PEDIATRIC NURSING Positioning  head lower than the trunk

Alejandro S. Mendoza RN, MD Apgar scoring

Cord clamp  bleeding, AVA
GENERAL PRINCIPLES Voiding and meconium
Definition of Terms Footprints and fingerprints
A. Growth:
Growth: increase in size of a Identification bands
structure. Human growth is orderly Mother infant bonding
and predictable, but not even; it
follows a cyclical pattern. APGAR SCORING
B. Development:
Development: maturation of Heart rate
physiologic and psychosocial Respiratory effort
systems to more complex state. Muscle tone
C. Cephalocaudal:
Cephalocaudal: head-to-toe Reflex irritability
progression of growth and Skin color
development 1 minute  initial adaptation to
extrauterine life
GENERAL PRINCIPLES 5 minutes  overall status
Definition of Terms
D. Proximodistal:
Proximodistal: trunk-to-periphery APGAR SCORING
(fingers and toes) progression of INTERPRETATION
growth and development 7 to 10  Good condition
E. Phylogeny:
Phylogeny: development or
evolution of a species or group;
group; a 4 to 6  Fair condition
pattern of development for a species
F. Ontogeny:
Ontogeny: development of an 0 to 3  In danger  resuscitation
individual within a species
Ongoing Physical Assessment
Rates of Development
Vital Signs
Vital statistics
A. Fetal period and infancy:
infancy: the head and Gestational age assessment
neurologic tissue grow faster than other Administer medications
tissues. Perform laboratory tests
B. Infancy and adolescence:
adolescence: fast growth
periods
C. Toddler through school-age:
school-age: slow growth
periods
D. Toddler and preschool periods:
periods: the trunk
grows more rapidly than other tissue.
E. The limbs grow most during school-age
period.
F. The trunk grows faster than other tissue
during adolescence.
adolescence.

NEONATAL ASSESSMENT Ongoing Physical Assessment

Initial assessment Vital signs:
Ongoing assessment RR
Physical assessment 30 to 60 bpm
Sensory assessment Apical Pulse
Behavioral assessment 110  sleeping
120 – 160  awake
180  crying
Initial Assessment Temperature
Airway  suctioning and O2 if needed 36  36.8
Body temperature Blood Pressure
80/46 mmHg
Vital Statistics: Blue eyes
Weight Purulent discharge
2,500 – 4,000 g Congenital cataracts
Length
18 – 21 inches Ears
Head Circumference Normal
13 – 14 inches Pinna  top is horizontal line with
Chest Circumference outer cantus of the eye, flexible,
12 – 13 inches cartilage present
Abnormal
Ongoing Physical Assessment Low placement of ears
Absent of startle reflex in response
Gestational Age to loud noise
Preterm
Term
Postterm
Laboratory Test
Mother  Rh neg or blood type O
Blood type
Bilirubin level
Direct coomb’s test
Reticulocyte count MOUTH AND THROAT
Hct Epstein pearl
Administer Medications Reflexes
Vit K (Aquamephyton) Sucking
.5 to 1 mg Gag
IM Extrusion
Prevent transient deficiency of Candidiasis (thrush)
coagulation factors Inability to pass NGT
Erythromycin ointment High pitch cry or absent
.5%
1 to 2 cm Neck
Neisseria gonorrhea, chlamydia Normal
Short, thick, usually surrounded by
PHYSICAL ASSESSMENT skin folds
Skin Tonic neck reflex
Head Abnormal
Eyes Resistance to flexion
Ears Fractured clavicle
Nose No tonic neck reflex
Mouth and throat Chest
Neck Normal
Chest APD = TD
Genitalia Slight sternal retractions evident
Extremities during inspiration
Abnormal
HEAD Asymmetry of the chest
Depressed sternum
Eyes
Normal GENITALIA
Color  gray MALE
Absence of tears Normal
Searching nystagmus Urethral opening at tip of glans
Abnormal penis
Yellow sclera Palpable tetes
 Abnormal Loses 5 to 10% and regain within 10
Hypospadias days
Epispadias Gain of 28g /day  1st 6 months
FEMALE Gain of 14g/day  2nd 6 months
Normal Weight gain
Labia and clitoris usually edematous 2x  6 months
Urethral meatus behind clitoris 3x  1 year
Pseudomenstruation 4x  2 ½ year
Abnormal DAILY NUTRIONAL REQUIREMENTS
Fused labia
Calories  100 to 200 kcal/kg
Meconium in the vaginal area
Fluid  150 to 180ml/kg
Absence of vaginal opening
CHON  2.2g/Kg  1.6g/Kg
Fat  30 to 60% of daily calories
EXTREMITIES
NORMAL
Ten fingers and toes HIGH RISK INFANTS
Full range of motion According to size
Nail beds are pink, with transient LBW  < 2500g
cyanosis immediately after birth ELBW  < 1000g
Equal brachial pulses MLBW  < 1500g
Sole usually flat SGA
ABNORMAL Birth weight falls below 10th
Polydactyly percentile on intrauterine growth
Syndactyly  fused or webbed digits curve
Yellowing of nail beds LGA  above 90th %
Unequal gluteal folds According to age
Sole covered with creases Premature
Full term
SENSORY ASSESSMENT Postmature
Tactile Behaviors
Sensation to touch, pain and pressure DEVELOPMENTAL THEORIES
Olfactory behaviors
Vision Behaviors Psychosexual model (Freud)
Can see  7 to 12 inches 1. Oral
Auditory Behaviors a. 0-18 months
Taste Behaviors b. Pleasure and gratification through mouth
c. Behaviors:
Behaviors: dependency, eating,
eating, crying,
crying,
BEHAVIORAL ASSESSMENT biting
Period of Reactivity d. Distinguishes between self and mother
30 minutes after birth e. Develops body image, aggressive drives
Awake and active
VS are increased Psychosexual model (Freud)
Mother infant bonding  breastfeeding 2. Anal
Resting Period a. 18 months - 3 years
2 to 4 hours b. Pleasure through elimination or retention
