonstrate displeasure on the parents return - preschoolers are more secure interpersonally than toddlers, they can tolerate brief periods of separation from parents, more inclined to develop trust in other sig adults- BUT the stress of illness usually renders preschoolers ability to cope with separation --> behaviors of separation anxiety (but more subtle and passive than with younger children)

What is the most accurate measure of general development?

- skeletal or bone age- radiologic determination of osseous maturation - skeletal age correlates more closely with physiologic maturity like onset of menarche than with chronologic age or height - bone age is determined by comparing the mineralization of ossification centers and advancing bony form to age related standards

Sleep and Rest

- sleep allows for repair - newborns sleep as much time that is not occupied with feeding and other care then declines - sleep cycle increases from 50-60 minutes in infants to 90 minutes in adolescents - by time 12-18 months most have eliminated their second nap - age 3 usually given up daytime naps

Self-Esteem

- the value that an individual places on oneself and refers to an overall evaluation of oneself = affective component of self, self-concept is the cognitive component- the two are hard to distinguish often used interchangeably - refers to a personal, subjective judgment of one's worthiness - influenced by social groups - changes with development Factors that Influence are - the child's temperament and personality - abilities and opportunities available to accomplish age appropriate developmental tasks - how sig others interact with the child - social roles assumed and the expectations of these roles

Slow to Warm up Child

- typically react negatively and with mild intensity to new stimuli and unless pressured, adapt slowly with repeated contact - response with only mild passive resistance to new changes or routines - inactive and moody but show only moderate irregularity in functions 15% children

First Parts of Speech

- usually nouns, sometimes verbs ( go) and combination words (bye bye) - next use adjectives and adverbs - later pronouns and gender words are aded - by time enter school, able to use simple, structurally complete sentences that average 5-7 words

Unoccupied Behavior

-children are NOT playful but focusing their attention momentarily on anything that strikes interest - daydream, fiddle with clothes, walk aimlessly

Lymphoid Tissues

-lymphoid tissue found in lymph nodes, thymus, spleen, tonsils, adenoids, lymphocytes following different growth pattern than other body tissues - these tissues are small in relation to total body size, but are well developed at birth - increase rapidly to reach adult dimensions by 6 years - at 10-12 reach max development- approx. twice their adult size -- followed by rapid decline to stable adult dimensions by the end of adolescent

Cognition

-the process by which developing individuals become acquainted with the world and the object it contains - children are born with inherited potentials for intellectual growth, but they must develop that potential through interaction w/ the environment

Early Childhood

1-6 Years Toddler: 1-3 years Preschool: 3-6 years - extends from time children attain upright locomotion until they enter school - characterized by intense activity and discovery - marked physical and personality development - motor development advances steadily - acquire language and wider social relationships, learn role standards, self control, develop increasing awareness of dependence and independence --> self concept

Attributes/ Characteristics of Temperament

1. Activity 2. Rhythmicity- regularity in timing physiologic functions like hunger, sleep, elimination 3. Approach-withdrawl- nature of initial response to new stimulus 4. Adaptability 5. Threshold of responsiveness/sensory threshold- among of stimulation like sound to evoke a response 6. Intensity of reaction 7. Mood 8. Distractibility 9. Attentino span and Persistence

Freud's Stages

1. Oral Stage: Birth-1 year- major source of pleasure seeking is centered on oral activities- sucking, biting, chewing, vocalizing 2. Anal Stage: 1-3 years- as sphincter muscles develop can withhold or expel fecal material at will-- toilet training can have lasting effects on children's personalities 3. Phallic Stage 3-6 years- the genetilia become interesting and sensitive area of body, child recognizes differences between sexes and more curious.. oedipus and electra complexes, penis envy and castration anxiety= controversial issues 4. Latency period 6-12 years: children elaborate on previously acquired traits and skills. Physical and psychic energy is channeled into acquisition of knowledge and vigorous play 5. Genital Stage: 12+- begins at puberty with maturation of reproductive system and sex hormones production. Genital organs= major source of sexual tensions, pleasures -- prep for marriage

Later Childhood

11-19 years Prepubertal 10-13 Adolescence 13-18 years - rapid maturation and change- onset of puberty to entry into adult world- HS graduation - biologic and personality maturation accompanied by physical and emotional turmoil - redefining of self concept - late adolescent internalized all previous learned values and focus on individual rather than identity

Middle Childhood

6-11/12 years - referred to as school age - child is directed away from the family group and centered around the wider of peer relationships - steady advancement in physical, mental and social development with emphasis on skill competencies - critical period in development of self concept***

Infancy Period

= Birth-12 months Neonatal: Birth-27/28 days Infancy: 1-12 months - infancy period is rapid motor, cognitive and social development - infant establishes trust in world - critical first month of life (although part of infancy period) is often differentiated because of major physical adjustments to existence and to parent

