PEDIATRIC CASE STUDY

IN PARTIAL FULFILLMENT

OF

REQUIREMENTS FOR NCM-101

SUBMITTED TO:

MRS. LOURDES TAYAG

CLINICAL INSTRUCTOR

SUBMITTED BY:

IVY JANE P. PAHAPAY

BSN-2a
 INTRODUCTION

Infancy stage of human development lasting from birth to approximately two years of age. The
hallmarks of infancy are physical growth, motor development, vocal development, and cognitive
and social development.

Physical Growth

The first year is characterized by rapid physical growth. A normal baby doubles its birth weight
in six months and triples it in a year. During that time, there is great expansion of the head and
chest, thus permitting development of the brain, heart, and lungs, the organs most vital to
survival. The bones, which are relatively soft at birth, begin to harden, and the fontanelles, the
soft parts of the newborn skull, begin to calcify, the small one at the back of the head at about 3
months, the larger one in front at varying ages up to 18 months. Brain weight also increases
rapidly during infancy: by the end of the second year, the brain has already reached 75% of its
adult weight.

Growth and size depend on environmental conditions as well as genetic endowment. For
example, severe nutritional deficiency during the mother's pregnancy and in infancy are likely to
result in an irreversible impairment of growth and intellectual development, while overfed, fat
infants are predisposed to become obese later in life. Human milk provides the basic nutritional
elements necessary for growth; however, in Western cultures supplemental foods are generally
added to the diet during the first year.

The newborn infant sleeps almost constantly, awakening only for feedings, but the number and
length of waking periods gradually increases. By the age of three months, most infants have
acquired a fairly regular schedule for sleeping, feeding, and bowel movements. By the end of the
first year, sleeping and waking hours are divided about equally.

Motor Development

Development of motor activity follows a fairly standard sequence. The infant learns to lift its
head, to turn over on its back, and to develop the muscular coordination for refined, visually
directed hand movements and for sitting, crawling, standing, and walking, generally in that
order. Motor development proceeds more rapidly than actual physical growth by the beginning
of the second year. Bowel and bladder control is sometimes possible after 18 months. However,
many normal, healthy infants show delayed response in one or several developmental activities,
or may apparently skip a stage altogether.

Vocal Development

An infant's early crying sounds are largely limited to frontal vowels, such as in "dada," and a few
consonants; the remaining vowel and consonant sounds gradually appear, first produced in a
babbling manner, and the first meaningful words may appear at ten months. By the end of the
second year, the infant's active vocabulary may reach 250 words. One of the key reasons infants
can produce more sounds is the developing larynx, or voice box, which "descends" between the
ages of 1 1/2 to 2 years. Thus, as the infant's vocal tract develops, the wider the range of sounds.

Cognitive and Social Development

Studies indicate that certain cognitive processes, the order of which is largely biologically
controlled, begin as early as two months after birth. Up to six months of age, differences in
motor and conceptual development are generally independent of the infant's rearing conditions
and culture, but by one year of age, cultural differences affect intellectual development. From the
early months on, the infant forms attachments to those who care for him or her, and on the basis
of their behavior, begins to develop expectations of gratification, e.g., adult responses to cries of
distress. Social smiling appears early, and by the latter part of the first year the baby may depend
on the presence of familiar faces and become apprehensive in the presence of strangers.
 PATIENT’S PROFILE

Patient John Paul Eseguera, 4 months old, male, a resident from Moryo-moryo,

Camaman-an, Cagayan de Oro City. He was born last May 14, 2009 through Normal

Spontaneous Vaginal Delivery with the assistance of a “ Manghihilot “. The third of son of Mr. &

Mrs. Emilio Eseguera, both of his parents are unemployed and are dependent on the support of

their extended family. The infant is still under breastfeeding, and has partially accomplished two

vaccinations which includes DPT1 and Hepa B.