VS returning to baseline of feces
1 ½ sleep and difficult to be aroused c. Behaviors:
Behaviors: control of holding on or letting
Second Period of Reactivity go
4 to 6 hours d. Develops concept of power,
power, punishment,
ambivalence, concern with cleanliness
or being dirty
NUTRITION
Psychosexual model (Freud)
3. Phallic/Oedipal
GENERAL INFORMATION a. 3 - 6 years
b. Pleasure through genitals
c. Behaviors:
Behaviors: touching of genitals,
genitals, erotic
attachment to parent of opposite sex
d. Develops fear of punishment by parent of
same sex,
sex, guilt,
guilt, sexual identity
Psychosexual model (Freud)
4. Latency
a. 6 - 12 years
b. Energy used to gain new skills in social
relationships and knowledge
c. Behaviors:
Behaviors: sense of industry and mastery
d. Learns control over aggressive,
destructive impulses
e Acquires friends
Psychosexual model (Freud)
5. Genital
a. 12 - 20 years
b. Sexual pleasure through genitals
c. Behaviors:
Behaviors: becomes independent of
parents,
parents, responsible for self
d. Develops sexual identity, ability to love
and work
Psychosocial Model (Erikson)
1. Trust vs mistrust
a. 0 - 18 months
b. Significant relations: mother
c. Psychosocial virtues: hope,
hope, faith
d. Maladaptations & malignancies:
sensory distortion- withdrawal
Psychosocial Model (Erikson)
2. Autonomy vs shame and doubt
a. 18 months - 3 years
b. Significant relations: parents
c. Psychosocial virtues: will, determination
d. Maladaptations & malignancies:
impulsivity -- compulsion
Psychosocial Model (Erikson)
3. Initiative vs guilt
a. 3 - 5 years
b. Significant relations: family
c. Psychosocial virtues: purpose, courage
d. Maladaptations & malignancies:
ruthlessness -- inhibition
Psychosocial Model (Erikson)
4. Industry vs inferiority
a. 6 - 12 years
b. Significant relations: neighborhood and
school
c. Psychosocial virtues: competence
d. Maladaptations & malignancies:
narrow virtuosity -- inertia
Psychosocial Model (Erikson)
5. Identity vs role confusion
a. 12 - 20 years
b. Significant relations: peer groups,
groups, role
models
c. Psychosocial virtues: fidelity, loyalty
d. Maladaptations & malignancies:
fanaticism -- repudiation
Psychosocial Model (Erikson)
6. Intimacy vs isolation
a. 20 - 25 years
b. Significant relations: partners,
partners, friends
c. Psychosocial virtues: love
d. Maladaptations & malignancies:
promiscuity -- exclusivity
Psychosocial Model (Erikson)
7. Generativity vs stagnation
a. 25 - 45 years
b. Significant relations: household,
workmates
c. Psychosocial virtues: care
d. Maladaptations & malignancies:
overextension -- rejectivity
Psychosocial Model (Erikson)
8. Integrity vs despair
a. 45 years to end of life
b. Significant relations: mankind or “my
kind”
c. Psychosocial virtues: wisdom
d. Maladaptations & malignancies:
presumption -- despair
Interpersonal Model (Sullivan)
1. Infancy
a. 0 - 18 months
b. Others will satisfy needs
2. Childhood
a. 18 months - 6 years
b. Learn to delay need gratification
3. Juvenile
a. 6 - 9 years
b. Learn to relate to peers
Interpersonal Model (Sullivan)
4. Preadolescence
a. 9-12 years
b. Learn to relate to friends of same sex
5. Early adolescence
a. 12-14 years
b. Learn independence and how to relate to CONVENTIONAL LEVEL level 2
opposite sex Stage 3
Age : 7-10
6. Late adolescence Description:
a. 14-21 years "Good boy/girl"
b. Develop intimate relationship with person Orientation to interpersonal relations of
of opposite sex mutuality
A child follows rules because of a need
Cognitive Theory (Piaget) to be a good person in own eyes and
A. 0 - 2 years: sensorimotor in the eyes of others
-reflexes,
reflexes, repetition of acts CONVENTIONAL LEVEL level 2
Stage 4
B. 2 - 4 years: preoperational Age : 10-12
-no cause and effect reasoning; Description:
egocentrism; use of symbols; Law and Order
symbols; magical
thinking Maintenance of social order, fixed rules
and authority
Child follows rules of authority figures as
C. 4 - 7 years: intuitive well as parents to keep the system
-beginning of causation working
Cognitive Theory (Piaget)
D. 7 - 11 years: concrete operations POSTCONVENTIONAL LEVEL level 3
- uses memory to learn Stage 5
aware of reversibility Age :older
:older than 12
Description:
social contract,
contract, utilitarian law making
E. 11 - 15 years: formal operations perspective
-reality, abstract thought child follows standards of society for the
-can deal with the past, present and good of all people
future
POSTCONVENTIONAL LEVEL level 3
KOHLBERG’S STAGES OF Stage 6
MORAL DEVELOPMENT Age :older
:older than 12
Descriptions:
PRECONVENTIONAL LEVEL Principled Conscience
Stage 1 universal ethical principle orientation
Age: 2-3 child follows internalized standards of
Description: conduct
Punishment or obedience
(heteronomous morality) NEONATAL REFLEXES
A child does the right things because a
parent tells him or her to avoid
punishment Reflex:
Reflex: Symmetric tonic neck
PRECONVENTIONAL LEVEL Stimulus:
Stimulus: neck flexion, neck extension
Stage 2 Response:arm
Response:arm flexion, leg extension, arm
Age : 4-7 extension, leg flexion
Description: Onset:
Onset: birth-1month
Individualism, Instrumentalism, and Suppression:
Suppression: 4 mos
Exchange
