Hsci 102:

Care of the
Infants and
Children
Module 1: Principles of
Growth and Development
–This module covers the different stages of the child’s growth
and development. This is important for you to provide specific
care to the needs of the growing child and assist the family to
understand normal limits.

– Newborn refers to the stage immediately after birth until 1

month.
– Infancy is the period from 1 month until 12 months.
– The toddler stage is from 12 months until 3 years.
– The early childhood or preschool ranges from 3 to 6 years
old.
– School age children are 6-12 years old.
– Adolescence begins around 12 or 13 and lasts until the
beginning of adulthood.
Learning Outcomes

 Integrate knowledge and principles of normal growth and development

with application of appropriate nursing care to the child and family.
 Assess the child to determine if a stage of development has been achieved.
 Formulate nursing diagnosis/es that address the wellness as well as both
potential for and actual delay in growth and development.
 Implement safe and quality interventions to support normal development
and growth.
 Evaluate with the mother and family the health outcomes.
Module Outline

I. Growth and Development

II. Principles of Growth and Development
III.Factors affecting Growth and Development
IV.Structures of Personality
V. Theories of Development
VI.Assessment for promotion of normal growth and
development
VII.Nursing diagnosis
VIII.Outcome identification and planning
IX.Evaluation
–
GROWTH

– Increase in the number and size of cells; measured in terms of

quantity;
– Orderly and predictable but not even.
Parameters of Growth:
1. Weight - It is measured in grams, kilograms or pounds.
2. Height – It is measured in inches, feet or centimeters.
DEVELOPMENT

– Indicates an increase in skill or the ability to function; Viewed as a qualitative

change in the child that is demonstrated by functioning or skill and that is
achieved through maturation, and learning

Ways to measure development:

1. By directly observing the child’s performance.
2. By noting parents’ description of the child’s progress.
3. By DDST (Denver Developmental Screening Test), in the Philippines, it is
modified as MMDST (Metro Manila Developmental Screening Test).
Five Main Areas
of Development
– Physical
– Emotional
– Intellectual
– Social
– Spiritual
MATURATION DEVELOPMENT

– It means development - It is a growth responsibility

of those cells until they that arises at a certain time in
are ready to function; the course of development
Literally, it means ripen;
an increase in human
competence and
adaptability
PRINCIPLES OF GROWTH AND DEVELOPMENT

1. Growth and development are continuous processes from conception until death.
2. Growth and development follows an orderly pattern
3. All aspects of development are interrelated
4. Growth is continuous and gradual
– There are periods of accelerated & decelerated growth rate
– Infancy: most rapid period of growth
– Preschool to puberty: slow and uniform rate of growth
– Puberty: (growth spurt) second most rapid growth period
– After Puberty: decline in growth rate till death
5. Growth is not uniform
PRINCIPLES OF GROWTH AND DEVELOPMENT

6. All individuals are different

7. Early foundations are critical
8. Each phase of development has hazards
9. Each phase of development has characteristic behavior
10. There is an optimum time for initiation of developmental experiences
or learning
– A child cannot learn tasks until the nervous system mature enough to
allow that particular learning.
PRINCIPLES OF GROWTH AND DEVELOPMENT

11. Most developmental skills and behaviors are learned by

practice
12. Neonatal reflexes must be lost before motor development can
proceed
13. Development is affected by cultural changes
14. There are social expectations for every stage of development
15. Development is a product of heredity and environment
Major Genetics
Factors Gender
Influencin
Health
g Growth
and Intelligence
Developm Environment
ent Temperament
Categories – THE EASY CHILD
of – THE DIFFICULT CHILD

Temperame – The Intermediate Child

– SLOW–TO-WARM-UP CHILD
nt
Development of
mental function &
personality
development
– Personality is the totality of
one’s physical or inherited
attributes as well as those
psychological factors that
determine one’s
characteristic behavior
Structure of – ID
Personality – EGO
– SUPEREGO
ID
– developed during infancy
– "I know what I want and I want it now!”
– the only component of personality that is present at birth.
– operates on pleasure principle to reduce tension or discomfort. Thus, a
– Newborn is said to be a “bundle of id”, seeking pleasure only to satisfy needs
and demands immediate gratification to find release from physiological
– tension.
– Pleasure principle
EGO