 THEORIES

OF

DEVELOPMENT
 Freud's Psychosexual Stages of
Development

A newborn baby, according to Freud, is bubbling with energy (libido;

psychic energy). However, this energy is without focus or direction, which would
not allow for survival. How, then, does the child develop the ability to control
and direct his/her energy?

Psychic energy is an important concept in Freudian psychology. The structure

of the mind and development all revolve around how the individual attempts to
deal with psychic energy. Raw libinal impulses provide the basic fuel that the
mind runs on. But the vehicle (mind) needs to well-formed and well-tuned in
order to get maximum energy.

In order to understand development (and neuroses), then, we should “follow the

energy” and see where it goes. As with physical energy, psychic energy cannot
be created or destroyed in a big picture sense, however it may be dealt with in
non-obvious ways.

So, where does the infant’s, then the child’s, the adolescent's, and adult's
energy get focused? Freud believed that as development occurs the baby
begins to focus on first one object then another. As the infant’s focus shifts the
style and type of gratification being sought changes.

The focal objects for the developing child's energy serves to define five main
stages of psychological

development.

• oral (0-18 months)

• anal (18 months - 3 1/2 years)
• phallic (3 1/2 years - 6 years)
• latency (6 years - puberty)
• genital (puberty - adulthood)

Each psychosexual stage has three main parts:

1. A physical focus: where the child’s energy is concentrated and their

gratification obtained.
2. A psychological theme: this is related to both the physical focus and
the demands being made on the child by the outside world as he/she
develops. For each stage, there can be two extremes in psychological
reaction - either doing too much or not enough of what is ideal.
3. An adult character type: in the first three stages this adult character
type is one that is related to being fixated or stuck at that stage. If a
person doesn’t resolve the psychological issues that arise at that stage
they will always have problems relating to those issues.

Oral stage: Birth - 18 months (approx.)

Physical focus: mouth, lips tongue (sucking). Sucking is the primary source of
pleasure for a newborn. Everything goes in the mouth. Sucking = food.

Psychological theme: dependency. A baby is very dependent and can do little

for itself. If babies needs properly fulfilled can move onto the next stage. But if
not fulfilled baby will be mistrustful or over-fulfilled baby will find it hard to cope
with a world that doesn’t meet all of his/her demands.

Adult character: highly dependent/highly independent. If baby becomes

fixated at this stage Freud felt that he or she would grow to be an oral
character. Mostly these people are extremely dependent and passive people
who want everything done for them. However Freud also suggests that another
type of oral character is the person who is highly independent and that when
under stress the orally fixatedperson may flip from one type to the other. This
exemplifies Freud’s doctrine of opposites.

Anal Stage: 18 months - 3.5 years (approx.)

Physical focus: anus (elimination). Until now the baby has had it pretty easy.
Now baby is supposed to control bowels. Freud believed baby’s sexual pleasure
centred around the anus at this time.

Psychological theme: self-control/obedience. These things are not just related

to toilet training but also the baby must learn to control urges and behaviours
(terrible twos). What goes wrong here is either parents being too controlling or
not controlling enough (Freud was a great believer in moderation).

Adult character: anally retentive (rigid, overly organised, subservient to

authority) vs. anally expulsive (little self-control, disorganised, defiant, hostile).

Phallic Stage: 3.5 - 6 years (approx.)

Physical focus: penis. Freud believed that boys and girls both focussed on the
penis. Boys: why hasn’t she got one? Girls: why haven’t I got one? Children
become particularly interested in playing with their genitals at this stage.

Psychological theme: morality and sexuality identification and figuring out

what it means to be a girl/boy. Children, according to Freud have sexual feelings
for the opposite sexed parent at this stage (and deal with Oedipus / Electra
complexes - basically erotic attachment to parent of opposite sex, but since
these feelings are not socially acceptable, it may become hostility) and feel
some hostility to same-sex parent. Boys experience castration anxiety and girls
suffer penis envy. During this time emotional conflicts are resolved by
eventually identifying with the same sex parent

Adult character: promiscuous and amoral/ asexual and puritanical (Doctrine of

opposites again)

Latency Stage: 6 years to puberty

The latency stage is the period of relative calm. The sexual and aggressive
drives are less active and there is little in the way of psychosexual conflict.