Child carries out actions to satisfy own NEONATAL REFLEXES
needs rather than society’s. The child Reflex:
Reflex: positive supporting
does something for another if that Stimulus:
Stimulus: tactile contact and weight bearing
person does something for him in on sole
return Response:leg
Response:leg extension for supporting
partial body weight
Onset:
Onset: 2 months
Suppression:
Suppression: 3-7 mos, replaced by volitional able to hear in the utero
standing within hrs after birth, hearing in NB
becomes acute
NEONATAL REFLEXES VISION:
Reflex:
Reflex: rooting focus on black and white objects
Stimulus:
Stimulus: stroking the corner of the distance of 9-12 inches
mouth,upper or lower lip pupillary reflex present at birth
Response:moving
Response:moving the tongue, mouth and
head towards the site of stimulus NEONATAL SENSES
Onset:
Onset: birth TASTE:
Suppression:
Suppression: 4 mos developed before birth
TOUCH:
NEONATAL REFLEXES well developed at birth
Reflex: react to painful stimuli
Reflex: palmar grasp
Stimulus: SMELL:
Stimulus: pressure or touch on the palm,
stretch of finger flexors present as soon as the nose is cleared
Response:flexion of mucus
Response:flexion of fingers
Onset: ability to respond to odors can be used
Onset: birth
Suppression: to document alertness
Suppression: 4-6 mos
Infant
NEONATAL REFLEXES A. Physical tasks
Reflex:
Reflex: Plantar grasp 1. Neonate (Birth to 1 month)
Stimulus:
Stimulus: pressure on the sole just distal to a. Weight:
Weight: 6 - 8 lb (2750 - 3629 g); gains
the metatarsal heads 5 - 7 oz (142 - 198 g) weekly for first 6
Response:flexion
Response:flexion of toes months
Onset:
Onset: birth b. Length:
Length: 20 inches (50 cm); grows 1
Suppression:
Suppression: 12-18 mos inch (2.5 cm) monthly for first 6
months
NEONATAL REFLEXES
Reflex:
Reflex: Automatic neonatal walking
Stimulus:
Stimulus: contact of the sole in vertical Infant
position tilting the body forward and from A. Physical tasks
side to side 1. Neonate (Birth to 1 month)
Response:
Response: automatic alternating steps c. Head growth
Onset:
Onset: birth 1) head circumference 33 - 35.5 cm (13
Suppression:
Suppression: 3-4 mos - 14 inches)
2) head circumference equal to or
REFLEXES slightly larger than chest
Blinking or corneal reflex 3) increases by 1/2 inch (1.25 cm)
Pupillary reflex monthly for first 6 months
Doll’s eye  fixation develops
Sneeze reflex Infant
Sucking reflex A. Physical tasks
Gag reflex 1. Neonate (Birth to 1 month)
Rooting reflex  3 to 4 months d. Vital signs
1) pulse: 110 - 160 and irregular; count
REFLEXES for a full minute apically
Extrusion reflex  4 months 2) respirations: 32 - 60 and irregular;
Cough reflex neonates are abdominal breathers,
breathers,
Babinski reflex obligate nose breathers
Moro reflex  3 to 4 months 3) blood pressure: 75/49 mm Hg
Dance or step reflex  3 to 4 weeks
Infant
NEONATAL SENSES A. Physical tasks
HEARING: 1. Neonate (Birth to 1 month)
 e. Motor development 3. 5 - 6 months
1) behavior is reflex controlled c. Eruption of teeth begins
2) flexed extremities 1) lower incisors first
2) causes increased saliva and
Infant drooling
A. Physical tasks 3) enzyme released with teething
1. Neonate (Birth to 1 month) causes mild diarrhea,
diarrhea, facial skin
f. Sensory development irritation
1) hearing and touch well developed at 4) slight fever may be associated
birth with teething, but not a high fever
2) sight not fully developed until 6 years or seizures
a) differentiates light and dark at
birth Infant
b) rapidly develops clarity of vision A. Physical tasks
within 1 foot 3. 5 - 6 months
c) fixates on moving objects d. Motor development
d) strabismus due to lack of 1) supports weight on arms
binocular vision 2) sits with support

Infant
Infant A. Physical tasks
A. Physical tasks 3. 5 - 6 months
2. 1 - 4 months e. Sensory development
a. Head growth:
growth: posterior fontanel 1) hearing: can localize sounds above
closes and below ear
b. Motor development 2) vision: smiles at own mirror image
1) reflexes begin to fade (e.g., Moro, and responds to facial expressions of
tonic neck) others
2) gains head control;
control; balances 3) taste: sucking needs have decreased
head in sitting position and cup weaning can begin; chewing,
chewing,
3) rolls from back to side biting,
biting, and taste preferences begin to
4) begins voluntary hand-to-mouth develop
activity Infant
Infant A. Physical tasks
A. Physical tasks 4. 7 - 9 months
2. 1 - 4 months a. Teething continues
c. Sensory development 1) 7 months: upper central incisors
1) begins to be able to coordinate stimuli 2) 9 months: upper lateral incisors
from various sense organs b. Motor development
2) hearing: locates sounds by turning 1) crawls;
crawls; may go backwards initially
head and visually searching 2) pulls self to standing position
3) vision: follows objects 180°
180° 3) develops finger-thumb opposition
(pincer grasp)

Infant Infant
A. Physical tasks A. Physical tasks
3. 5 - 6 months 5. 10-12 months
a. Weight:
Weight: birth weight doubles;
doubles; gains 3- a. Weight:
Weight: birth weight tripled
5 oz (84-140 g) weekly for next 6 b. Length:
Length: 50% increase over birth
months length
b. Length:
Length: gains 1/2 inch (1.25 cm) for c. Head and chest circumference equal
next 6 months d. Teething
