Test 1 _ Chapter 03: Developmental and Genetic Influences on Child Health Promotion

3. What characterizes the stage of initiative according to Erikson's psychosocial development theory? a. Vigorous, intrusive behavior and imagination b. Achievement and completion of tasks c. Competing and cooperating with others d. Rapid and marked physical changes

ANS: A Initiative is characterized by vigorous, intrusive behavior, enterprise, and a strong imagination, according to Erikson's theory. Page 45 Initiative versus guilt (3 to 6 years old): The stage of initiative corresponds to Freud's phallic stage and is characterized by vigorous, intrusive behavior; enterprise; and a strong imagination. Children explore the physical world with all their senses and powers (Fig. 3-4). They develop a conscience. No longer guided only by outsiders, they have an inner voice that warns and threatens. Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made to feel that their activities or imaginings are bad produces a sense of guilt. Children must learn to retain a sense of initiative without impinging on the rights and privileges of others. The lasting outcomes are direction and purpose.

27. Which is probably the single most important influence on growth at all stages of development? a. Nutrition b. Heredity c. Culture d. Environment

ANS: A Nutrition is the single most important influence on growth. Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways. Adequate nutrition is closely related to good health throughout life. Heredity, culture, and environment contribute to the child's growth and development. However, good nutrition is essential throughout the life span for optimal health. Page 43 Nutrition

2. Which refers to those times in an individual's life when he or she is more susceptible to positive or negative influences? a. Sensitive period b. Sequential period c. Terminal points d. Differentiation points

ANS: A Sensitive periods are limited times during the process of growth when the organism will interact with a particular environment in a specific manner. These times make the organism more susceptible to positive or negative influences. The sequential period, terminal points, and differentiation points are developmental times that do not make the organism more susceptible to environmental interaction. Page 39/40 Sensitive Periods There are limited times during the process of growth when the organism interacts with a particular environment in a specific manner. 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. The quality of interactions during these sensitive periods determines whether the effects on the organism will be beneficial or harmful. For example, physiologic maturation of the central nervous system is influenced by the adequacy and timing of contributions from the environment, such as stimulation and nutrition. The first 3 months of prenatal life is a sensitive period in the physical growth of fetuses. Psychosocial development also appears to have sensitive periods when an environmental event has maximal influence on the developing personality. For example, primary socialization occurs during the first year when the infant makes the initial social attachments and establishes a basic trust in the world. A warm and consistently responsive relationship with a parent figure is fundamental to a healthy personality. The same concept might be applied to readiness for learning skills, such as toilet training or reading. In these instances, there appears to be an opportune time when the skill is best learned.

5. What is the outcome of successful mastery in the identity versus role confusion stage? a. Devotion and fidelity to others and values b. Self-control and willpower c. Direction and purpose d. Competence

ANS: A Successful mastery of the identity versus role confusion stage leads to devotion and fidelity to others and values. Page 45 Identity versus role confusion (12 to 18 years old): Corresponding to Freud's genital period, the development of identity is 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 compared with their own self-concept. Adolescents struggle to fit the roles they have played and those they hope to play with the current roles and fashions adopted by their peers, to integrate their concepts and values with those of society, and to come to a decision regarding an occupation. An inability to solve the core conflict results in role confusion. The outcome of successful mastery is devotion and fidelity to others and to values and ideologies.

2. What is the key outcome of the autonomy versus shame and doubt stage? a. Self-control and willpower b. Direction and purpose c. Trust in the world d. Competence

ANS: A The favorable outcomes of the autonomy versus shame and doubt stage include the development of self-control and willpower. Page 45 Autonomy versus shame and doubt (1 to 3 years old): Corresponding to Freud's anal stage, the problem of autonomy can be symbolized by the holding on and letting go of the sphincter muscles. The development of autonomy during the toddler period is centered on children's increasing ability to control their bodies, themselves, and their environment. They want to do things for themselves using their newly acquired motor skills of walking, climbing, and manipulating and their mental powers of selecting and decision making. Much of their 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. The favorable outcomes are self-control and willpower.