Genital stage: post puberty

Physical focus: genitals

Psychological theme: maturity and creation and enhancement of life. So this

is not just about creating new life (reproduction) but also about intellectual and
artistic creativity. The task is to learn how to add something constructive to life
and society.

Adult character: The genital character is not fixed at an earlier stage. This is
the person who has worked it all out. This person is psychologically well-
adjusted and balanced. According to Freud to achieve this state you need to
have a balance of both love and work.

If you have had problems during any of the psychosexual stages which are not
effectively resolved, then you will become fixated at one of the earlier stages
and when under stress will regress more and more to characteristics of that
stage.
 Piaget's Stages of Cognitive
Development
The following information is based on the work of Jean Piaget, a
developmental biologist who devoted his life to closely observing and
recording the intellectual abilities of infants, children and adolescents. Piaget
concluded that human development involves a series of stages. Given below
is an outline of the four stages of Piagetian development. During each of
these new abilities are gained. Each stage prepares the child for the
succeeding levels.

The Sensorimotor Stage

The Sensorimotor Stage is the first stage Piaget uses to define cognitive
development. During this period, infants are busy discovering relationships
between their bodies and the environment. Researchers have discovered
that infants have relatively well developed sensory abilities. The child relies
on seeing, touching, sucking, feeling, and using their senses to learn things
about themselves and the environment. Piaget calls this the sensorimotor
stage because the early manifestations of intelligence appear from sensory
perceptions and motor activities.

Countless informal experiments during the sensorimotor stage led to

one of the important achievements. They enable the infant to develop the
concept of separate selves, that is, the infant realizes that the external world
is not an extension of them. The sensorimotor stage is also marked by the
child's increasing ability to coordinate separate activities. An example of the
fundamental importance of this is coordination between looking and
reaching, without this an action as simple as picking up an object is not
possible.

Infants realize that an object can be moved by a hand (concept of

causality), and develop notions of displacement and events. An important
discovery during the latter part of the sensorimotor stage is the concept of
"object permanence".

Object permanence is the awareness that an object continues to exist

even when it is not in view. In young infants, when a toy is covered by a
piece of paper, the infant immediately stops and appears to lose interest in
the toy (see figure above). This child has not yet mastered the concept of
object permanence. In older infants, when a toy is covered the child will
actively search for the object, realizing that the object continues to exist.
 After a child has mastered the concept of object permanence, the
emergence of directed groping" begins to take place. With directed
groping, the child begins to perform motor experiments in order to see what
will happen. During directed groping, a child will vary his movements to
observe how the results will differ. The child learns to use new means to
achieve an end. The child discovers he can pull objects toward himself with
the aid of a stick or string, or tilt objects to get them through the bars of his
playpen. The child begins to recognise cause-and-effect relationships at this
stage, allowing the development of intentionally. Once a child knows what
the effects of his activities will be, he can intend these effects.

The Preoperational Stage

In the preoperational stage a child will react to all similar objects as

though they are identical (Lefrancois, 1995). At this time all women are
'Mummy' and all men 'Daddy'. While at this level a child's thought is
transductive. This means the child will make inferences from one specific
to another (Carlson & Buskist, 1997). This leads to a child looking at the
moon and reasoning; 'My ball is round, that thing there is round; therefore
that thing is a ball' .

From the age of about 4 years until 7 most children go through the
Intuitive period. This is characterized by egocentric, perception-dominated
and intuitive thought which is prone to errors in classification (Lefrancois,
1995).

Most preoperational thinking is self-centred, or Egocentric. According

to Piaget, a preoperational child has difficulty understanding life from any
other perspective than his own. In this time, the child is very me, myself, and
I oriented.