1) lower lateral incisors erupt
2) average of eight deciduous teeth
Infant Infant
A. Physical tasks A. Physical tasks
5. 10-12 months
e. Motor development
1) walks with help or cruises
2) may attempt to stand alone
Infant
B. Psychosocial tasks
1. Neonatal period
a. Cries to express displeasure
b. Smiles indiscriminately
c. Receives gratification through sucking
d. Makes throaty sounds
Infant
B. Psychosocial tasks
2. 1 - 4 months
a. Crying becomes differentiated at 1
month
1) decreases during awake periods
2) ceases when parent in view
b. Vocalization distinct from crying at 1
month
1) coos,
coos, babbles,
babbles, laughs;
laughs; vocalizes
when smiling
Infant
B. Psychosocial tasks
2. 1 - 4 months
c. Socialization
1) stares at parents’
parents’ faces when
talking at 1 month
2) smiles socially at 2 months
3) shows excitement when happy at
4 months
4) demands attention, enjoys social
interaction with people at 4
months
Infant
B. Psychosocial tasks
3. 5 - 6 months
a. Vocalization: begins to imitate sounds
b. Socialization: recognizes parents,
stranger anxiety begins to develop;
comfort habits begin
Infant
B. Psychosocial tasks
4. 7 - 9 months
a. Vocalization: verbalizes all vowels
and most consonants
b. Socialization
1) shows increased stranger anxiety
and anxiety over separation from
parent
2) exhibits aggressiveness by biting
at times
3) understands the word “no
“no””
Infant
B. Psychosocial tasks
5. 10 - 12 months
a. Vocalization: imitates animal sounds,
can say only 4 - 5 words but
understands many more (ma, da)
b. Socialization
1) begins to explore surroundings
2) plays games such as pat-a-cake,
pat-a-cake,
peek-a-boo
3) shows emotions such as
jealousy, affection, anger, fear
(especially in new situations)
Infant
C. Cognitive tasks
1. Neonatal period:
period: reflexive behavior only
2. 1 - 4 months
a. Recognizes familiar faces
b. Is interested in surroundings
c. Discovers own body parts
Infant
C. Cognitive tasks
3. 5 - 6 months
a. Begins to imitate
b. Can find partially hidden objects
4. 7 - 9 months
a. Begins to understand object
permanence;
permanence; searches for dropped
objects
b. Reacts to adult anger; cries when
scolded
c. Imitates simple acts and noises
d. Responds to simple commands
Infant
C. Cognitive tasks
5. 10-12 months
a. Recognizes objects by name
b. Looks at and follow pictures in book
c. Shows more goal-directed actions
Infant
D. Nutrition
1. Birth to 6 months
a. Breast milk is a complete and
healthful diet; supplementation may
include 0.25 mg fluoride, 400 IU
vitamin D, and iron after 4 months.
months.
b. Commercial iron-fortified formula is
acceptable alternative;
 supplementation may include 0.25 mg
fluoride if water supply is not
fluoridated.
c. Juices may be introduced at 5-6
months, diluted 1:1 and preferably
given by cup.
Infant
D. Nutrition
2. 6 - 12 months
a. Breast milk or formula continues to be
primary source of nutrition.
b. Introduction of solid foods starts with
cereal (usually rice cereal), which is
continued until 18 months.
Infant
D. Nutrition
2. 6 - 12 months
c. Introduction of other food is arbitrary;
most common sequence is fruits,
vegetables, meats.
1) introduce one new food a week.
week.
2) decrease amount of formula to
about 30 oz. as foods are added.
d. Iron supplementation can be stopped.
Infant
D. Nutrition
2. 6 - 12 months
e. Finger foods such as cheese, meat,
carrots can be started around 10
months.
months.
f. Chopped table food or junior food can
be introduced by 12 months
g. Weaning from breast or bottle to cup
should be gradual during second 6
months.
months.
Infant
E. Play (Solitary)
1. Birth to 4 months
a. Provide variety of brightly colored
objects, different sizes and textures.
b. Hang mobiles within 8-10 inches of
infant’s face.
Infant
E. Play (Solitary)
2. 5 - 7 months
a. Provide brightly colored toys to hold
and squeeze.
squeeze.
b. Allow infant to splash in bath.
c. Provide crib mirror.
3. 8 - 12 months
a. Provide toys with movable parts and
noisemakers;
noisemakers; stack toys, blocks; pots,
pans, drums to bang on; walker and
push-pull toys.
toys.
b. Plays games: hide and seek,
seek, pat-a-
cake.
cake.
Infant
F. Fears
1. Separation from parents
a. Searches for parents with eyes.
b. Shows preference for parents.
c. Develops stranger anxiety around 6
months (peaks at 8 months).
2. Pain
Toddler (12 months to 3 years)
A. Physical tasks: this is a period of slow
growth
1. Weight:
Weight: gain of approximately 11 lb (5
kg) during this time; birth weight
quadrupled by 2 1/2 years
2. Height:
Height: grows 20.3 cm (8 inches);
3. Head circumference:
circumference: 19½ - 20 inches
(49 - 50 cm) by 2 years; anterior
fontanel closes by 18 months
Toddler (12 months to 3 years)
A. Physical tasks: this is a period of slow
growth
4. Pulse 110; respirations 26; blood
pressure 99/64
5. Primary dentition (20
(20 teeth)
teeth)
completed by 2 1/2 years
6. Develops sphincter control necessary
for bowel and bladder control
Toddler (12 months to 3 years)
B. Psychosocial tasks
1. Increases independence;
independence; better able to
tolerate separation from primary
caregiver.
2. Less likely to fear strangers.
strangers.
3. Able to help with dressing/undressing at
18 months; dresses self at 24 months.
months.