– developed during toddler period

– "I can wait for what I want!"
– Reality principle
– balances the id and superego
– the result of individual’s interaction with the environment.
– It promotes satisfactory adjustment in relation to the environment.
ID
– developed during infancy
– "I know what I want and I want it now!”
– the only component of personality that is present at birth.
– operates on pleasure principle to reduce tension or discomfort. Thus, a
– Newborn is said to be a “bundle of id”, seeking pleasure only to satisfy needs
and demands immediate gratification to find release from physiological
– tension.
– Pleasure principle
SUPEREGO

– developed during preschool

– "I should not want that!”
– Conscience- Morality principle
– Develops as a person unconsciously incorporates standards and
restrictions from both parents and society to guide behaviors,
thoughts, and feelings.
– Emerges at around age five.
 1.Heredity
– certain characteristics that are present at birth:
Factors body build, eye color, skin, hair type and certain
aptitudes
Affecting 2. Birth order
– First born are likely to be achievement oriented
Personality and responsible
– Later born are more likely to be better in social
developmen relationships, affectionate, friendly, or rebels and
risk-takers.
t: 3. Parents
– It includes the age of the parents, occupation,
economic status, religious
orientation, level of education and cultural heritage
4. Culture
Theories of Child Development

– A theory is a systematic statement of principles that

provides a framework for explaining some
phenomenon.
FREUD’S – Sigmund Freud (1856–1939), an Austrian
neurologist and the founder of
PSYCHOANAL psychoanalysis, offered the first real
theory of personality development.
YTIC THEORY Freud based his theory on his
observations of mentally disturbed
adults.
 FREUD’S PSYCHOANALYTIC
THEORY
A. The Infant
– Freud termed the infant period the “oral phase” because infants are so interested in
oral stimulation or pleasure during this time. According to this theory, infants suck for
enjoyment or relief of tension, as well as for nourishment.

B. The Toddler
– Freud described the toddler period as an “anal phase” because during this time,
children’s interests focus on the anal region as they begin toilet training.
– Elimination takes on new importance for them. Children find pleasure in both the
retention of feces and defecation. This anal interest is part of toddlers’ self discovery,
a way of exerting independence.
 FREUD’S PSYCHOANALYTIC
THEORY
C. The Preschooler
– During the preschool period, children’s pleasure zone appears to shift from the anal to the genital area.
Freud called this period the “phallic phase.”
– Masturbation is common during this phase.
– Children may also show exhibitionism, suggesting they hope this will lead to increased knowledge of
the two sexes.
D. The School-Age Child
– Freud saw the school-age period as a “latent phase,” a time in which children’s libido appears to be
diverted into concrete thinking.
E. The Adolescent
– Freud termed the adolescent period the “genital phase.”
– Freudian theory Considers the main events of this period to be the establishment of new sexual aims
and the finding of new love objects.
ERIKSON’S – Erik Erikson was trained in
psychoanalytic theory but later
THEORY OF developed his own theory of
psychosocial development, a theory that
PSYCHOSOC stresses the importance of culture and
society in development of the
IAL personality (Erikson, 1993).