1. An infant gains head control before sitting unassisted. The nurse recognizes that this is which type of development? a. Cephalocaudal b. Proximodistal c. Mass to specific d. Sequential

ANS: A The pattern of development that is head-to-tail, or cephalocaudal, direction is described by an infant's ability to gain head control before sitting unassisted. The head end of the organism develops first and is large and complex, whereas the lower end is smaller and simpler, and development takes place at a later time. Proximodistal, or near to far, is another pattern of development. Limb buds develop before fingers and toes. Postnatally, the child has control of the shoulder before achieving mastery of the hands. Mass to specific is not a specific pattern of development. In all dimensions of growth, a definite, sequential pattern is followed. Page 38 The first pattern is the cephalocaudal, or head-to-tail, direction. The head end of the organism develops first and is large and complex, whereas the lower end is small and simple and takes shape at a later period. The physical evidence of this trend is most apparent during the period before birth, but it also applies to postnatal behavior development. Infants achieve control of the heads before they have control of their trunks and extremities, hold their backs erect before they stand, use their eyes before their hands, and gain control of their hands before they have control of their feet. Second, the proximodistal, or near-to-far, trend applies to the midline-to-peripheral concept. The third trend, differentiation, describes development from simple operations to more complex activities and functions, from broad, global patterns of behavior to more specific, refined patterns. All areas of development (physical, cognitive, social, and emotional) proceed in this direction.

1. Play serves many purposes. In teaching parents about appropriate activities, the nurse should inform them that play serves which of the following function? (Select all that apply.) a. Intellectual development b. Physical development c. Socialization d. Creativity e. Temperament development

ANS: A, C, D A common statement is that play is the work of childhood. Intellectual development is enhanced through the manipulation and exploration of objects. Socialization is encouraged by interpersonal activities and learning of social roles. In addition, creativity is developed through the experimentation characteristic of imaginative play. Physical development depends on many factors; play is not one of them. Temperament refers to behavioral tendencies that are observable from the time of birth. The actual behaviors, but not the child's temperament attributes, may be modified through play. Page 49-50 Functions of Play Sensorimotor Development: Sensorimotor activity is a major component of play at all ages and is the predominant form of play in infancy. Intellectual Development: Through exploration and manipulation, children learn colors, shapes, sizes, textures, and the significance of objects. Socialization: From very early infancy, children show interest and pleasure in the company of others. . Creativity: In no other situation is there more opportunity to be creative than in play. Self-Awareness: Beginning with active explorations of their bodies and awareness of themselves as separate from their mothers, the process of developing a self-identity is facilitated through play activities. Therapeutic Value: Play is therapeutic at any age (Fig. 3-10). Morality: Although children learn at home and at school those behaviors considered right and wrong in the culture, the interaction with peers during play contributes significantly to their moral training. Toys: The type of toys chosen by or provided for children can support and enhance children's development in the areas just described.

13. A 12-year-old child enjoys collecting stamps, playing soccer, and participating in Boy Scout activities. The nurse recognizes that the child is displaying which developmental task? a. Identity b. Industry c. Integrity d. Intimacy

ANS: B Industry is engaging in tasks that can be carried through to completion, learning to compete and cooperate with others, and learning rules. Industry is the developmental task characteristic of the school-age child. Identity is the developmental task of adolescence. Integrity and intimacy are not developmental tasks of childhood. Page 38 Stages of Development A developmental task is a set of skills and competencies specific to each developmental stage that children must accomplish or master to function effectively within their environment. Page 44 Psychosocial Development (Erikson) Industry versus inferiority (6 to 12 years old): The stage of industry is the latency period of Freud. Having achieved the more crucial stages in personality development, children are ready to be workers and producers. They 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, and they learn the rules. It is a decisive period in their social relationships with others. Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. The ego quality developed from a sense of industry is competence.

11. Which statement is true about the basal metabolic rate (BMR) in children? a. It is reduced by fever. b. It is slightly higher in boys than in girls at all ages. c. It increases with age of child. d. It decreases as proportion of surface area to body mass increases.

ANS: B The BMR is the rate of metabolism when the body is at rest. At all ages, the rate is slightly higher in boys than in girls. The rate is increased by fever. The BMR is highest in infancy and then closely relates to the proportion of surface area to body mass. As the child grows, the proportion decreases progressively to maturity. Page 42 Metabolism The rate of metabolism when the body is at rest (basal metabolic rate, or BMR) demonstrates a distinctive change throughout childhood. Highest in newborn infants, the BMR closely relates to the proportion of surface area to body mass, which changes as the body increases in size. In both sexes, the proportion decreases progressively to maturity. The BMR is slightly higher in boys at all ages and further increases during pubescence over that in girls.