Prenatal Period

= Conception to Birth germinal: Conception - 2 weeks Embryonic: 2-8 weeks Fetal: 8-40 weeks (birth) - rapid growth rate and total dependency make this one of most crucial periods in developmental process - relationship between maternal health and certain manifestations in the newborn emphasizes importance of adequate prenatal care

Psychosexual Development

= Freud - all human behavior is energized by psychodynamic force, and this psychic energy is divided among 3 components of personality 1. The id= unconscious mind- the inborn component that is driven by instincts, it obeys the pleasure principle of immediate gratification of needs regardless 2. The ego= the conscious mind, serves the reality of principle - functions as the conscious or controlling self that is able to find REALISTIC means for gratifying the instances while blocking the irrational thinking of the id 3. The superego= the conscience, functions as the moral arbitrator and represents the IDEAL. It is the mechanism that prevents individuals from expressive undersell instincts that might threaten the social order - He considered sexual instances to be sig in development of personality - used the term psychosexual to describe any sensual pleasure Oral stage Anal Stage Phallic Stage Latency Period Genital Stage

Undifferentiated Stage

= Stage 0 Fowler Spiritual Development - encompasses the period of infancy during which children have no concept or right or wrong, no beliefs and no convictions to guide their behavior - beginnings of faith are established with development of basic trust with primary caregiver

intuitive projective stage

= Stage 1 Fowler, spiritual development - Toddlerhood time of imitating the behavior of others - children imitate the religious gesture and behaviors of others without comprehending any meaning - during preschool they assimilate some of the vales and beliefs of their parents - parental attitudes towards moral codes and religious believe convey to children good and bad - children still imitate behavior and follow parents beliefs rather then their own

Temperament

= The manner of thinking, behaving, or reacting characteristic of an individual- refers to the way which a person deals with life - a genetic basis has been suggested for some differences in temperament - 9 characteristics of temperament have been ID - Most children can be placed into one of 3 overall patterns 1. Easy Child 2. Difficult 3. Slow to Warm Up - 35% of children either have some but not all of the characteristics of the categories or are inconsistent - many normal children demonstrate wide range of behavioral patterns*

Activities to Promote Mastery Motivation

= perform a task successfully 1. encourage unobtrusive assistance during play 2. Share pleasure with infant in accomplishments 3. do not interrupt infant during tasks 4. do not give immediate assistance during tasks 5. Let infant initiate activities 6. Limit controlling feedback during play 7. Provide audio and visually responsive toys 8. Provede early kinesthetic stimulation- picking up

Psychosocial Development

Erikson - most widely accepted theory of personality development - built on Freudian theory - known as psychosocial development emphasized a healthy personality - also uses biologic concepts of critical periods and epigenesis, describing key conflicts or core problems that the individual strives to master during critical periods of development - each psychosocial stage has 2 components and progress to the next stage depends on resolution of this conflict

Autonomy vs. Shame and Doubt

Erikson 1-3 years - corresponds to Freud's anal stage - autonomy can be symbolized by holding on and letting go of the sphincter - centered on children's increasing ability to control their bodies, themselves and environment - want to be independent - much of learning is acquired by imitating the activities and behavior of others - negative feelings of doubt and shame arise when children are made to feel small and self-conscious, when their choices are disastrous, when others shame them or when they are forced to be dependent in areas in which they are capable of assuming control - favorable outcomes= self-control and willpower

Identity vs. Role Confusion

Erikson 12-18 years - corresponds to Freud's genital period - characterized by rapid and marked physical changes - previous trust in their bodies is shaken, and children become overly preoccupied with the way they appear in the eyes of others/self-cncept - adolescents struggle to fit the roles they have played - the outcome of successful mastery is devotion and fidelity to others and to values and ideologies

Initiative vs. Guilt

Erikson 3-6 years - corresponds to Freud's phallic stage - characterized by vigorous, intrusive behavior, enterprise and strong imagination - explore the physical world with all senses and powers - they develop a conscious - no longer guided by outsiders, have inner voice that warns and threatens - must learn to retain a sense of initiative without impinging on the rights and privileges of others - outcomes= direction and purpose

Industry vs. Inferiority

Erikson 6-12 years - corresponds to latency of Freud - they are ready to be worker and producers - want to engage in tasks and activities that they can carry through to completion they need and want real achievement - children learn to compete and cooperate with others - learn rules - feelings of inadequacy and inferiority may develop if too much is expected of them or if the believe they cannot measure up t the standards set for them by others - the ego quality developed from a sense of industry is competence

Trust vs. Mistrust

Erikson Birth- 1 year - first and most important attribute to healthy personality - establishing basic trust dominates the first year of life - corresponding to Freud's oral stage it is a time of getting and taking in through all senses - exists in relation to something or someone - Mistrust develops when trust are lacking/inadequately met - shreds of mistrust are sprinkled throughout there personality form a basic trust in parents stems trust in world --> faith and optimism