4. Has sustained attention span.
5. May have temper tantrums during this
period; should decrease by 2 1/2 years.
6. Vocabulary increases from about 10 - 20
words to over 900 words by 3 years.
Toddler (12 months to 3 years)
B. Psychosocial tasks
7. Has beginning awareness of ownership
(my, mine) at 18 months; shows proper
use of pronouns (I, me, you) by 3 years.
8. Moves from hoarding and possessiveness
at 18 months to sharing with peers by 3
years.
9. Toilet training usually completed by 3
years.
a. 18 months: bowel control
b. 2 - 3 years: daytime bladder control
c. 3 - 4 years: nighttime bladder control
Toddler (12 months to 3 years)
C. Cognitive tasks
1. Follows simple directions by 2 years.
2. Begins to use short sentences at 18
months to 2 years.
3. Can remember and repeat 3 numbers
by 3 years.
4. Knows own name by 12 months;
refers to self, gives first name by 24
months; gives full name by 3 years.
5. Able to identify geometric forms by 18
months.
Toddler (12 months to 3 years)
C. Cognitive tasks
6. Achieves object permanence;
permanence; is
aware that objects exist even if not in
view.
7. Uses “magical”
“magical” thinking;
thinking; believes own
feelings affect events (e.g., anger
causes rain).
8. Uses ritualistic behavior;
behavior; repeats
skills to master them and to decrease
anxiety.
9. May develop dependency on
“transitional object” such as blanket or
stuffed animal.
Toddler (12 months to 3 years)
D. Nutrition
1. Caloric requirement is approximately
100 calories/kg/day.
2. Increased need for calcium, iron, and
phosphorus.
3. Needs 16 - 24 oz milk/day.
4. Appetite decreases.
5. Able to feed self.
6. Negativism may interfere with eating.
7. Initial dental examination at 3 years.
Toddler (12 months to 3 years)
E. Play
1. Predominantly- “parallel
“parallel play”
play” period.
2. Provide toys appropriate for increased
locomotive skills: push toys,
toys, rocking
horse,
horse, riding toys or tricycles;
tricycles; swings and
slide.
3. Give toys to provide outlet for aggressive
feelings:
feelings: work bench, toy hammer and
nails, drums, pots, pans.
4. Provide toys to help develop fine motor
skills,
skills, problem-solving abilities: puzzles,
puzzles,
blocks;
blocks; finger paints, crayons.
crayons.
Toddler (12 months to 3 years)
G. Fears: separation anxiety
1. Learning to tolerate and master brief
periods of separation is important
developmental task.
2. Increasing understanding of object
permanence helps toddler overcome this
fear.
Toddler (12 months to 3 years)
G. Fears: separation anxiety
3. Potential patterns of response to
separation
a. Protest:
Protest: screams and cries when
mother leaves; attempts to call her
back.
b. Despair:
Despair: whimpers, clutches
transitional object, curls up in bed,
decreased activity, rocking.
c. Denial:
Denial: resumes normal activity but
does not form psychosocial
relationships; when mother returns,
child ignores her
Preschooler (3 to 5 years)
A. Physical tasks
1. Slower growth rate continues
a. Weight: increases 4 - 6 lb (1.8 - 2.7
kg) a year
b. Height: increases 2 1/2 inches (5-6.25
cm) a year
c. Birth length doubled by 4 years
2. Vital signs decrease slightly
a. Pulse: 90-100
b. Respirations: 24-25/minute
c. Blood pressure: systolic 85-100 mm
Hg
diastolic 60-
90 mm Hg
Preschooler (3 to 5 years)
A. Physical tasks
3. Permanent teeth may appear late in
preschool period; first permanent teeth
are molars,
molars, behind last temporary teeth.
4. Gross motor development
a. Walks up stairs using alternate feet
by 3 years.
b. Walks down stairs using alternate feet
by 4 years.
c. Rides tricycle by 3 years.
d. Stands on 1 foot by 3 years.
Preschooler (3 to 5 years)
A. Physical tasks
4. Gross motor development
e. Hops on 1 foot by 4 years.
f. Skips and hops on alternate feet by 5
years.
g. Balances on 1 foot with eyes closed
by 5 years.
h. Throws and catches ball by 5 years.
i. Jumps off 1 step by 3 years.
j. Jumps rope by 5 years.
Preschooler (3 to 5 years)
A. Physical tasks
5. Fine motor development
a. Hand dominance is established by 5
years.
b. Builds a tower of blocks by 3 years.
c. Ties shoes by 5 years.
d. Ability to draw changes over this time
1) copies circles,
circles, may add facial
features by 3 years.
2) copies a square,
square, traces a
diamond by 4 years.
Preschooler (3 to 5 years)
B. Psychosocial tasks
1. Becomes independent
a. Feeds self completely.
b. Dresses self.
c. Takes increased responsibility for
actions.
2. Aggressiveness and impatience peak at 4
years then abate.
3. Gender-specific behavior is evident by 5
years.
years.
4. Egocentricity changes to awareness of
others; rules become important;
important;
understands sharing.
Preschooler (3 to 5 years)
C. Cognitive development
1. Focuses on one idea at a time;
time; cannot
look at entire perspective.
2. Awareness of racial and sexual
differences begins.
a. Prejudice may develop based on
values of parents.
b. Manifests sexual curiosity.
curiosity.
c. Sexual education begins.
d. Beginning body awareness.
awareness.
Preschooler (3 to 5 years)
C. Cognitive development
3. Has beginning concept of causality.
4. Understanding of time develops during
this period.
a. Learns sequence of daily events.
events.
b. Is able to understand meaning of
some
time-oriented words (day of week,
month, etc.) by 5 years.
5. Has 2000-word vocabulary by 5 years.
6. Can name 4 or more colors by 5 years.
7. Is very inquisitive (why?, why? why?).
why?).
