Concepts of Growth and Development: The Capacity and Skill of A Person To Function "The Behavioral Aspect of Growth"

CONCEPTS OF GROWTH AND DEVELOPMENT
Definition of Terms
• GROWTH - physical change and increase in
size
- measured QUANTITATIVELY
- ex: eight, weight, bone size,
dentition, etc.
• DEVELOPMENT - increase in the complexity of

function and skill progression
- measured QUALITATIVELY
- the capacity and skill of a person to function
- "the behavioral aspect of growth"
- x: ability to work, to run, and to talk
e
- Synonyms
MATURATION / DIFFERENTATION
PRINCIPLES OF GROWTH AND DEVELOPMENT:

1. Growth and development are continuous
processes from conception until death+ womb to
tomb
2. Growth and development proceed in an orderly
sequence.
3. Different children pass through the predictable
stage at different rates.
4. All body systems do not develop at the same rate.
5. Development is cephalocaudal.
6. Development proceeds from proximal to distal
body parts.
7. Development proceeds from gross to refined
skills.
8. There is an optimum time for initiation of
experiences or learning.
9. Neonatal reflexes must be lost before
development can proceed.
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10. A great deal of skill and behavior is learned by
practice.
FACTORS INFLUENCING GROWTH AND

DEVELOPMENT:
1. enetic Influences
G
1.1 physical characteristics
1.2 gender-related characteristics
1.3 race and cultural influences
2. Environmental Influences
2.1 quality of nutrition
2.2 socio-economic levels
2.3 parent-child relationship
2.4 ordinal positions in the family
2.5 health
PERIODS OF GROWTH:
PERIOD OF GROWTH TIME RANGE

I. Prenatal 0 – 280 days
Ovum 0 – 14 days
Embryo 14 days – 9 wks
Fetus 9 wks - birth
II. Natal
Premature/Preterm 23 – 37 weeks

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Mature/Term 37 – 42 weeks
III. Postnatal
Neonate 0 – 28 days
Infant 0 – 1 year
Toddler 1 – 3 years
Preschooler 3 – 6 years
School Age 6 – 12 years
Adolescence 12 – 18 years
GROWTH AND DEVELOPMENT THEORIES:
I. PSYCHOSEXUAL THEORY (by Sigmund Freud)
- Freud proposes that the underlying motivation to

human development is an energy form or life
instinct called LIBIDO.
- Unconscious mind is the mental life of a person of
which the person is unaware.
- Proposed concepts like:
* ID - developed during infancy
- "I know what I want and 1 want it
now!”
- Pleasure principle
* EGO - developed during toddler
period
- "I can wait for what I want!"
- reality principle
- balances the id and superego
* SUPEREGO - developed during
preschool period
- "I should not want that!"
- Conscience
- Defense mechanisms are the adaptive
mechanisms of an individual as a result of conflicts
between inner impulses and the anxiety that attends
these conflicts.
AGE RANGE GROWTH PERIOD STAGE/S

0 – 18 months Infancy Oral Stage
1 8 months – 3 years Toddler Anal Stage
3 – 6 years Preschool Phallic.Oedipal Stage

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6 – 12 years School Age Latency Stage
12 – 18 years Adolescence Genital Stage
- I f the individual does not achieve a satisfactory

resolution at each stage, the personality becomes
FIXATED at that stage.
II. PSYCHOSOCIAL THEORY (by Erik Erikson)
- Reflects both positive and negative aspects of the

critical life periods
- Erikson believes that the greater the task
achievement, the healthier the personality of the
person; failure to achieve a task influences the
ability to I achieve the next task.
- Resolution of the task can be complete, partial or
unsuccessful.
AGE RANGE GROWTH PERIOD STAGE/S

0 – 1 year Trust vs. Mistrust Optimism
1 – 3 years Autonomy vs. Shame & Self-Control/Will Power
Doubt
3 – 6 years Initiative vs. Guilt Direction & Purpose
6 – 12 years Industry vs. Inferiority Method & Competence
12 – 18 years Identity vs. role Confusion Devotion & Fidelity
III. COGNITIVE THEORY (by Jean Piaget)
- Cognitive development refers to the manner in which

people learn to think, reason, and use language.
- It involves a person's intelligence, perceptual ability,
and ability to process information.
- Cognitive development represents a progression of
mental abilities from illogical to logical thinking,
from simple to complex problem solving, and from
understanding abstract concepts
Stage of Age Nursing Implications

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Development Span
Sensorimotor
Neonatal reflex 1 mo Stimuli are assimilated into beginning mental
images. Behavior entirely reflexive
Primary circular 1-4 mo Hand-mouth and ear-eye coordination develop.
reaction Infant spends much time looking at objects and
separating self from them. Beginning intention of
behavior present (the infant brings thumb to mouth
.for a purpose: to suck it). Enjoyable activity for this
period: a rattle or tape of parent's voice:
Secondary circular 4-8 mo
reaction Infant learns to initiate, recognize, and repeat
pleasurable experiences from environment. Memory
traces are present; infant anticipates familiar events
Coordination of 8-12 mo (a parental coming near him will pick him up). Good
secondary toy for this period: mirror: good game: peek-a-boo
reactions Infant can plan activities to attain specific goals.
Perceives that others can cause activity and that
activities of own body are separate from activity of
objects. Search for and retrieve toy that disappears
from view. Recognizes shapes and sizes of familiar
12-18 objects. Because of increased sense of
Tertiary circular mo separateness, infant experiences separation anxiety
reaction when primary caregiver leaves. Good toy for this
period: nesting toys (i.e., colored boxes),
Child is able to experiment to discover new
properties of objects and events Capable of space
Invention of new 18-24 yr perception and time perception as well as
means through permanent. Objects outside self are understood as
mental causes of actions. Good game for this period:
combinations throw and retrieve.
Transitional phase to the preoperational thought
2-7 yr period, Uses memory and limitation to act. Can
Preoperational solve basic problems; foresee maneuvers that will
Thought succeed of fail. Good toys for this period: those
with several uses, such as blocks, colored plastic
rings.
Thought becomes more symbolic; can arrive at answers
mentally instead through physical attempt. Comprehends
simple abstractions but thinking is basically concrete and
literal. Child is egocentric (unable to see the view point of
another). Displays static thinking. (Inability to remember what
he or she started to talk about so that at the end of a
sentence the child is talking about another topic). Concept of
time is now and concept of distance is only as far as she or
can see. Centering or focusing on a single aspect of an
object causes distorted reasoning. No awareness of
7-12 yr
reversibility (for every action there is an opposite action) is
present. Unable to state cause-effect relationships,
Concrete categories or abstractions. Good toy for this period: items
Operational that require imagination, such as modeling clay. Concrete
Thought operations include systematic reasoning. Uses memory to
learn broad concepts (fruit) and subgroups of concepts
(apples, oranges). Classifications involve sorting objects
according to attributes such as color; seriation in which
objects are ordered according to increasing or decreasing
measures such as weight; multiplication, in which objects are
simultaneously classified and seriated using weight. Child is
aware of reversibility, an opposite operation or continuation
of reasoning back to a starting point (follows a route through;
and then reverses steps). Understands conservation, sees