Egocentrism is very apparent in the relationship between two

preschool children. Imagine two children are playing right next to each other,
one playing with a coloring book and the other with a doll. They are talking
to each other in sequence, but each child is completely oblivious to what the
other is saying.

Julie: "I love my dolly, her name is Tina"

Carol: "I'm going to colour the sun yellow"

Julie: "She has long, curly hair like my auntie"

Carol: "Maybe I'll colour the trees yellow, too"

 Julie: "I wonder what Tina's eyes are made of?"

Carol: "I lost my orange crayon"

Julie: " I know her eyes are made of glass."

These types of exchanges are called "collective monologues". This type

of monologue demonstrates the "egocentrism" of children's thinking in this
stage.

According to Piaget, egocentrism of the young child leads them to

believe that everyone thinks as they do, and that the whole world shares
their feelings and desires. This sense of oneness with the world leads to the
child's assumptions of magic omnipotence. Not only is the world created for
them, they can control it. This leads to the child believing that nature is
alive, and controllable. This is a concept of egocentrism known as
"animism", the most characteristic of egocentric thought.

Closely related to animism is artificialism, or the idea that natural

phenomena are created by human beings. Such as the sun is created by a
man with a match. "Realism" is the child's notion that their own perspective
is objective and absolute. The child thinks from one perspective and regards
this reality as absolute. Names, for example, are real to the child. The child
can't realize that names are only verbal labels, or conceive the idea that they
could have been given a different name.

During the pre-operational period, the child begins to develop the use
of symbols (but can not manipulate them), and the child is able to use
language and words to represent things not visible. Also, the pre-operational
child begins to master conservation problems.

By the age of four children are developing a more complete

understanding of concepts and tend to have stopped reasoning tranductively
(Lefrancois, 1995). However their thought is dominated more by perception
than logic. This is clearly illustrated by conservation experiments. In such an
experiment a pre-operational child may be shown two balls of clay, that the
child acknowledges are equal in size, one of which is then squashed. The
child is now asked if both lots of clay are equal. A child at this stage will say
they are no longer equal.

Although the child is still unable to think in a truly logical fashion, they
may begin to treat objects as part of a group. The pre-operational child may
have difficulty with classification. This is because, to a pre-operational
child, the division of a parent class into subclasses destroys the parent group
(Lefrancois, 1995). For example, a child has a pile of toy vehicles which are
then split into trucks and cars. Next the child is asked 'Tell me, are there
more trucks than vehicles, or less, or the same number?' the child will almost
always say there are more trucks than vehicles!

In the latter part of the preoperational period, the child begins to have
an understanding between reality and fantasy.

The Concrete Operational Stage

During this stage, children begin to reason logically, and organize

thoughts coherently. However, they can only think about actual physical
objects, and cannot handle abstract reasoning. They have difficulty
understanding abstract or hypothetical concepts.

This stage is also characterized by a loss of egocentric thinking.

During this stage, the child has the ability to master most types of
conservation experiments, and begins to understand reversibility.
Conservation is the realization that quantity or amount does not change
when nothing has been added or taken away from an object or a collection of
objects, despite changes in form or spatial arrangement. The concrete
operational stage is also characterized by the child’s ability to coordinate two
dimensions of an object simultaneously, arrange structures in sequence, and
transpose differences between items in a series. The child is capable of
concrete problem-solving. Categorical labels such as "number" or "animal"
are now available to the child.

Logic:

Piaget determined that children in the concrete operational stage were

fairly good at the use of inductive logic. Inductive logic involves going from a
specific experience to a general principle. On the other hand, children at this
age have difficulty using deductive logic, which involves using a general
principle to determine the outcome of a specific event.

Reversibility:

One of the most important developments in this stage is an

understanding of reversibility, or awareness that actions can be reversed. An
example of this is being able to reverse the order of relationships between
mental categories. For example, a child might be able to recognize that his
or her dog is a Labrador, that a Labrador is a dog, and that a dog is an
animal.