Preschooler (3 to 5 years)
D. Nutrition
1. Caloric requirement is approximately 90
calories/kg/day.
2. May demonstrate strong taste
preferences.
preferences.
3. More likely to taste new foods if child can
assist in the preparation.
Preschooler (3 to 5 years)
F. Play
1.Predominantly associative play
2. Enjoys imitative and dramatic play.
play.
a. Imitates same-sex role functions in
play.
b. Enjoys dressing up, dollhouses,
trucks, cars, telephones, doctor and
nurse kits.
3. Provide toys to help develop gross motor
skills: tricycles,
tricycles, wagons,
wagons, outdoor gym;
gym;
sandbox, wading pool.
Preschooler (3 to 5 years)
F. Play
4. Provide toys to encourage fine motor
skills,
skills, self-expression, and cognitive
development: construction sets, blocks,
carpentry tools; flash cards, illustrated
books, puzzles;
puzzles; paints,
paints, crayons,
crayons, clay,
clay,
simple sewing sets.
5. Television,
Television, when supervised, can provide
a quiet activity; some programs have
educational content.
Preschooler (3 to 5 years)
G. Fears
1. Greatest number of imagined and real
fears of childhood during this period.
2. Fears concerning body integrity are
common.
a. Magical and animistic thinking allows
children to develop many illogical
fears (fear of inanimate objects,
objects,
the dark,
dark, ghosts).
ghosts).
School-age (6 to 12 years)
A. Physical tasks
1. Slow growth continues.
a. Height: 2 inches (5 cm) per year
b. Weight: doubles over this period
c. At age 9,
9, both sexes same size;
size; age
12,
12, girls bigger than boys
2. Dentition
a. Loses first primary teeth at about 6
years.
b. By 12 years, has all permanent teeth
except final molars.
School-age (6 to 12 years)
A. Physical tasks
3. Bone growth faster than muscle and
ligament development; very limber but
susceptible to bone fractures during this
time.
4. Vision is completely mature;
mature; hand-eye
coordination develops completely.
5. Gross motor skills: predominantly
involving large muscles; children are very
energetic,
energetic, develop greater strength,
strength,
coordination, and stamina.
6. Develops smoothness and speed in fine
motor control.
School-age (6 to 12 years)
B. Psychosocial tasks
1. School occupies half of waking hours;
hours; has
cognitive and social impact.
a. Readiness includes emotional
(attention span), physical (hearing
and vision), and intellectual
components.
b. Teacher may be parent substitute,
substitute,
causing parents to lose some
authority.
School-age (6 to 12 years)
B. Psychosocial tasks
2. Morality develops
a. Before age 9 moral realism
predominates: strict superego,
superego, rule
dominance; things are black or white,
right or wrong.
wrong.
b. After age 9 autonomous morality
develops: recognizes differing points
of view, sees “gray” areas.
School-age (6 to 12 years)
B. Psychosocial tasks
3. Peer relationships
a. Child makes first real friends during
this period.
b. Is able to understand concepts of
cooperation and compromise (assist
in acquiring attitudes and values);
learns fair play vs competition.
competition.
c. Help child develop self-concept.
d. Provide feeling of belonging.
School-age (6 to 12 years)
B. Psychosocial tasks
4. Enjoys family activities.
5. Has some ability to evaluate own
strengths and weaknesses.
6. Has increased self-direction.
self-direction.
7. Is aware of own body; compares self to
others;
others; modesty develops.
School-age (6 to 12 years)
C. Cognitive development
1. Period of industry
a. Is interested in exploration and
adventure.
adventure.
b. Likes to accomplish or produce.
produce.
c. Develops confidence.
School-age (6 to 12 years)
C. Cognitive development
2. Concept of time and space develops.
a. Understands causality.
b. Masters concept of conservation:
permanence of mass and volume;
concept of reversibility.
reversibility.
c. Develops classification skills:
understands relational terms; may
collect things.
 d. Masters arithmetic and reading.
School-age (6 to 12 years)
D. Nutrition
1. Caloric needs diminish in relation to body
size: 85 kcal/kg.
2. “Junk”
“Junk” food may become a problem;
excess sugar, starches, fat.
3. Obesity is a risk in this age group.
4. Nutrition education should be integrated
into school program.
School-age (6 to 12 years)
E. Play
1. Rules and ritual dominate play;
individuality not tolerated by peers;
knowing rules provides sense of
belonging; “cooperative
“cooperative play.”
play.”
2. Team play: games or sports
a. Help learn value of individual skills and
team accomplishments.
b. Help learn nature of competition.
competition.
3. Quiet games and activities: board games,
collections, books, television, painting
4. Athletic activities: swimming, hiking,
bicycling, skating
School-age (6 to 12 years)
G. Fears:
more realistic fears than younger
children; include death,
death, disease or bodily
injury,
injury, punishment;
punishment; school phobia may
develop, resulting in psychosomatic
illness.
Adolescent (12 to 19 years)
A. Physical tasks
a. Girls:
Girls: height increases approximately 3
inches/year; slows at menarche; stops
around age 16.
b. Boys:
Boys: growth spurt starts around age 13;
height increases 4 inches/year; slows in
late teens.
c. Boys double weight between 12 and 18,
related to increased muscle mass.
Adolescent (12 to 19 years)
A. Physical tasks
d. Body shape changes
1) boys become leaner with broader
chest.
2) girls have fat deposited in thighs,
hips, and breasts; pelvis broadens.
e. Apocrine glands cause increased body
odor.
odor.
f. Increased production of sebum and
plugging of sebaceous ducts causes
acne.
acne.
Adolescent (12 to 19 years)
A. Physical tasks
4. Sexual development: girls
c. Development of secondary sex
characteristics and sexual functioning
under hormonal control
d. Breast development is first sign of
puberty.