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constancy despite transformation (mass or quantity remains
the same even if it changes shape or position). Good activity
for this period: collecting and classifying natural object such
as native plants, seashells, etc. Expose child to other
viewpoints by asking questions such as, "How do you think
12 yr you'd feel if you were a nurse and tell a boy to stay in bed?"
Can solve hypothetical problems with scientific
reasoning; understands causal and can deal with
Formal Operational the past, present, and future. Adult or mature
Thought thought. Good activity' for this period: "talk time" to
sort through attitudes and opinion
IIII. MORAL THEORY (by L. Kohlberg)

- Moral development is a complex process not fully
understood since it involves learning what ought to
be and what ought not to be done
- The term “moral” means relating to right and wrong
- Moral development is the pattern of change in moral
behavior with age.
V. SPIRITUAL THEORY (by James Fowler

- The spiritual component of growth and development
refers to the individual’s understanding of their
relationship with the universe and their perceptions
about the direction and meaning of life
- Fowler believes that faith is an active “mode-of-
being-in-relation” to another or others in which we
invest commitment, belief, love, risk and hope.
DEVELOPMENT OF CHILDREN'S CONCEPTS AND

FEELINGS ABOUT DEATH—I
Age
0 - 2 years No concept of death
Developing awareness of separation and loss
First death-related perceptions? “All gone”; “peek-a-boo” games
3 – 5 years Egocentric orientation: animism, magical thinking, & artificialism
Conceive death as continuous with life; not final
Death understood as separation like travel (& thus temporary,
reversible, cyclical) or as a diminished life-form like asleep (&
thus on-going functioning at a reduced level).
Death applies to others, i.e., is not personal
Curious for specific, concrete information
May moralize about death, i.e., punishment and responsibility
6 – 9 years Gradual decentering in ego-orientation; recognition of law of
conservation or permanency
Growing understanding of death as final and irreversible

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Continued subjectivity in viewpoint; others may die, but death is
capricious and personal death is avoidable
May personify death: angel, grim reaper, skeleton, bogeyman
10 & older Death understood as final, universal, and inevitable
Applies to all of us, including me; i.e., death is personal (but distant
Death is an internal reality, not an external force
Adolescence Increasingly abstract and generalized thinking
Deepening of mature or adult conceptions of death
Determination of personal philosophical or religious view of life,
death, and their meaning
Emphasis on present living and future promise.
NEONATE
Immediate Care:
1. Establish and maintain a patent airway

- Never stimulate to cry unless secretions have been
drained out.
- Head lower than the rest of the body (except in

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increased ICP)
- Suction secretions properly:
1. MOUTH before NOSE (prevent inhalational
reflex)
2. AVOID PROLONGED (>10 min) and DEEP
SUCTIONING (stimulates vagus nerve ®
BRADYCARDIA
3. OCCLUDE ONE NOSTRIL AT A TIME ® Check
for struggle (Choanal atresia) *** Note:
Newborns are obligate nasal breathers!
2. aintain appropriate body temperature.
M
- Body temperature is about 37.2°C at the moment of
birth (confined in an internal body organ
- There's heat loss due to immature temperature-
regulating mechanisms.
- COLD STRESS ® due to large.' losses of heat
(Convection, Conduction, Radiation, Evaporation)
Effects:
1. Metabolic acidosis (breakdown of brown fat
found in INTRASCAPULAR AREA, THORAX
and PERIRENAL REGIONS)
2. Hypoglycemia (due to use of glucose stored
as glycogen)
Prevention:
1. Dry' the newborn immediately.
2. Wrap him with warn sheets
3. Put him under a droplight.
Immediate Assessment:
1. APGAR score
I min score =
cardiovascular and respiratory
status
5 min score = neurologic status
Criteria 0 1 2
A – ppearance Blue Acrocyanosis Pink

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(color)
P – ulse 0 < 100 100 and above
(Heart Rate)
G – rimace No response Grimace; weak cry Good, strong cry;
(Reflex Irritability) sneeze
A –ctivity Limp, flaccid Some flexion of Well-flexed
(Muscle Tone) extremities extremities
R- esp. Effort Absent Weak cry Good, strong cry
Score Interpretation:
0 - 3 Resuscitation ASAP!
4 - 6 guarded ® Continuous
monitoring & suctioning
7 -10 à Best possible condition
2. Gestational Age Assessment (BESTS)
Criteria 0.36 weeks 37-38 weeks 39 weeks & above