1. What is the primary attribute to develop during the first year of life according to Erikson's psychosocial development theory? a. Autonomy b. Trust c. Initiative d. Industry

ANS: B The first and most important attribute to develop during the first year of life is basic trust, according to Erikson's trust versus mistrust stage. This is established through consistent, loving care by a nurturing figure. Page 44 Trust versus mistrust (birth to 1 year old): The first and most important attribute to develop for a healthy personality is basic trust. Establishment of basic trust dominates the first year of life and describes all of the child's satisfying experiences at this age. Corresponding to Freud's oral stage, it is a time of "getting" and "taking in" through all the senses. It exists only in relation to something or someone; therefore, consistent, loving care by a mothering person is essential for development of trust. Mistrust develops when trust-promoting experiences are deficient or lacking or when basic needs are inconsistently or inadequately met. Although shreds of mistrust are sprinkled throughout the personality, from a basic trust in parents stems trust in the world, other people, and oneself. The result is faith and optimism.

5. Parents of an 8-year-old child ask the nurse how many inches their child should grow each year. The nurse bases the answer on the knowledge that after age 7 years, school-age children usually grow what number of inches per year? a. 1 b. 2 c. 3 d. 4

ANS: B The growth velocity after age 7 years is approximately 5 cm (2 inches) per year. One inch is too small an amount. Three and 4 inches are greater than the average yearly growth after age 7 years. Page 41 Table 3-1 General Trends in Height and Weight Gain during Childhood Yearly gain after age 7 years: 5 cm (2 inches) Birth length triples by about 13 years old

26. Parents are asking the clinic nurse about an appropriate toy for their toddler. Which response by the nurse is appropriate? a. "Your child would enjoy playing a board game." b. "A toy your child can push or pull would help develop muscles." c. "An action figure toy would be a good choice." d. "A 25-piece puzzle would help your child develop recognition of shapes."

ANS: B Toys should be appropriate for the child's age. A toddler would benefit from a toy he or she could push or pull. The child is too young for a board game, action figure, or 25-piece puzzle. Page 50 The type of toys chosen by or provided for children can support and enhance children's development in the areas just described. Although no scientific evidence shows that any toy is necessary for optimal learning, toys offer an opportunity to bring children and parents together. Research has indicated that a positive parent-child interaction can enhance early childhood brain development (Glassy, Romano, Committee on Early Childhood, Adoption, and Dependent Care, et al, 2003). Toys that are small replicas of the culture and its tools help children assimilate into their culture. Toys that require pushing, pulling, rolling, and manipulating teach them about physical properties of the items and help develop muscles and coordination. Rules and the basic elements of cooperation and organization are learned through board games.

5. According to Erikson, which psychosocial task is developing in adolescence? a. Intimacy b. Identity c. Initiative d. Independence

ANS: B Traditional psychosocial theory holds that the developmental crises of adolescence lead to the formation of a sense of identity. Intimacy is the developmental stage for early adulthood. Independence is not one of Erikson's developmental stages. Powerpoint slide 67 •Core stages/psychosocial tasks or crises: Infant - Birth-1yr: trust vs mistrust Early chilldhood/toddler - 1-3 yrs: autonomy vs shame & doubt Preschooler - 3-6 yrs: initiative vs guilt Middle childhood - 6-12 yrs: industry vs inferiority Adolescence - 12-18 yrs: identity vs role confusion

6. Parents express concern that their pubertal daughter is taller than the boys in her class. The nurse should respond with which statement regarding how the onset of pubertal growth spurt compares in girls and boys? a. It occurs earlier in boys. b. It occurs earlier in girls. c. It is about the same in both boys and girls. d. In both boys and girls, the pubertal growth spurt depends on growth in infancy.