A large portion of the defining characteristics of the stage can be

understood in terms of the child overcoming the limits of stage two, known
as the pre-operational stage. The pre-operational child has a number of
cognitive barriers which are subsequently broken down, and it is important
to note that overcoming these obstacles is not due to gradual improvement
in abilities the child already possesses. Rather the changes are genuine
qualitative shifts, corresponding to new abilities being acquired.

The first, and most discussed, of these limitations is egocentrism. The

pre-operational child has a “'self-centred' view of the world” (Smith, Cowie
and Blades, 2003, p. 399), meaning that she has difficulty understanding
that other people may see things differently, and hence hold a differing point
of view. Piaget's classic test for egocentrism is the three mountains task
(Piaget and Inhelder, 1956), which concrete operational thinkers can
complete successfully.

A second limitation which is overcome in the concrete operational

stage is the perceptual domination of one aspect of a situation. Before the
stage begins, the child's perception of any situation or problem will be
dominated by one aspect; this is best illustrated by the failure of pre-
operational children to pass Piaget's conservation tasks (Piaget and Inhelder,
1974).

Perhaps the most important limitation, yet the most difficult to

describe and measure, is that of the turn to logical operators. A pre-
operational child will use mostly simple, heuristic strategies in problem
solving. Once a child reaches the concrete operational stage, they will be in
possession of a completely new set of strategies, allowing problem solving
using logical rules. This new ability manifests itself most clearly in children's
justifications for their answers. Concrete operational thinkers will explicitly
state their use of logical rules in problem solving (Harris and Butterworth,
2002). This area also indicates the way in which the concrete operational
stage can be negatively defined; although children can now use logical
strategies, these can only be applied to concrete, immediately present
objects. Thinking has become logical, but is not yet abstract.

These shifts in the child's thinking lead to a number of new abilities

which are also major, positively defined characteristics of the concrete
operational stage. The most frequently cited ability is conservation. Now that
children are no longer perceptually dominated by one aspect of a situation,
they can track changes much more easily and recognise that some
properties of an object will persevere through change. Conservation is
always gained in the same order, firstly with respect to number, followed
secondly by weight, and thirdly by volume.

A second new ability gained in the concrete operational stage is

reversibility. This refers to the ability to mentally trace backwards, and is of
enormous help to the child in both their problem solving and the knowledge
they have of their own problem solving. For the former this is because they
can see that in a conservation task, for example, the change made could be
reversed to regain the original properties. With respect to knowledge of their
own problem solving, they become able to retrace their mental steps,
allowing an entirely new level of reflection.

Concrete operational children also gain the ability to structure objects

hierarchically, known as classification. This includes the notion of class
inclusion, e.g. understanding an object being part of a subset included within
a parent set, and is shown on Piaget's inclusion task, asking children to
identify, out of a number of brown and white wooden beads, whether there
were more brown beads or wooden beads (Piaget, 1965).

Seriation is another new ability gained during this stage, and refers to
the child's ability to order objects with respect to a common property. A
simple example of this would be placing a number of sticks in order of
height. An important new ability which develops from the interplay of both
seriation and classification is that of numeration. Whilst pre-operational
children are obviously capable of counting, it is only during the concrete
operational stage that they become able to apply mathematical operators,
thanks to their abilities to order things in terms of number (seriation) and to
split numbers into sets and subsets (classification), enabling more complex
multiplication, division and so on.

Finally, and also following the development of seriation, is transitive

inference. This is the name given to children's ability to compare two objects
via an intermediate object. So for instance, one stick could be deemed to be
longer than another by both being individually compared to another (third)
stick.

The Formal Operational Stage

The Formal Operational stage is the final stage in Piaget's theory. It

begins at approximately 11 to 12 years of age, and continues throughout
adulthood; although Piaget does point out that some people may never
reach this stage of cognitive development.
 The formal operational stage is characterized by the ability to
formulate hypotheses and systematically test them to arrive at an answer to
a problem.

The individual in the formal stage is also able to think abstractly and to
understand the form or structure of a mathematical problem.