B – reast nodule 2 mm 4 mm 7 mm
E – ar lobe No cartilage Some cartilage Thick cartilage
S – calp hair Fine and fuzzy Fine and fuzzy Coarse and silky
T – Testes in lower sac; Intermediate; Testes pendulous;
estes/Scrotum scrotum with no scrotum with some scrotum with rugae
rugae rugae
S – ole creases Anterior transverse Creases over Entire sole covered
crease only anterior 2/3 with creases
3. Ballard's Scoring
A. Neuromuscular Maturity
- Posture
- Square window
- Arm recoil
- Popliteal angle
- Scarf sign
- Heel to ear
B. Physical
- Skin

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- Lanugo
- Plantar surface
- Breast
- Eye-ear
- Genitalia
4. Physical Examination
A. Vital signs
HR = 120 - 140/min (Apical) **Palpable radial
pulse => Coarctation of Aorta
RR = 30 - 60/min (diaphragmatic, abdominal,
quite irregular, rapid, quiet and shallow)
BP = 80/46 ® 1 00/50 mmHg after 10 days
Temp = must be maintained at 35.5°C - 36.5°C
(rectal route. preferred to check patency of
anus)
B. Anthropometric measurements
Length = 47.5 - 53.75 cm (Ave: 50 cm)
HC = 33-35 cm (measure center of forehead and
the prominence of occiput)
CC = 31-33 cm (measure at the level of nipples)
AC = 31-33 cm (measure at the level of
umbilicus)
Weight = 6.5-7.5 lbs (3.0-3.4 kg)
** 5.5 lbs (2.5 kg) = low birth weight
** 5-10% physiologic weight loss (6-10 oz)
during the 1 10 daysst
Reasons:
1. no maternal hormone influence
2. voids and passes stools
3. limited caloric intake due to
colostrum (1513 days)
C. Skin
- Normally ruddy because of increased RBC
concentration and decreased amount of
subcutaneous fats
- acrocyanosis mottling (normal in 24-48 hrs);

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HARLEQUIN SIGN
- generalized mottling (Cutis Marmorata) may be
seen
- desquamation (drying of skin)
Abnormal skin findings:

1. Pallor - excessive blood loss; inadequate blood
flow from cord; decrease iron stores; blood
incompatibility
2. Gray – infection
3. Jaundice (Use natural light and blanch skin on
the chest or tip or the nose
- Inability to conjugate bilirubin (decreased
GLUCORONY TRANSFERASE)
- Normal values:
Total Bilirubin 15.0 mg/dl
Direct Bilirubin 1.5 mg/dl
Indirect Bilirubin 13.5 mg/dl
** If value of total bilirubin = 10 to 12 mg/dl,
start treatment
** If value of total bilirubin is >20 mg/dl =
KERNICTERUS
- Physiologic jaundice: 2nd to 7'11 day
- Breastfed babies have longer physiologic
jaundice because human milk has
PREGNANEDIOL ® depresses glucoronyl
transferase, a liver enzyme
- Estimates of indirect bilirubin:
Up to neck 8 mg/dl
Up to umbilicus 5-12 mg/dl
Up to knees 8-16 mg/dl
Up to ankles 11-18 mg/dl
Up to soles 15-20 mg/d1
- Treatment of Pathologic Jaundice:

1. Phototherapy (photoisomerization of
indirect bilirubin)
- 10 pcs 20-watt daylight or blue
fluorescent lights at 30 inches

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above
- cover eyes and scrotum with an
opaque mask
- monitor temperature
- adequate hydration
- turn q 2H to expose all body areas
- measure I & Q
2. Exchange transfusion
Common skin marks of the newborn:

1. Desquamation - peeling of skin; indicates
post-maturity
2. Mongolian spots - bluish-black/slate gray
pigmentation across the sacrum or buttocks;
disappear by SCHOOL AGE.
3. Vernix caseosa - cheese-like material; serves
as insulator
4. Lanugo - fine, downy hair at shoulders, back
and upper arms; disappear by 2 weeks.
5. Milia - plugged or unopened sebaceous gland
on the cheek or across the bridge of the nose;
disappear by 2-4 weeks
6. Nevi (Stork bites) - pink or red flat areas of
capillary dilatation seen on upper lids, nose,
upper lip, nape and neck; disappears at 1 st
and 2 year.
nd
7. Erythema toxicum - aka fleabite.rash; pink

papules with vesicles seen at nape, back and
buttocks; appears usually 2nd day; no
treatment needed.
8. Nevus flammeus - aka portwine stain; red to
purple in color; do not blanch on pressure
and do not disappear.
9. Strawberry hemangioma - elevated areas
formed by immature capillaries and
endothelial cells; complete disappearance by
10 yrs old.
10. Cavernous hemangiomas - dilated vascular
spaces; do not disappear with time.

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11. Forceps marks - disappears in 1-2 days.
D. H ead - forehead prominent; chin receding

1. Fontanelles - should be flat; not indented or
bulging
Anterior (diamond-shaped) closes 12-18
months
Posterior (triangular shaped) closes 2-3
months.
2. Molding - some overlapping of sutures
3. Craniotabes - localized softening of the
cranial bones caused by pressure of fetal
skull against the mother's pelvic bone; more
common in firstborn infants
If found in older child ® faulty metabolism
or kidney dysfunction
4. Craniosynostosis - premature closure of
sutures and fontanelles ® MENTAL
RETARDATION.
5. Caput succedaneum vs. Cephalhematoma
Criteria Caput succedaneum Cephalhematoma

Cause Scalp edema Collection of blood between
periosteum and skull bone
Extent of Both hemispheres (Crosses
Does not cross sutures
Involvement sutures)
Absorption About 3 days Several weeks
E. Eyes (Assess by putting infant in upright

position)
- tearless due to immature lacrimal ducts
- cornea is round
- pupil is dark
- temporary cross-eyed (STRABISMUS)
F. Ears
- The level of top part of the external ear should
bean a line drawn from the inner canthus to
the outer canthus of the eye
- Low-set ears is found in kidney malfunction;
Down's syndrome