DEVELOPME
NT
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT
A. The Infant
– trust versus mistrust (other terms are “learning confidence” or “learning to love”).
– When an infant is hungry, a parent feeds and makes the infant comfortable again. By these simple
processes, infants learn to trust that when they have a need or are in distress, a parent will come
and meet that need.
– If care is inconsistent, inadequate, or rejecting, this fosters a basic mistrust: infants become
fearful and suspicious of the world and of people.
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT
B. The Toddler
– autonomy versus shame
– Autonomy (self-government or independence) arises from a toddler’s new motor and
mental abilities. Children take pride in new accomplishments and want to do
everything independently, when parents recognize toddlers need to do what they are
capable of doing, at their own pace and in their own time, then children develop a
sense of being able to control their muscles and impulses during this time.
– When caregivers are impatient and do everything for them, this enforces a sense of
shame and doubt. If children are never allowed to do things they want to do, they will
eventually doubt their ability to do them; they will stop trying and cannot do them.
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT
C. The Preschooler
– initiative versus guilt
– Learning initiative is learning how to do things. Children can initiate motor
activities of various sorts on their own and no longer merely respond to or imitate
the actions of other children or of their parents.
D. The School-Age Child
industry versus inferiority, or accomplishment rather than inferiority.
When they are encouraged in their efforts to do practical tasks or make practical
things and are praised and rewarded for the finished results, their sense of industry
grows.
Parents who see their children’s efforts at making and doing things as merely “busy
work” or who do not show appreciation for their children’s efforts may cause them
to develop a sense of inferiority rather than pride and accomplishment
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT
E. The Adolescent
– identity versus role confusion
– adolescents must bring together everything they have learned about themselves as a son or
daughter, an athlete, a friend, a fast-food cook, a student, a garage band musician, and so on, and
integrate these different images into a whole that makes sense.
– If adolescents cannot do so, they are left with role confusion; that is, they are left unsure of what
kind of person they are and are uncertain what they can do or what kind of person they can
become.

F. The Young Adult

– intimacy versus isolation
– Intimacy is the ability to relate well with other people, not only with members of the opposite sex
but also with one’s own sex to form long-lasting friendships. A sense of intimacy grows out of
earlier developmental tasks, because people need a strong sense of identity before they can
reach out fully and offer deep friendship or love.
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT
G. The Middle-Aged Adult
– generativity versus stagnation
– People with a sense of generativity are self-confident and better able to juggle
their various lives (mother, soccer coach, church member, teacher, political party
chairperson, cook).
– People without this sense become stagnated or self- absorbed. Those who have
devoted themselves to only one role are more likely to find themselves at the end
of middle age with a narrow perspective and lack of ability to cope with change.
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT
H. The Older Adult
– developmental task of older adults is integrity versus despair.
– Older adults with integrity feel good about the life choices they have
made; those with a feeling of despair wish life could begin over again
so that things could turn out differently.
PIAGET’S – Jean Piaget (1896–1980), a Swiss
psychologist defined four stages of
THEORY OF cognitive development. Each
COGNITIVE period is an advance over the
previous one. To progress from
DEVELOPME one period to the next, children
reorganize their thinking processes
NT to bring them closer to adult
thinking.
 PIAGET’S THEORY OF COGNITIVE
DEVELOPMENT
A. The Infant
– sensorimotor stage.
– At the beginning of infancy, babies relate to the world through their senses, using only reflex
behavior. During this stage, infants learn objects in the environment – their bottle, blocks, their
bed, or even a parent – are permanent and continue to exist even though they are out of sight or
changed in some way (permanence).
– Gaining a concept of permanence also contributes to separation anxiety, which can begin at 8 and
12 months of age. During this stage, infants continue to cry for their parents because they know
their parents still exist even when out of sight.
PIAGET’S THEORY OF COGNITIVE
DEVELOPMENT

B. The Toddler
begins to develop some cognitive skills of the preoperative period, such as symbolic
thought and egocentric thinking.
PIAGET’S THEORY OF COGNITIVE
DEVELOPMENT

C. The Preschoolers
Piaget saw preschool children as moving on to a substage of preoperational thought
termed intuitive thought. During this time, the preschoolers believe in the following:
– Centering, when they are able to see only one of its characteristics
– Lack of conservation
– Role fantasy or how children would like something to turn out
– Animism, animals and inanimate objects as being capable of thought and feelings
also known as magical thinking
 PIAGET’S THEORY OF COGNITIVE
DEVELOPMENT

D. The School-Age Child

Piaget viewed school age as a period during which concrete operational thought
begins as school-age children:
– Concrete solutions to everyday problems and recognize cause-and effect
relationships
– Conservation is the ability to discern truth, even though physical properties change
– Reversibility, is the ability to retrace steps.
PIAGET’S THEORY OF COGNITIVE
DEVELOPMENT