Spiritual Development

Fowler - children need to have meaning, purpose and hoe in their lives - extending beyond religion, spirituality affects the WHOLE person- mind, body, spirit Fowler identified 7 stages 4 which related to childhood 0. undifferentiated 1. intuitive projective 2. Mythical Literal 3. Synthetic-Convention 4. Individuating Reflexive

Preoperational

Piaget 2-7 years - Predominant characteristics= Egocentrism- the inability to put oneself in the place of another - interpret objects and events not in terms of general properties but in terms of their relationship or their use to them - cannot see things from another perspective - thinking is concrete and tangible - cannot reason beyond the observable - lack ability to make generalization - increasingly able to use language and symbols - imaginative play, questioning and other interactions they begin to elaborate concept and make simple associations - later in this period, their reasoning is intuitive - reasoning is transductive- because two events go together they cause each other- all women with big bellies have babies

Moral Development

Kohlberg - Moral reasoning in sequence 3 levels with 2 stages each 1. pre conventional level 2. conventional level 3. Post conventional, autonomous or principled level

Post-conventional, Autonomous or Principled Level

Kohlberg Moral Reasoning Third stage - individual has reached the cognitive stage of formal operations - correct behavior tends to be defined in terms of general individual rights and standards that have been examined and agreed on by the entire society - although procedural rules for reaching consensus become important, with emphasis on the legal point of view, there is also emphasis on the possibility for changing law in therms or societal needs and rational considerations *Note last stage is one in which self chosen ethical principles guide decisions of consciousness, believed that few people reach this stage

Conventional level

Kohlberg Moral Reasoning 2nd - correlates with concrete operations in cognitive development - concerned with conformity and loyalty - value maintence of family, group or national expectations regardless of consequences - behavior that meets with approval and pleases others= Good - one earls approval by being nice - obeying the rules, doing one's duty, showing respect for authority and maintaining the social order are correct behaviors

Pre-Conventional level

Kohlberg Moral Reasoning- 1st stage - parallels prepositional level of cognitive development and intuitive thought - culturally oriented to the labels of good/bad and right/wrong they integrate these in terms of the physical or pleasurable consequences of their actions - at first, determine goodness or badness of an action in terms of consequences - they avoid punishment - obey without question those who have the power to determine and enforce rules - have NO concept of basic moral order that supports these consequences - later, they determine that the right behavior consists of that which satisfies their own needs- and sometimes the needs of others - although elements of fairness give and take and equal sharing are evident, they are interpreted in a practical concrete manner without loyalty, gratitude or justice

Seperation Anxiety: Despair

Observed behaviors: is inactive, withdraws from others, is depressed, sad, lacks interest in environment, is uncommunicative, regress to earlier behavior- thumb sucking, bed wetting, use of pacifier, bottle - behaviors may last for variable time - child's physical condition may deteriorate from refusal to eat, drink, move

Sensorimotor

Piaget Birth-2 years - this stage of intellectual development costs of 6 substages governed by sensations in which simple learning takes place - progress from reflex activity through simple repetitive behaviors to imitative behavior - develop a sense of cause and effect - problem solving by trial and error - high level of curiosity - become aware that objects have permanence- an object exists even if no longer visible** - towards the end, they use language

Formal Operations

Piaget 11-15 - characterized by adaptability and flexibility - adolescents think in abstract terms, use symbols draw logical conclusions- if A is bigger than B, B is larger than C which is largest?- A - can make hypotheses and test them, philosophic matters - most contraindications in the world can be dealt with and resolved

Concrete Operations

Piaget 7-11 years - thought becomes increasingly logic and coherent - able to classify, sort, order and organize facts - develop conservation- realize that volume, weight, and number aka physical factors remain the same even though outward appearances are changed - able to deal with a number of different aspects of a situation simultanesouly - do NOT have capacity to deal in abstraction - solve problems concrete, what they can perceive - reasoning is inductive - thought becomes less self centered - can consider points of view other than their own - thinking become socialized

Mythical-Literal

Stage 2 Fowler, spiritual development - school age years it parallels cognitive development and closely related to children's experiences and social interaction - most children have a strong interest in religion during the school age years - they accept the existence of a deity and petitions to an omnipotent being are important and expected - good behavior is rewarded, bad is punished - developing conscious bothers them when they disobey - able to articulate their faith - may question validity of faith

Individuating Reflexive

Stage 4 Fowler, spiritual - adolescents become more skeptical and being to compare religious standards of their parents with others - attempt to determine the standards they are going to adopt and incorporate into their set of values - compare religion to scientific viewpoint - adolescents are uncertain about religious ideas but do not achieve profound insights until late adolescent or early adulthood

Children greatest fear with hospitalization

being separated from family and friends, being in an unfamiliar environment, receiving investigations or treatments and losing self determination and choices - school aged chidlren are better able to cope with separation in general, the stress often accompanying regression imposed by illness may increase their needs for parental security and guidance

Young children appear withdrawn and sad in presence of a parent

could be despair of separation anxiety stage