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G. Nose
- appear large for the face; no septal deviation
- obligate nasal breathers
H. Mouth
- should open evenly when crying
- tongue appears large
- palate intact; lips should have no breaks
- EPSTEIN PEARLS: small, round glistening
cysts on the palate (due to hypercalcemia of
the mother)
- NATAL TEETH- teeth upon birth if loose,
should be extracted; Neonatal teeth are teeth
erupted BEFORE age 56 months
- Oral thrush: white or gray patches on the
tongue or cheeks due to Candida albicans
(oral moniliasis)
I. Neck
- short and chubby; creased with folds
- thymus is palpable (triples at 3 yrs; stops
growth and recedes by 10 years old)
- head should rotate freely
J. Chest
- should be symmetrical
- breasts may be engorged
- WITCH'S MILK: due to maternal hormones
- You may hear rhonchi
K. Abdomen
- slightly protuberant; dome-shaped
- if scaphoid ® diaphragmatic hernia
- liver, spleen and kidneys are palpable
- umbilical cord - 2 arteries and 1 vein (stump
falls off 6-1 0 days)
L. Anogenital region
- Pseudemenstruation-= this is thought to be
due to the influence of the maternal
hormones
- epispadia, hypospadia, hydrocele

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- oreskin should be retracted to test for
phimosis and paraphimosis
- testes should be descended (If not,
Cryptorchidism should be suspected)
- "wink reflex" sign of anal patency
M. Back
- appears flat when prone
- mass, hairy nebule or a dimple along axis –
this is seen in Spina bifida
N. Extremities
- arms and legs are short and plump
- should move symmetrically ® ERB
DUCHENNE'S PARALYSIS
(Absent Mora reflex on affected arm)
Tx: Abduct the affected arm in external
rotation with the elbow
flexed
- extra digits (polydactyly); fused (syndactyly)
- Simian line: a single palmar crease ® Down’s
syndrome
- Ortolani’s sign: congenital hip discoloration
Mgt: 3 diapers; carry astride on hips; hip
spica
Systemic Evaluation
1. Cardiovascular System
Fetal accessory structures
Fetal accessory
Functional Closure Adult structure
structures
Foramen ovale 1 year Fossa ovalis
Ductus arteriosus 1 month Ligamentum arteriosum
Ductus venosus 2 months Ligamentum venosum
Umbilical arteries (2) 2-3 months Lateral umbilical ligament
Ligamentum teres
Umbilical vein (1) 2-3 months
(round
ligament of liver)

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Blood values:
RBC = 6 M
Hgb = 17-18 gm %
Bct = 40-50%
WBC = 15,000 - 45,000/cu mm
2. GI System
Stools:
A. Meconium - sticky, tarlike, blackish-green,
odorless
- mucus, vernix, lanugo, hormones and
carbohydrates that accumulated during
intrauterine life.
B. Transitional stools - 2nd to 3rd day up to 10th
day
- slimy green and loose resembling diarrhea to
the untrained eye
C. Usual stools (10 day onwards) th
Criteria Breastfed Infant Bottlefed Infant

Color Golden yellow Pale yellow
Consistency Mushy, soft Finn
Frequency of
3-4x/day 2-3x/day
passage
Smell Sweet-smelling Malodorous
(increased lactic acid
which decreases
putrefactive organism
in
stool)
3. Urinary System
- about 15 ml of urine per void
- females: form a strong stream when voiding
- males: small projected stream when voiding
- should void within 24 hours.
4. Autoimmune System
- difficulty forming antibodies against invading
antigens up to 2 months
- receives IgG from mother (passive natural
immunity)

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- no immunity from chickenpox and herpes simplex
5. Senses
- Touch – the most developed sense
6. Neuromuscular System
Neonatal Reflexes
Reflexes Disappearance
Rooting reflex 6 weeks
Sucking Reflex 6 months
Extrusion Reflex 4 months
Palmar grasp 6 weeks-3 months
Stepping (Walk-in-place/Dancing) Reflex 3 months
Placing (**anterior surface of leg) 3 months
Plantar, grasp 8-9 months
Tonic neck (Fencing/Boxer) Reflex 2-3 months
Moro reflex 4-5 months
Barbinski Reflex 3 months
Magnet Reflex 3 months
Crossed Extension Reflex 3 months
Trunk Incurvation Reflex 2-3 months
Landau Reflex (Parachute Reaction) 3 months
Bauer's (Crawling) Reflex 6 weeks
Blink Reflex (see objects 9-12" at midline) Do not disappear
Swallowing Reflex Do not disappear


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Routine Care of the Newborn:
1. Give initial oil bath to cleanse the 'baby of blood,
mucus and vernix.
2. Dress umbilical cord (70% alcohol or PNSS)
3. Crede's prophylaxis - against Ophthalmia
neonatorum/gonorrheal conjunctivitis
a. 2 gtts 1 % AgN03 on lower conjunctival sac; flush
with NSS
** Disadvantages:
1. chemical conjunctivitis
2. stain cheeks
3. no effect against Chlamydia
b. Erythromycin/Terramycin ointment
** inner to outer canthus; on lower conjunctival
sac
4. Vitamin KI (Phytomenadione) administration ®
inject at vastus lateralis, middle third
** Clotting factors 2, 7, 9, 10
1.0 mg ® full term infants
0.5 mg ® pretern1 infants
5. Identification
** Bands; footprints
6. Feeding
NSVD = within 30 mins
C/S = within 3-4 hours
Initial feeding - with sterile water only; glucose is
irritating to the lungs if aspirated (1 oz)
Subsequent feeding - per demand
RDA Calories 120 cal/kg BW or 50-55 cal/lb
or 380 cal/day