E. The Adolescent
formal operational thought begins.
– Abstract thinking, capable of thinking in terms of possibility rather than
limited to thinking about what already is.
– Deductive reasoning, from general to the specific.
KOHLBERG’ – Lawrence Kohlberg (1927–1987), a
psychologist, studied the reasoning
S THEORY ability and developed a theory on the
way children gain knowledge of right
OF MORAL and wrong or moral reasoning

DEVELOPME
NT
KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
A. The Infant
– The infant period is a pre-religious stage. Infants have little concept of
any motivating force beyond that of their parents.
– Infants learn that when they do certain actions, parents give affection
and approval; for other actions, parents scold and label the behavior
“bad.” To support this stage of development, it is important for
caregivers to praise infants for doing what they have been asked to do
KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
B. The Toddler
– Toddlers begin to formulate a sense of right and wrong, but their reason for doing
right is centered most strongly in “mother or father says so” rather than in any
spiritual or societal motivation.
– Kohlberg referred to this as a “punishment obedience orientation” (a child is good
because a parent says a child must be good, not because it is “right” to be good).
– This is the first substage of preconventional stage.
KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
C. The Preschooler
– Preschoolers tend to do good out of self-interest rather than out of
true intent to do good or because of a strong spiritual motivation.
– When asked why it is wrong to steal from a neighbor, for example, a
preschooler will answer, “Because my mother won’t like me anymore.”
Because of egocentrism, a preschooler may do things for others only in
return for things done for him or her.
KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
D. The School-Age Child
– School-age children enter a stage of moral development termed
conventional development, a level at which many adults
continue to function.
– Young school-age children adhere to a phase of development termed
the “nice girl, nice boy” stage. Children engage in actions that are
“nice” or “fair” rather than necessarily right.
KOHLBERG’S THEORY OF MORAL
DEVELOPMENT
E. The Adolescent
– As adolescents become capable of abstract thought, they become
capable of internalizing standards of conduct (they do what they think
is right regardless of whether anyone is watching).
– This is termed postconventional development and is the mature
form of moral reasoning.
– In this stage, if asked why it is wrong to steal from a neighbor,
adolescents answer, “Because it deprives my neighbors of possessions
they have earned.”
Assessment for Promotion of Normal
Growth and Development
– Measure and plot height and weight on a standard growth chart for
children at all health care visits
– Take a health history from both parents and the child and observe what
specific activities the child can accomplish to establish whether
developmental milestones (major markers of normal development) are
being met.
Nursing Diagnosis

– Risk for delayed growth and development related to lack of age-appropriate toys
and activities
– Delayed growth and development related to prolonged illness
– Readiness for enhanced family coping related to parent’s seeking information about
child’s growth and development
– Health-seeking behaviors related to appropriate stimulation for infants
– Imbalanced nutrition, less than body requirements, related to parental knowledge
deficit regarding child’s protein need
– Deficient knowledge related to potential long-term effects of obesity in school-age
child
Outcome Identification and Planning

To provide holistic care, consider all aspects of a child’s health

(physical, emotional, cultural, cognitive, spiritual, nutritional,
and social), remembering that each child’s developmental
progress is unique. Children cannot be forced to achieve
milestones faster than their own timetable will allow.
Outcome Evaluation

Evaluation for specific growth and developmental milestones must be

– ongoing to be accurate and useful, because many children do not test well on any
given day. Ongoing evaluation is necessary also because it provides an opportunity
for early detection of various problems.
– Evaluation must also be comprehensive. Examples of expected outcomes are:
– At 9-month checkup, parents describe how they have made a safe space in their
home for their infant to crawl so that he is not confined to a playpen.
– Parents list household tasks they believe are appropriate for a 6- year-old child by
next visit.
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s: Childbearing and Childrearing Family (8th
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London, M., Ladewig, P., Davidson, M.,
Cpnp, B. J. D. R., Bindler, R., & Cowen, K.
(2016). Maternal & Child Nursing Care (5th
ed.). Pearson.
Perry, S. E., Hockenberry, M. J., Lowdermilk,
D. L., & Wilson, D. (2014). Study Guide for
Maternal Child Nursing Care - E-Book (5th
ed.). Mosby.