1) bud stage: areola around nipple
is protuberant.
2) breast development is complete
around the time of first menses.
Adolescent (12 to 19 years)
A. Physical tasks
5. Sexual development: boys
a. Development of secondary sex
characteristics,
characteristics, sex organs and
function under hormonal control.
b. Enlargement of testes is first sign of
sexual maturation; occurs at
approximately age 13, about 1 year
before growth spurt.
c. Scrotum and penis increase in size
until age 18.
d. Reaches reproductive maturity about
age 17, with viable sperm.
Adolescent (12 to 19 years)
A. Physical tasks
5. Sexual development: boys
e. Nocturnal emission:
emission: a physiologic
reflex to ejaculate buildup of semen;
natural and normal; occurs during
sleep (child should not be made to
feel guilty; needs to understand that
this is not enuresis).
f. Masturbation increases (also a normal
way to release semen).
g. Pubic hair continues to grow and
spread until mid 20s.
h. Facial hair;
hair; appears first on upper lip.
Adolescent (12 to 19 years)
A. Physical tasks
5. Sexual development: boys
i. Voice changes due to growth of
laryngeal, cartilage.
 j. Gynecomastia:
Gynecomastia: slight hypertrophy of
breasts due to estrogen production;
will pass within months but causes
embarrassment.
Adolescent (12 to 19 years)
B. Psychosocial tasks
1. Early adolescence:
adolescence: ages 12-14 years
a. Starts with puberty.
b. Physical body changes result in an
altered self-concept.
c. Tends to compare own body to
others.
d. Early and late developers have
anxiety regarding fear of rejection.
e. Fantasy life, daydreams,
daydreams, crushes are
all normal, help in role play of varying
social situations.
f. Is prone to mood swings.
swings.
g. Needs limits and consistent discipline.
Adolescent (12 to 19 years)
B. Psychosocial tasks
2. Middle adolescence:
adolescence: ages 15-16 years
a. Is separate from parents (except
financially).
b. Can identify own values.
c. Can define self (self-concept,
strengths and weaknesses).
d. Partakes in peer group; conforms to
values/fads.
e. Has increased heterosexual interest;
interest;
communicates with opposite sex; may
form “love” relationship.
Adolescent (12 to 19 years)
B. Psychosocial tasks
3. Late adolescence:
adolescence: ages, 17-19 years
a. Achieves greater independence.
independence.
b. Chooses a vocation.
vocation.
c. Participates in society.
d. Finds an identity.
e. Finds a mate.
mate.
f. Develops own morality.
g. Completes physical and emotional
maturity.
Adolescent (12 to 19 years)
C. Cognitive development
1. Develops abstract thinking abilities.
2. Is often unrealistic.
3. Is capable of scientific reasoning and
formal logic.
logic.
4. Enjoys intellectual abilities.
5. Is able to view problems
comprehensively.
Adolescent (12 to 19 years)
D. Nutrition
1. Nutritional requirements peak during
years of maximum growth: age 10-12 in
girls, 2 years later in boys
2. Appetite increases.
increases.
3. Inadequate diet can retard growth and
delay sexual maturation.
4. Food intake needs to be balanced with
energy expenditure.
5. Increased needs include calcium for
skeletal growth; iron for increased muscle
mass and blood cell development; zinc
for development of skeletal and muscle
tissue and sexual maturation.
Adolescent (12 to 19 years)
F. Activities:
group activities predominate (sports are
important); activities involving opposite
sex by middle adolescence.
G. Fears
1. Threats to body image:
image: acne, obesity
2. Injury or death
3. The unknown
Child’s Response to Death
1. toddlers - may insist on seeing a
significant other long after that person’s
death.
2. Preschoolers - See death as temporary;
temporary;
a type of sleep or separation.
3. School-age – See death as a period of
immobility.
- Feel death is
punishment.
punishment.
4. Adolescents - Have an accurate
understanding of death.
BREAST FEEDING
ADVANTAGE
Readily available
Economical
Promotes facial muscles, jaw and teeth
Mother infant bonding
Reduced incidence of allergies
Reduced incidence of maternal breast
cancer
Transfer of maternal antibodies
Ig A
Lactoferrin
Lysozyme
 Leukocytes
Macrophages IMMUNIZATION
Measles
DISADVANTAGE 9 months
Prevents other from feeding the infant .5ml
Limits paternal role in feeding Subcutaneous
Compels the mother to monitor her diet Left outer part of the upper arm
carefully Vitamin A Contraindication:
Maybe difficult to a working mother Fever
Digest quickly  more feeding Compromise Immune system
Seizure disorder must be controlled
ADEQUATE ??? Never give gluteal
Wets 6 to 8 diapers a day
Gaining weight INFANCY (0 to 1 yr)
I – ron supplement (4 to 6 months),
BOTTLE FEEDING immunization
ADVANTAGE N – o choking hazard
Permits the father to feed F – ear of stranger peaks at 8 months
Mother  medications A – llow to use a pacifier if NPO
Fewer feedings N – ote the weight changes
Feeding  public  embarrassment T – rust V.S. mistrust
DISADVANTAGE S – olitary play
Cost
Greater preparation and effort TODDLER (1 to 3yr)
Hands  clean T – alk to the child at simple terms
Requires refrigeration and storage O – ffer choices to the child to provide some
No transfer of maternal antibodies control
Doesn’t benefit mother physiologically D – on’t leave alone near the bathtub or
swimming pool
IMMUNIZATION D – oubt and shame V.S. Autonomy
BCG L – earns about death @ age 3
Infants E – limination pattern
.05 ml R – rituals and routines
Intradermal
Right deltoid TODDLER
School Entrants P – ush-pull toys (mobile), parallel play
.1ml (forget sharing)
Intradermal R – rituals and routines (eyes and
Left deltoid consistency), regression
DPT A – utnomy VS shame and doubt, accidents
6, 10 and 14 weeks (death)
.5ml I – nvolve parents
Intramuscular S – eparation anxiety
Upper outer portion of the thigh E – limination and explore
IMMUNIZATION
COMMON ACCIDENTS
Hepatitis
P – revent further absorption
6, 10, and 14 weeks
O – ff, shower or wash off
.5ml
I - dentify
Intramuscular
S - upport
Upper outer portion of the thigh
O – ngoing safety education
OPV
N – otify local poison control center
6, 10 and 14 weeks
2 drops
Mouth PRESCHOOL (3 to 6 yr)
P – lay is associative/cooperative
R – gression is common Subcutaneous
E – xplain procedures
S – ame age group for room assignment The nurse should teach Kristin’s mother
C - urious about the normal reaction an infant can
H – ighly imaginative experience approximately 12 to 24 hours
O – bserve for initiative VS guilt after DPT. One of these reactions could
O – ff limits to the kitchen (risk for poisoning be:
and burn) Lethargy
L – oss of body part is a common fear Mild fever
Diarrhea
PRESCHOOL Nasal congestion
M - utilation
A – associate play, abandonment Mrs. Ortega brings her 4-month-old child
G - uilt Paula, to the clinic. She says, “The soft
I – nitiative, imaginary playmate, imagination spot near the front of the Paula’s head is
C – urious  “Y” still big. When will it close?” The nurse’s
response should be guided by knowledge
SCHOOL AGE ( 6 to 12 yr) that most often the anterior fontanel
S – ame sex stage closes when the infant’s age is between
C – ompetitive play about?