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Protein 2.2 grams/kg BW /day
Fluids 200z/day
Burp the baby 2X - middle and after feeding
Comparison of Human Milk and Cow's Milk:
Composition Human Milk Cow’s Milk
Calories 20 cal/oz 20 cal/oz
CEO High (Lactose) Low
CHON Low (Lactalbumin/Whey) High (Casein)
COOH Same (Linoleic Acid) Sam e
Minerals Low High
Iron Low Low
Table 6.1 COMPOSITION OF MATURE HUMAN MILK AND COW MILK

Composition Human Milk Cow Milk Composition Human Milk Cow Milk
Water (ml/dl) 87.1 87.2 Serine 69 160
Energy (kcal/dl) 75 66 Tyrosine 61 17S
Total solids (g/d!) 12.9 12.8 Major minerals per liter
Protein (g/dl) 1.1 3.5 Calcium (mg) 340 1170
Fat (g/dl) 4.5 3.7 Phosphorus (mg) 140 920
Lactose (g/dl) 6.8 4.9 Sodium (mEq) 7 22
Ash (g/dl) 0.2 0.7 Potassium (mEn) 13 35
Protein (% of total
Chloride (mEq) 11 29
protein)
Casein 40 82 Magnesium (mg) 40 120
Whey proteins 60 13 Sulfur (mg) 140 303
Nonprotein nitrogen
32 32 Trace minerals per liter
(mg/dl)
% Of total nitrogen) 15 6 Chromium (ug) --- 8-13
Amino acids (mg/dl) Manganese (ug) 7-15 20-40
Essential Copper (ug) .400 30

Histidine 22 95 Zinc (mg) 3-5 3-5
Isolellcine 68 228 Iodine (ug) 30 47
Leucine 100 350 Selenium (ug) 13-50 5-50
Lysine 73 277 Iron (mg) 0.5 0.5
Methionine 25 88 Vitamins per liter
Phenylalanine 48 172 Vitamin 1 (I.V.) 1898 1025
Threonine 50 164 Thiamine (ug) 160 440
Tryptophan 1.8 49 Riboflavin (ug) 360 1750
Valine 70 245 Niacin (ug) 1470 940
Nonessential Pyridoxine (ug) 100 640
Arginine 45 129 Pantothenate (mg) 1.84 3.46
Alanine 35 75 Folacin (ug) 52 55
Aspartic acid 116 166 BI2 (ug) 0.3 4
43
Cystine 22 32 Vitamin C (mg) 11
Glutamic acid 230 680 Vitamin D (LV.) 22 14

Glycine 0 11 Vitamin E (mg) 1.8 0.4
Proline 80 250 Vitamin K (ug) - 15 60
7. Bathing

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- done anytime but not within 30 minutes after
feeding
- sponge baths done until cord falls off
Common Health Problems Needs:

1. Constipation - more common among
bottle-fed infants.
** Mgt:
- add more fluids or carbohydrates/sugar
- if anal sphincter is tight, dilate 2-3X daily
with gloved little finger
2. Loose stools - management depends on
cause
3. Colic
Causes:
- overfeeding
- gas distention
- too much carbohydrates
- tense and unsure mother
Mgt:
- feed by self-demand
- burp the baby twice during a feeding
- feed in upright position
- change milk formula if needed
- reduce sugar content
4. Spitting up - due to poorly developed
sphincter
Mgt:
- feed in upright position
- position on right side after feeding
- burp more frequently
5. Skin irritation - may be due to poor hygiene, or
irritation from urine, feces or laundry products
Mgt:
- expose to air
- careful washing and rinsing of skin
- starch bath (for Miliaria or prickly-heat rash)
6. Seborrheic dermatitis/cradle cap - involves
sebaceous glands; due to poor hygiene

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Mgt:
- apply mineral oil or Vaseline on the scalp at night
- giving shampoo bath in the morning
7. Clothing
- If mother feels warm, keep the baby cool.
- If the mother feels cold, keep the baby warm.
8. Sleep patterns
- need 16-20 hours of sleep a day
PREMATURE NEWBORN
- Born before the 37 week of gestation
th
SGA < 1Oth percentile

AGA 10-90 percentile th
LGA > 90 percentile

th
- Characteristics:
1. Underdeveloped SC tissues; thin-skinned
Mgt: Incubator
Temp 33.3 - 34.4°C
Humidity 55-65%
Position on right side
2. Poikilothemlic
Take axillary’s temperature not rectal to
decrease energy expenditure
3. Exaggerated weight loss
4. Frog-like position
5. CNS centers for respiration underdeveloped
02 inhalation (Never more than 40% ®
Retrolental fibroplasia)
6. Poor sucking mechanism for feeding
Feeding ® OGT; determine residual milk
Special Problems:
1. Hyperbilirubinemia
2. Infection
3. Anemia (Iron stores given to baby during last 2
weeks of pregnancy)
4. Respiratory Distress Syndrome (Hyaline
Membrane Disease) - lack of pulmonary
surfactants

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POSTMA TURE NEWBORN
- Born after the 42nd week of gestation
- Characteristics:
1. "Old man's" facies
2. Weight loss
3. Dehydrated
4. Chronic Hypoxia
5. Hypoglycemia
6. Long and thin
7. With cracked skin
8. Stained with meconium
9. Long nails; firm skull
10. Wide-eyed alertness
INFANCY
- Traditionally designated as the period 0 - 1 year of

age.
- FIRST "period of rapid growth and development"
Growth and Development of the Infant
PHYSICAL GROWTH
A. Weight
- a simple reproducible growth parameter which