ANS: B Usually, the pubertal growth spurt begins earlier in girls. It typically occurs between the ages of 10 and 14 years for girls and 11 and 16 years for boys. The average earliest age at onset is 1 year earlier for girls. There does not appear to be a relation to growth during infancy. Page 41 Table 3-1 General Trends in Height and Weight Gain during Childhood

3. The child of 15 to 30 months is likely to be struggling with which developmental task? a. Trust b. Initiative c. Autonomy d. Intimacy

ANS: C Autonomy vs shame and doubt is the developmental task of toddlers. Trust vs mistrust is the developmental stage of infancy. Initiative vs guilt is the developmental stage of early childhood. Intimacy and solidarity vs isolation is the developmental stage of early adulthood. Powerpoint slide 67 •Core stages/psychosocial tasks or crises: Infant - Birth-1yr: trust vs mistrust Early chilldhood/toddler - 1-3 yrs: autonomy vs shame & doubt Preschooler - 3-6 yrs: initiative vs guilt Middle childhood - 6-12 yrs: industry vs inferiority Adolescence - 12-18 yrs: identity vs role confusion

4. What may lead to feelings of inadequacy and inferiority during the industry versus inferiority stage? a. Achievement and completion of tasks b. Engaging in tasks and activities c. Too much expectation or belief in inability to measure up d. Rapid and marked physical changes

ANS: C Feelings of inadequacy and inferiority may develop if too much is expected of children or if they believe they cannot measure up during the industry stage. Page 45 Industry versus inferiority (6 to 12 years old): The stage of industry is the latency period of Freud. Having achieved the more crucial stages in personality development, children are ready to be workers and producers. They 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, and they learn the rules. It is a decisive period in their social relationships with others. Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. The ego quality developed from a sense of industry is competence.

22. In which type of play are children engaged in similar or identical activity, without organization, division of labor, or mutual goal? a. Solitary b. Parallel c. Associative d. Cooperative

ANS: C In associative play, no group goal is present. Each child acts according to his or her own wishes. Although the children may be involved in similar activities, no organization, division of labor, leadership assignment, or mutual goal exists. Solitary play describes children playing alone with toys different from those used by other children in the same area. Parallel play describes children playing independently but being among other children. Cooperative play is organized. Children play in a group with other children who play in activities for a common goal. Page 48 Social Character of Play Onlooker play: During onlooker play, children watch what other children are doing but make no attempt to enter into the play activity. Solitary play: During solitary play, children play alone with toys different from those used by other children in the same area. Parallel play: During parallel activities, children play independently but among other children. Associative play: In associative play, children play together and are engaged in a similar or even identical activity, but there is no organization, division of labor, leadership assignment, or mutual goal. Children borrow and lend play materials, follow each other with wagons and tricycles, and sometimes attempt to control who may or may not play in the group. Each child acts according to his or her own wishes; there is no group goal (Fig. 3-8). For example, two children play with dolls, borrowing articles of clothing from each other and engaging in similar conversation, but neither directs the other's actions or establishes rules regarding the limits of the play session. Cooperative play: Cooperative play is organized, and children play in a group with other children (Fig. 3-9).

4. By what age does birth length usually double? a. 1 year b. 2 years c. 4 years d. 6 years

ANS: C Linear growth or height occurs almost entirely as a result of skeletal growth and is considered a stable measurement of general growth. On average, most children have doubled their birth length at age 4 years. One and 2 years are too young for doubling of length. Most children will have achieved the doubling by age 4 years. Page 41 Table 3-1 General Trends in Height and Weight Gain during Childhood Birth length doubles by 4 years old Yearly gain: 5 to 7.5 cm (2 to 3 inches)

30. A nurse is observing children at play. Which figure depicts associative play? a. b. c. d.

ANS: C The children depicted in the figure at the carnival ride are demonstrating associative play. They are engaged in similar or identical activities. The child depicted playing alone is demonstrating solitary play. The children playing on the beach depict parallel play. They are playing side by side but are participating in different activities. The children depicted playing a board game are engaging in cooperative play. Page 48 Social Character of Play Onlooker play: During onlooker play, children watch what other children are doing but make no attempt to enter into the play activity. Solitary play: During solitary play, children play alone with toys different from those used by other children in the same area. Parallel play: During parallel activities, children play independently but among other children. Associative play: In associative play, children play together and are engaged in a similar or even identical activity, but there is no organization, division of labor, leadership assignment, or mutual goal. Children borrow and lend play materials, follow each other with wagons and tricycles, and sometimes attempt to control who may or may not play in the group. Each child acts according to his or her own wishes; there is no group goal (Fig. 3-8). For example, two children play with dolls, borrowing articles of clothing from each other and engaging in similar conversation, but neither directs the other's actions or establishes rules regarding the limits of the play session. Cooperative play: Cooperative play is organized, and children play in a group with other children (Fig. 3-9).