Another characteristic of the individual is their ability to reason

contrary to fact. That is, if they are given a statement and asked to use it as
the basis of an argument they are capable of accomplishing the task. For
example, they can deal with the statement "what would happen if snow were
black".

Erikson’s Stages of Psychosocial

Development
Like Piaget, Erik Erikson (1902-1994) maintained that children develop in a
predetermined order. Instead of focusing on cognitive development,
however, he was interested in how children socialize and how this affects
their sense of self. Erikson’s Theory of Psychosocial Development has eight
distinct stage, each with two possible outcomes. According to the theory,
successful completion of each stage results in a healthy personality and
successful interactions with others. Failure to successfully complete a stage
can result in a reduced ability to complete further stages and therefore a
more unhealthy personality and sense of self. These stages, however, can be
resolved successfully at a later time.

1. Infancy: Birth to 18 Months

Ego Development Outcome: Trust vs. Mistrust

Basic strength: Drive and Hope

Erikson also referred to infancy as the Oral Sensory Stage (as anyone might
who watches a baby put everything in her mouth) where the major emphasis
is on the mother's positive and loving care for the child, with a big emphasis
on visual contact and touch. If we pass successfully through this period of
life, we will learn to trust that life is basically okay and have basic
confidence in the future. If we fail to experience trust and are constantly
frustrated because our needs are not met, we may end up with a deep-
seated feeling of worthlessness and a mistrust of the world in general.

Incidentally, many studies of suicides and suicide attempts point to the

importance of the early years in developing the basic belief that the world is
trustworthy and that every individual has a right to be here.

Not surprisingly, the most significant relationship is with the maternal parent,
or whoever is our most significant and constant caregiver.

2. Early Childhood: 18 Months to 3 Years

Ego Development Outcome: Autonomy vs. Shame

Basic Strengths: Self-control, Courage, and Will

During this stage we learn to master skills for ourselves. Not only do we learn
to walk, talk and feed ourselves, we are learning finer motor development as
well as the much appreciated toilet training. Here we have the opportunity to
build self-esteem and autonomy as we gain more control over our bodies
and acquire new skills, learning right from wrong. And one of our skills during
the "Terrible Two's" is our ability to use the powerful word "NO!" It may be
pain for parents, but it develops important skills of the will.

It is also during this stage, however, that we can be very vulnerable. If we're
shamed in the process of toilet training or in learning other important skills,
we may feel great shame and doubt of our capabilities and suffer low self-
esteem as a result.

The most significant relationships are with parents.

3. Play Age: 3 to 5 Years

Ego Development Outcome: Initiative vs. Guilt

Basic Strength: Purpose

During this period we experience a desire to copy the adults around us and
take initiative in creating play situations. We make up stories with Barbie's
and Ken's, toy phones and miniature cars, playing out roles in a trial
universe, experimenting with the blueprint for what we believe it means to
be an adult. We also begin to use that wonderful word for exploring the world
—"WHY?"
While Erikson was influenced by Freud, he downplays biological sexuality in
favor of the psychosocial features of conflict between child and parents.
Nevertheless, he said that at this stage we usually become involved in the
classic "Oedipal struggle" and resolve this struggle through "social role
identification." If we're frustrated over natural desires and goals, we may
easily experience guilt.

The most significant relationship is with the basic family.

4. School Age: 6 to 12 Years

Ego Development Outcome: Industry vs. Inferiority

Basic Strengths: Method and Competence

During this stage, often called the Latency, we are capable of learning,
creating and accomplishing numerous new skills and knowledge, thus
developing a sense of industry. This is also a very social stage of
development and if we experience unresolved feelings of inadequacy and
inferiority among our peers, we can have serious problems in terms of
competence and self-esteem.

As the world expands a bit, our most significant relationship is with the
school and neighborhood. Parents are no longer the complete authorities
they once were, although they are still important.