Page 22 of 75
serves as index of acute nutritional depletion.
- birth weight doubles at 4-6 months of age
- birth weight triples at 12 months
- Quadruples at 2 ½ years
- Weight gain is approximately 1 lb/month or 6-8
oz/week for the 1 6 mos; slightly less for the next
st
6 mos.
- average weight:
male - 10 kg (22 lbs)
female - 9.5 kg (lbs)
- Formula:
BIRTH WEIGHT x Age in months + 600 grams= for
the first 6 months
BIRTH WEIGHT X Age in months + 500 grams= for
the 7 to 12 months
B. Height
- A reliable criterion for growth since this is not
affected by excess fat or fluid.
- reflects growth failure and chronic under nutrition
- 50% increase of the birth length during the 1 year st
- average height: 30 inches (76.2 cm) at 1 year old

- growth is apparently in the trunk during the early
months; lengthening of the legs happens during
the 2nd half of the 1 year st
- Should be taken with the child lying supine or

standing erect against measuring board.
- Summary of height pattern:
0-3 mos 9 cm
3-6 mos 8 cm
6-9 mos 5 cm
9-12 mos 3 cm
25cm
C. Head Circumference
- a reflection of rapid brain growth
- at the end of 1 st year, brain has already reached
2/3 of adult size
- head may have some asymmetry due to
"persistent position" for sleep

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- Pattern of growth:
1st 4 mos ½ inch per month
Next 8 mos ¼ inch per month
D. Body Proportion
- Mandible (lower jaw) becomes more prominent
- Head circumference becomes equal to chest
circumference @ 6 mos
- Abdomen still protuberant .
- Start of development of vertebral curves (cervical,
thoracic, lumbar) - there is lengthening of lower
extremities during the last 6 mos which Readies the
child for walking
E. Body Systems
1. Cardiovascular System
- HR = 100-120 beats per minute
- BP = 80 - 100 mmHg
40 – 60
- physiologic anemia occurs because:
a. fetal RBC's life span is through and new
replacement is not adequate yet
b. serum iron levels decrease since iron
stores established in utero are already used
up
c. fetal hemoglobin is converted to adult
hemoglobin (5-6 mos)
2. Respiratory System
- RR = 20-30 cycles per minute
- tubal cavity of the resp. tract is still small and
mucous production still inefficient
- thoracic index (transverse: anteroposterior
diameter) = 1.25
3. GI System
- digestion of CHON is adequate
- low amylase (until 3rd month)
- low lipase (until 12th month)
- liver function is immature:
a. decreased conjugation of drugs
b. decreased storage of CHO, CHON and
vitamins

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- swallowing coordination is not developed until
about 6 months
- extrusion reflex disappears at 3-4 months
- drinking from cup rather from the breast or bottle
@ 8-10 mos
4. Immune System
- functional @ 2 mos
- produce IgG and IgM by 12 mos
- IgA, IgD, IgE are not plentiful even until preschool
period
5. Temperature Regulation
- shivering is possible by 6 mos (increases muscle
activity and warmth)
- there is development of additional adipose tissues
which serve as insulators
- brown fat decreases in amount
6. Other Systems
- Kidneys remain immature and not as efficient in
eliminating body wastes.
- Endocrine system remains immature ~ not able
to react to STRESS efficiently.
7. Fluid Balance
COMPARTMENTS INFANT ADULT

Intracellular 40% 40%
Extracellular 35% 20%
• The higher the EC, the more prone to dehydration
should illnesses like diarrhea occur.
8. Dentition
-1st tooth erupts @ 6 mos (LOWER CENTRAL
INCISORS)
- Slightly earlier in girls that in boys
- RULE: No. of teeth = (age in months) - 6
- Some newborns may be born with teeth (called
NATAL TEETH) or have teeth erupt in the 1 1st 4
weeks of life ( called NEONATAL TEETH) which
occurs in 1 :2000 infants.
- if tooth is fixed firmly, it might as well not be
removed; if loose, it mustbe removed to prevent

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aspiration.
DEVELOPMENTAL MILESTONES
(Motor Development, Socialization, Language,
Play)
Motor development progress systematically

during the 1st year that reflects the principles of
cephalocaudal development and gross to fine motor
development. Control proceeds from head to trunk to
lower extremities in progressive, predictable
sequence. The Denver developmental screening test
is the best known and most widely used screening
test that focuses on four important developmental
areas: PERSONAL-SOCIAL, FINE MOTOR ADAPTIVE,
LANGUAGE AND GROSS MOTOR. The DDST is used
up to age 6 years
Two (2) Major Areas of Motor Development
Assessment:
A. GROSS MOTOR
- Ability to accomplish large body movements
- Infant is observed in four (4) positions: ventral
suspension, supine. prone, and sitting.
B. FINE MOTOR
- Measured by observing or testing prehensile
ability (ability to coordinate hand movements)
In addition to gross and fine motor skills that are
developing at this time, language, socialization
and play behaviors also mark the major
milestones during this age group.
PROMOTING SENSORY STIMULATION

VISION - Teach parents to make eye-to-eye contact
with the infant to stimulate vision and to
promote socialization.
- Infants enjoy mobiles and crib
mirror
- Photos of family members may be
posted near the baby's crib.
HEARING - Infant's toys should have soft,

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musical or cooing sounds.
- An audiotape of family voices might be
soothing
Reminder of their presence when
they are not around.
TOUCH - Clothes should feel comfortable
and diaper should always be dry.
- Teach parents to handle the infant
with assurance and with gentleness.
- Kangaroo hold" promotes close
physical contact.
TASTE - Infants turn away or spit out a

taste they do not enjoy.
- Urge parents to make a mealtime for
fostering trust as well as supplying
nutrition.
- Feedings should be at the infant's
pace and the amount should fit the
child's needs and not the parent's
idea how much should be eaten.
- Solid foods may be introduced at 4-6
mos in the following sequence:
cereals, fruits, vegetables, meats, the
eggs.
- New foods should be introduced one
at a time so that the child can
become accustomed to one new
taste before another is tried.
- This also lets parents detect adverse
reactions, such as allergy to a new
food.
SMELL - infants smell accurately within 1-