1. Place in order the sequence of cephalocaudal development that the nurse expects to find in the infant. Begin with the first development expected, sequencing to the final. Provide answers using lowercase letters separated by commas (e.g., a, b, c, d). a. Crawl b. Sit unsupported c. Lift head when prone d. Gain complete head control e. Walk

ANS: C, D, B, A, E Cephalocaudal development is head-to-tail. Infants achieve structural control of the head before they have control of their trunks and extremities, they lift their head while prone, obtain complete head control, sit unsupported, crawl, and walk sequentially.

7. A 13-year-old girl asks the nurse how much taller she will get. She has been growing about 2 inches per year but grew 4 inches this past year. Menarche recently occurred. The nurse should base her response on which statement? a. Growth cannot be predicted. b. Pubertal growth spurt lasts about 1 year. c. Mature height is achieved when menarche occurs. d. Approximately 95% of mature height is achieved when menarche occurs.

ANS: D At the time of the beginning of menstruation or the skeletal age of 13 years, most girls have grown to about 95% of their adult height. They may have some additional growth (5%) until the epiphyseal plates are closed. Although growth cannot be definitively predicted, on average, 95% of adult height has been reached with the onset of menstruation. Pubertal growth spurt lasts about 1 year does not address the girl's question. Young women usually will grow approximately 5% more after the onset of menstruation. Page 41 Table 3-1 General Trends in Height and Weight Gain during Childhood Pubertal Growth Spurt Females: 10 to 14 years Height gain: 5 to 25 cm (2 to 10 inches); ≈95% of mature height achieved by onset of menarche or skeletal age of 13 years old Mean: 20.5 cm (8 inches)

3. An infant who weighs 7 pounds at birth would be expected to weigh how many pounds at age 1 year? a. 14 b. 16 c. 18 d. 21

ANS: D In general, birth weight triples by the end of the first year of life. For an infant who was 7 pounds at birth, 21 pounds would be the anticipated weight at the first birthday; 14, 16, or 18 pounds is below what would be expected for an infant with a birth weight of 7 pounds. Page 41 At birth, weight is more variable than height and is, to a greater extent, a reflection of the intrauterine environment. The average newborn weighs from 3175 to 3400 g (7 to 7.5 pounds). In general, the birth weight doubles by 4 to 7 months old and triples by the end of the first year. By 2 to 2-1/2 years old, the birth weight usually quadruples. After this point, the "normal" rate of weight gain, just as the growth in height, assumes a steady annual increase of approximately 2 to 2.75 kg (4.4 to 6 pounds) per year until the adolescent growth spurt. Page 41 Table 3-1 General Trends in Height and Weight Gain during Childhood Weight gain: 85 to 140 g (3 to 5 ounces) Birth weight triples by end of first year

10. A nurse has completed a teaching session for adolescents regarding lymphoid tissue growth. Which statement, by the adolescents, indicates understanding of the teaching? a. The tissue reaches adult size by age 1 year. b. The tissue quits growing by 6 years of age. c. The tissue is poorly developed at birth. d. The tissue is twice the adult size by ages 10 to 12 years.

ANS: D Lymphoid tissue continues growing until it reaches maximal development at ages 10 to 12 years, which is twice its adult size. A rapid decline in size occurs until it reaches adult size by the end of adolescence. The tissue reaches adult size at 6 years of age but continues to grow. The tissue is well developed at birth. Page 42 Lymphoid Tissues Lymphoid tissues contained in the lymph nodes, thymus, spleen, tonsils, adenoids, and blood lymphocytes follow a growth pattern unlike that of other body tissues. These tissues are small in relation to total body size, but they are well developed at birth. They increase rapidly to reach adult dimensions by 6 years old and continue to grow. At about 10 to 12 years old, they reach a maximum development that is approximately twice their adult size. This is followed by a rapid decline to stable adult dimensions by the end of adolescence.