H – eroworship 2 to 4 months
O – bserve for industry VS inferiority 4 to 8 months
O – ff limits to vehicles 8 to 12 months
L – oss of control is a common fear 12 to 18 months
E – xplain procedurse
R – egression is common Mrs. Ortigas brings her 4-month-old infant,
Timmy, to the clinic. He appears well.
Mrs. Ortigas asks the nurse when she
SCHOOL AGE
should wean Timmy from breast-feeding
D – eath (bogeyman), honesty  funerals
and have him use a cup. The nurse
and burials
should explain that Timmy will show
I – ndustry VS inferiority (collections)
readiness to be weaned when he is:
M – odesty (privacy)
Taking solid foods well
P – eers (own sex)
Sleeping through the night
L – oss of control  hospitalization, Shortening his nursing time
encourage Eating on a regular schedule
decision making
E - xplaination of procedures In counseling a teenage mother on the first-
solid food to introduce to her 5-month-old
ADOLESCENT (12 to 18 yr) child, least allergenic foods are given.
P – eer group  activities, peer pressure Which of the following should be
A – ltered body image  don’t want to be recommended in the usual order in
seen different introducing solid foods?
I – dentity – image  college or career
R – ole diffusion
S – eparation from peers Eggs
Pureed chicken
SAMPLE QUESTIONS Bananas
Rice cereal
Two month old Kristin is brought to the
health clinic for his first immunization
against DPT. What route should the A nurse is observing all of the following
nurse use to administer the vaccine? babies in the clinic. Which baby may be
Oral experiencing a developmental delay?
Intramuscular A 1-month-old who does not coo
Intradermal A 3-month-old who does not crawl
An 8-month-old who does not walk
A 10-month-old who does not sit
A first-time mother is concerned that her 6-
month-old infant is not gaining enough
weight. The best response for the nurse
to make is which of the following?
“Birth weight doubles by 6 months of age.’
“Birth weight doubles by 3 months of age.”
“The baby will eat what he needs.”
“You need to make sure the baby finishes
each bottle.”
The nurse discusses Lucy’s motor skill
development with her mother. The nurse
explains to Lucy’s mother that at about 7
months of age, Lucy will most likely to be
able to
Walk with support
Feed herself with a spoon
Stand holding onto furniture
Sit alone using her hand with support
A mother of an infant asks the nurse when
she can expect her baby to sit up. The
nurse informs the mother that an infant
can generally sit up without support at:
4 months
6 months
8 months
10 months
A mother of a 10-month-old baby asks a
clinic nurse about appropriate and safe
toys for the baby. The nurse tells the
mother that the most appropriate toys for
a 10-month-old is which of the following?
cradle gym
Teddy bears
Low rocking horses
Blocks
Which is the best way to deal with a toddler
who is having a temper tantrum?
Reason with the child
Threaten the child
Spank the child
Ignore the child’s outburst
The nurse observes a group of 2-year-old
children at play in the beach. The nurse
would expect to see:
Four children playing soft ball
Three children playing tag
Two children playing sandbox building
castles side by side
One child digging a hole
When assessing a 2-year-old child brought
by his mother to the clinic for a routine
check-up. The nurse would expect the
child is able to do which of the following?
Ride a tricycle
Tie his shoelaces
Kick a ball forward
Use blunt scissors
Mrs. Sara tells the nurse that her 4-year-old
son, Charles does not seem to know the
difference between right and wrong. She
explains that he knows he should not
push other children, but the only reason
for not pushing them is that he avoids
trouble. Mrs. Sara is describing typical
behavior of a child who has reached with
level of moral development as described
by Kohlberg?
Autonomous
Conventional
Preconventional
Principles
A mother brings her 5-year-old son to the
pediatrician’s office for a complete health
appraisal before he enters kindergarten
next moth. The nurse should focus part of
the assessment on the child’s
achievement of psychosocial tasks. At
this age, he should be trying to
accomplish a sense of
Autonomy
Identity
Mastery
Initiative
The mother of a 10-year-old student is
concerned about her daughter’s
compulsion for collecting things. The
nurse explains that this behavior is
related to the cognitive ability to perform:
Concrete operations
Formal operations
Coordination of secondary schemas
Tertiary circular reactions