2 hours after birth.
- Infants draws back from irritating
smell and enjoys pleasant
odors like that of the breast milk .
- teach parents to be alert to substances

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that cause sneezing when sprayed
into the air, such as room
deodorizers or cleaning compounds,
and to keep irritating odors from the
child’s environment.
INFANT’S DAILY ACTIVITIES
A. BATHING
- An infant does not need a daily bath except in
very hot weather.
- Bath serves many functions:
a. to promote cleanliness.
b. to provide opportunity for the baby to
exercise and kick.
c. to give parents time to talk, touch and
communicate with the
baby.
d. to give the baby the opportunity to learn
different textures and
sensations.
B. DIAPER – AREA CARE
- Good diaper-area hygiene means not to allow an
infant to wear soiled diapers for a lengthy time.
- Diapers should be changed frequently.
- Skin should be washed thoroughly with water
and mild soap.
- Petroleum jelly or A&D ointment may be used as
prophylaxis.
C. CARE OF THE TEETH

- Fluoride is important in proper tooth development
and prevention of tooth decay. Water level should
have 1 ppm Fluoride to protect the tooth enamel.
- Teach parents to begin "brushing" even before
teeth erupt by rubbing apiece of gauze over the gum
pads.
- Toothpaste is not necessary.
D. DRESSING

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- Clothes should be easy to launder and simply
constructed
- Type of clothing should suit infant’s activity level
E. SLEEP
- Infants need 10-12 hours of sleep a night and one
or several naps during the day.
- Caution parents not to place pillows to avoid
possibility of suffocation.
F. EXERCISE
- The infant benefits from outings in a carriage or
stroller, as sunlight provides a natural source of
vitamin D.
- Early mornings and late afternoons are the best
times for the infant to be outside.
- Use of infant walkers must be closely supervised.
PARENTAL CONCERNS AND PROBLEMS RELATED

TO INFANCY
1. Teething
2. Thumb sucking
3. Use of Pacifiers
4. Head Banging
5. Sleep Problems
6. Constipation
7. Loose Stools
8. Colic
9. Spitting up
10. Diaper Dermatitis
11. Miliaria
12. Seborrhea
13. Baby-Bottle Syndrome
TODDLER

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- Considered as the age from age 1 or 1 ½ years – 3
years, a period in which enormous changes take place
in the child and in the family as well
- The largely immobile and preverbal child now
becomes a walking, talking child with a sense of
independence
PHYSICAL GROWTH
Physical growth actually begins to slow through
the toddler makes great developmentally.
A. Weight
- Gains only about 5-6 Ibs.(2.5 kg)
- Decreased weight gain due to increased activity
B. Height
- Gains on 5 inches (12 cm) a year during toddler
period
- Subcutaneous fat ("baby fat") begins to
disappear
- Estimate adult height: multiplying by 2 at 2 years
C. Head
- HC = CC at 6 months to 1 year
- CC > HC at 2 years
- Head circumference increases only 7 about 2 cm
during the 2nd year compared to about 12 cm
during the 1st year
- Anterior fontanel (bregma) closes at 12 -18
months
D. Body Contour
- Prominent abdomen (LORDOSIS)
- With wide-stanced gait
E. Body System
E.1 Respiratory System
- Respiration slows slightly but remains to be
abdominal
- The lumen of the tract increase progressively
so that the threat of
Lower respiratory infection is less
E.2 Cardiovascular System
- HR slow from 110 to 90 beats/min
- BP increase to about 99/64 mmHg

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E.3 Nervous System
- brain develops to about 90% of adult size
- complete myelination of spinal cord cause
urinary and anal sphincter control
E.4 GI System
- stomach capacity increases to the point that
the child can eat 3 meals a day
- stomach secretions become more acid ~ GI
infections are less common
E.5 Immune System
- IgG and IgM antibody production becomes
mature @ 2 yrs of age
- the passive immunity effects from intrauterine
life are no longer operative
E.6 Dentition
- 8 new teeth (the canines and the first molars)
erupt during the 2nd year
- All 20 deciduous teeth are generally present
by 2 y;, to 3 years of age
Special Needs of the Toddler

A. Sense of Autonomy
- Favorite word: “NO”
- Child learns to be independent
- Understanding love of the child is shown by:
a. giving him all the freedom he can safety use
b. giving him all the love and help he needs to
keep him safe in an environment beyond his
control
c. giving in which he feels himself to be focal
point
B. Graded Independence/Negativism
- gives the child opportunity to make choices
- Independence may be denied for possible
painful experience which may hinder a child to try
new skills because of fear these needs are met
by:
a. Regulating the toddler’s activities which is an
important part of his training is a challenge to the

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adult
b. Providing safe environment for a gradually
expanding area of growth
c. Avoiding use of pain and ridicule as a means
of punishment or of prevention of for bidden
activities
d. Allowing the child to have certain amount of
defiance, which is normal
C. Love and Security
- Love enables the toddler to grow up and reach
out for more mature goals because he feels
secure
- Love for the mother decreases; attachment to a
loving father increases.
- “Security object” (e.g diaper, blanket, toy, etc.)
Specific Areas for Guidance

A. Toilet Training
- The child must begin accepting the “reality
principle” (giving up an immediate pleasure in
order to gain another pleasure later.)
- Toddler must give up the pleasure of excreting
where and when he wishes in order to gain his
mother‘s approval.
Requisites for Toilet Training
1. Physiology readiness
1.1 Sphincter control – myelination of nerve tract
occurs at around 15 – 18 months of age (MOST
IMPORTANT REQUIREMENT)
1.2 Recognizes the urge and with ability to stand and
walk to the bathroom and manage clothing
2. Psychological readiness
2.1 Understands the act of elimination
2.2 Ability to verbally communicate need to defecate
or urinate
2.3 Mother or caretaker must be able to recognize
verbal behavior
3. Desire to please the mother
Schedule/Timing of Training