25. Which following function of play is a major component of play at all ages? a. Creativity b. Socialization c. Intellectual development d. Sensorimotor activity

ANS: D Sensorimotor activity is a major component of play at all ages. Active play is essential for muscle development and allows the release of surplus energy. Through sensorimotor play, children explore their physical world by using tactile, auditory, visual, and kinesthetic stimulation. Creativity, socialization, and intellectual development are each functions of play that are major components at different ages. Page 49 Functions of Play Sensorimotor Development Sensorimotor activity is a major component of play at all ages and is the predominant form of play in infancy. Active play is essential for muscle development and serves a useful purpose as a release for surplus energy. Through sensorimotor play, children explore the nature of the physical world. Infants gain impressions of themselves and their world through tactile, auditory, visual, and kinesthetic stimulation. Toddlers and preschoolers revel in body movement and exploration of objects in space. With increasing maturity, sensorimotor play becomes more differentiated and involved. Whereas very young children run for the sheer joy of body movement, older children incorporate or modify the motions into increasingly complex and coordinated activities, such as races, games, roller skating, and bicycle riding.

9. Trauma to which site can result in a growth problem for children's long bones? a. Matrix b. Connective tissue c. Calcified cartilage d. Epiphyseal cartilage plate

ANS: D The epiphyseal cartilage plate is the area of active growth. Bone injury at the epiphyseal plate can significantly affect subsequent growth and development. Trauma or infection can result in deformity. The matrix, connective tissue, and calcified cartilage are not areas of active growth. Trauma in these sites will not result in growth problems for the long bones. Page 41 Skeletal Growth and Maturation Bone formation begins during the second month of fetal life when calcium salts are deposited in the intercellular substance (matrix) to form calcified cartilage first and then true bone. Bone formation exhibits some differences. In small bones, the bone continues to form in the center, and cartilage continues to be laid down on the surfaces. In long bones, the ossification begins in the diaphysis (the long central portion of the bone) and continues in the epiphysis (the end portions of the bone). Between the diaphysis and the epiphysis, an epiphyseal cartilage plate (or growth plate) unites with the diaphysis by columns of spongy tissue, the metaphysis. Active growth in length takes place in the epiphyseal growth plate. Interference with this growth site by trauma or infection can result in deformity.

8. How is a child's skeletal age best determined? a. Assessment of dentition b. Assessment of height over time c. Facial bone development d. Radiographs of the hand and wrist

ANS: D The most accurate measure of skeletal age is radiologic examinations of the growth plates. These are the epiphyseal cartilage plates. Radiographs of the hand and wrist provide the most useful screening to determine skeletal age. Age of tooth eruption has considerable variation in children. It would not be a good determinant of skeletal age. Assessment of height over time will provide a record of the child's height but not skeletal age. Facial bone development will not reflect the child's skeletal age, which is determined by radiographic assessment. Page 41 Skeletal Growth and Maturation The most accurate measure of general development is skeletal or bone age, the radiologic determination of osseous maturation.

21. A nurse observes a toddler playing with sand and water. How should the nurse document this type of play? a. Skill b. Dramatic c. Social-affective d. Sense-pleasure

ANS: D The toddler playing with sand and water is engaging in sense-pleasure play. This is characterized by nonsocial situations in which the child is stimulated by objects in the environment. Infants engage in skill play when they persistently demonstrate and exercise newly acquired abilities. Dramatic play is the predominant form of play in the preschool period. Children pretend and fantasize. Social-affective play is one of the first types of play in which infants engage. The infant responds to interactions with people. Page 47 Content of Play Social-affective play: Play begins with social-affective play, wherein infants take pleasure in relationships with people. Sense-pleasure play: Sense-pleasure play is a nonsocial stimulating experience that originates from without. Objects in the environment—light and color, tastes and odors, textures and consistencies—attract children's attention, stimulate their senses, and give pleasure. Pleasurable experiences are derived from handling raw materials (water, sand, food), body motion (swinging, bouncing, rocking), and other uses of senses and abilities (smelling, humming) (Fig. 3-5). Skill play: After infants have developed the ability to grasp and manipulate, they persistently demonstrate and exercise their newly acquired abilities through skill play, repeating an action over and over again Unoccupied behavior: In unoccupied behavior, children are not playful but focusing their attention momentarily on anything that strikes their interest. Dramatic, or pretend, play: One of the vital elements in children's process of identification is dramatic play, also known as symbolic or pretend play. Games: Children in all cultures engage in games alone and with others.