5. Adolescence: 12 to 18 Years

Ego Development Outcome: Identity vs. Role Confusion

Basic Strengths: Devotion and Fidelity

Up to this stage, according to Erikson, development mostly depends upon

what is done to us. From here on out, development depends primarily
upon what we do. And while adolescence is a stage at which we are neither
a child nor an adult, life is definitely getting more complex as we attempt to
find our own identity, struggle with social interactions, and grapple with
moral issues.

Our task is to discover who we are as individuals separate from our family of
origin and as members of a wider society. Unfortunately for those around us,
in this process many of us go into a period of withdrawing from
responsibilities, which Erikson called a "moratorium." And if we are
unsuccessful in navigating this stage, we will experience role confusion and
upheaval.
A significant task for us is to establish a philosophy of life and in this process
we tend to think in terms of ideals, which are conflict free, rather than
reality, which is not. The problem is that we don't have much experience and
find it easy to substitute ideals for experience. However, we can also develop
strong devotion to friends and causes.

It is no surprise that our most significant relationships are with peer groups.

6. Young adulthood: 18 to 35

Ego Development Outcome: Intimacy and Solidarity vs. Isolation

Basic Strengths: Affiliation and Love

In the initial stage of being an adult we seek one or more companions and
love. As we try to find mutually satisfying relationships, primarily through
marriage and friends, we generally also begin to start a family, though this
age has been pushed back for many couples who today don't start their
families until their late thirties. If negotiating this stage is successful, we can
experience intimacy on a deep level.

If we're not successful, isolation and distance from others may occur. And
when we don't find it easy to create satisfying relationships, our world can
begin to shrink as, in defense, we can feel superior to others.

Our significant relationships are with marital partners and friends.

7. Middle Adulthood: 35 to 55 or 65

Ego Development Outcome: Generativity vs. Self absorption or

Stagnation

Basic Strengths: Production and Care

Now work is most crucial. Erikson observed that middle-age is when we tend
to be occupied with creative and meaningful work and with issues
surrounding our family. Also, middle adulthood is when we can expect to "be
in charge," the role we've longer envied.

The significant task is to perpetuate culture and transmit values of the

culture through the family (taming the kids) and working to establish a stable
environment. Strength comes through care of others and production of
something that contributes to the betterment of society, which Erikson calls
generativity, so when we're in this stage we often fear inactivity and
meaninglessness.

As our children leave home, or our relationships or goals change, we may be

faced with major life changes—the mid-life crisis—and struggle with finding
new meanings and purposes. If we don't get through this stage successfully,
we can become self-absorbed and stagnate.

Significant relationships are within the workplace, the community and the
family.

8. Late Adulthood: 55 or 65 to Death

Ego Development Outcome: Integrity vs. Despair

Basic Strengths: Wisdom

Erikson felt that much of life is preparing for the middle adulthood stage and
the last stage is recovering from it. Perhaps that is because as older adults
we can often look back on our lives with happiness and are content, feeling
fulfilled with a deep sense that life has meaning and we've made a
contribution to life, a feeling Erikson calls integrity. Our strength comes
from a wisdom that the world is very large and we now have a detached
concern for the whole of life, accepting death as the completion of life.

On the other hand, some adults may reach this stage and despair at their
experiences and perceived failures. They may fear death as they struggle to
find a purpose to their lives, wondering "Was the trip worth it?" Alternatively,
they may feel they have all the answers (not unlike going back to
adolescence) and end with a strong dogmatism that only their view has been
correct.
 Robert J. Havighurst’s Developmental
Tasks

Developmental Tasks

(Ages 0-6)

• Learning to walk. * Learning to crawl. * Learning to take solid food. *

Learning to talk. * Learning to control the elimination of body wastes. *
Learning sex differences and sexual modesty. * Getting ready to read.
* Forming concepts and learning language to describe social and
physical reality.

(Ages 6-12)

• Learning physical skills necessary for ordinary games. * Learning to get

along with age mates. * Building wholesome attitudes toward oneself
as a growing organism. * Learning on appropriate masculine or
feminine social role. * Developing concepts necessary for everyday
living. * Developing conscience, morality and a scale of values. *
Achieving personal independence. * Developing attitudes toward social
groups and institutions.

(Ages 12-18)

• Achieving new and more mature relations with age mates of both
sexes. * Achieving a masculine or feminine social role. * Accepting
one’s physique and using the body effectively. * Achieving emotional
independence of parents and other adults. * Preparing for marriage and
family life. * Acquiring a set of values and an ethical system as a guide
to behavior. * Desiring and achieving socially responsible behavior.*
Selecting an occupation.

(Ages 18-30)
 • Selecting a mate. * Learning to live with a partner. * Starting family. *
Rearing children. * Managing home. * Getting started in occupation. *
Taking on civic responsibility. * Finding a congenial social group.

(Ages 30-60)

• Assisting teenage children to become responsible and happy adults. *

Achieving adult social and civic responsibility. * Reaching and
maintaining satisfactory performance in one’s occupational career. *
Developing adult leisure time activities. * Relating oneself to one’s
spouse as a person. * To accept and adjust to the physiological
changes of middle age. * Adjusting to aging parents.

(60 and over)

• Adjusting to decreasing physical strength and health. Adjusting to

retirement and reduced income. * Adjusting to death of a spouse. *
Establishing an explicit affiliation with one’s age group. * Adopting and
adapting social roles in a flexible way. * Establishing satisfactory
physical living arrangements.
Growth and developmental actual
Assessment

First Visit

During my first to my client,John Paul Eseguera, on that time

he is already two months old.I observe that he enjoys sucking and
he is very responsive as a sign of being healthy.This stage is best
describe to the oral stage of Freud's Psychosexual Stages of
Development.

• Oral stage of Freud's Psychosexual Stages of Development.

The oral stage begins at birth, when the oral cavity is

the primary focus of libidal energy. The child, of course,
preoccupies himself with nursing, with the pleasure of sucking
and accepting things into the mouth. The oral character who is
frustrated at this stage, whose mother refused to nurse him on
demand or who truncated nursing sessions early, is characterized
by pessimism, envy, suspicion and sarcasm. The overindulged
oral character, whose nursing urges were always and often
excessively satisfied, is optimistic, gullible, and is full of
admiration for others around him. The stage culminates in the
primary conflict of weaning, which both deprives the child of the
sensory pleasures of nursing and of the psychological pleasure of
being cared for, mothered, and held. The stage lasts
approximately one and one-half years.
Second Visit
During my second visit to my client, John Paul
Eseguera. At this point of time, he now enjoys grasping
an object and shows interest as if he wants to play. This
stage of development refer object permanence of
Piaget’s stages of cognitive development.

• Object permanence
 is the awareness that an object continues to exist even when it is
not in view. In young infants, when a toy is covered by a piece of
paper, the infant immediately stops and appears to lose interest
in the toy (see figure above). This child has not yet mastered the
concept of object permanence. In older infants, when a toy is
covered the child will actively search for the object, realizing that
the object continues to exist.
EVALUATION

DATE OF VISITS: FIRST VISIT SECOND VISIT

WEIGHT 6kg 7kg

LENGTH 52cm 57cm

HEAD CIRCUMFERENCE 39cm 41cm

CHEST CIRCUMFERENCE 41cm 44cm

TEMPERATURE 35.6˚C 36.5˚C

RESPIRATION 15cpm 14cpm

At the end of my third visit to my Client, John Paul Eseguera. I observed that
he developed different kind of stages as seen above that at first he enjoys on
sucking until he was able to recognized objects and tends to play with it.

Base on the graph shown above ,it is an evidence that my client healthy and
able to perform different stages in life as an infant.
referrals

As the researcher it is my responsibility to give health teachings to my client

with emphasis on:

• infant should have complete vaccination

• proper hygiene

• continue breastfeeding

• give vitamins that are appropriate to the infant

Appendix

infant pre-schooler

Toodler schooler