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15 – 18 moths start of training
18 mos – 24 mos bowel control
2 –3 years daytime bladder control
3 – 4 years nighttime bladder control
Principles of Toilet of Training

1. Bowel training should be started before bladder
training. Bladder training is done 1 or more
months after fairly well established bowel
training.
2. Training should not be accomplished during
illness.
3. Consistency – observe usual time for defecation
4. Firm but not strict training should be done (<10
minutes).
5. Positive maternal attitude – when successful, the
child should be praised and cuddled; if not, she
should not show any disapproval.
6. Child should feel secure when seated on the chair
or toilet bowl. NEVER FLUSH TOILET WHILE
CHILD IS SITTING ON IT!
7. Child should not be given food or toys during
training as it distracts him.
B. Delayed Speech
- A normal child will begin to speak by 15 months of
age.
- If by 2 years, he is not able to speak, cause of the
delay must be investigated.
D. Ritualistic Behavior
-Common between ages of 2-4 years
- Done to master skills
Intervention
1. Adults should recognize these rituals in such
phases as:
a. Bathing – use of a face towel
b. Eating – use of bib, own utensils

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c. Sleeping – taking a favorite toy a blanket to bed
with him
2. Show other ways of doing things.
E. Temper Tantrums
- Occur when a child cannot integrate his interval
impulses and the demands of reality
- He is frustrated and reacts in the only way he knows
by violent body activity and crying
Causes
1. In the hospital – fear of the unknown
2. Adult refuses to grant a request
3. When the child is tired, before bedtime or naptime
or during a tiring trip or visit.
4. When mother says, “No!” too frequently with
regards to getting dirty, using a spoon, running, etc.
5. As a response to difficulty in making choices or
decisions
6. When the child is under pressure such as toilet
training
Interventions
1. Remove him from immediate cause of tantrum with
the adult whom he knows loves him.
2. Be calm and be patient. Do not force attention upon
him, until he indicates he is ready for the comfort of
knowing he is loved.
3. He should not be given extra attention but should
be observed from self-injury or anything in the
environment which may be a source of injury to him
4. Avoid restraining the child
Care after a Tantrum

1. Make few comments of his behavior
2. He should not be punished
3. Wash face and hands if he cooperates
4. Give a toy to divert attention

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Prevention of Tantrums
1. The mother should try to show him better ways of
solving his problems and provide more socially
acceptable outlet for his anger and frustration.
2. He should be helped to release his tension in a
socially approved way such as physical exercise
going outdoors, gardening etc.
F. Dawdling
- Slowness in carrying out request the child gradually
learning the differences between right and wrong. He
cannot decide which of the two actions to take.
- Occurs when:
a. The task being is too difficult will end
failure
b. He tries to avoid a task he knows will end
in failure
- Handle this problem by giving specific
instructions. When the child learns through
experiences which action he should take, he will
be able to make decisions more wisely are quickly
Basic Needs of the Toddler

A. Bathing
- Time depends on the mother and the child’s wishes
- May be given before and evening meal, at bedtime
because
it relaxes child and helps him to sleep.
- Toddlers enjoy bath time so that mother must
proved to during the bath
B. Clothing
- Toddlers need clothing that can be changed quickly
because they can’t stand still for long
- Criteria for clothing:
1. Light or bright in color
2. Large and easily managed buttons and snaps
placed within easy reach of the child
3. Warm but not too bulky

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4. Easy to put on and remove
5. Shoes should be wide enough and long
enough, have pliable thicker soles, conform
to the shape of the foot, straight along
C. Vocabulary building
NOUNS ® VERBS ® ADJECTIVES ® ADVERBS ®
PRONOUNS
D. Discipline
- GOAL: Establish Self-control
Principles
1. Immediately after a wrongdoing
2. Consistency and firmness
3. Disapproval of the behavior and NOT of the child
4. Positive Approach
5. Allow child to explain; explain the reason for your
disciplining him.
6. Safety in disciplining
7. Provide physical care after so that DOUBT will be
erased.
8. Withdraw privileges and NOT BASIC NEEDS (i.e. not
sending child to sleep without dinner).
Forms of Discipline
1. Ignoring (BEST FOR TEMPER TANTRUM)
2. Redirecting child’s attention
3. Time-out
4. Corporal punishment (controversial)
5. Explaining and reasoning, reprimanding and loss of
privileges for older children
Effects of good discipline (3S)

1. Security
2. Self-control
3. Socially appropriate behavior
E. Dental Care
- Brush and floss daily (with parent’s help) – twice

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daily
- Proper oral hygiene and adequate diet are essential
for tooth decay prevention
- 21/3 – 3 years as soon as all the deciduous teeth are
out, he can have his
FIRST DENTAL VISIT
- If water is not fluoridated, give supplements: 0.25 to
0.5 day
- Limit concentrated sweets.
- Do not allow the child to carry a bottle of milk or
juice to bed
-3 years: instruct to brush teeth after eating and at
bedtime
F. Sleep and Exercise

- Depends on age, health, emotional tension, and
activity during the day
- 12 – 14 hrs at night and 1-2 hrs of daytime/afternoon
nap.
-Usually outgrows bedtime rituals by 3 years old
G. Play
- The toddler‘s “work”; REMEMBER that language of the child is PLAY
- PARALLEL PLAY
- Games: like throwing and retrieving games; selfish,
possessive of toys
(Lack of interest in toys: DANGER SIGN)
Purpose of Play
1. Physical development
2. Social development
3. Therapeutic value
4. Educational
5. Moral values formation
Characteristics of Play of toddler

1. Free, spontaneous, active, no rules
2. Constructive

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Selection of Play Materials
1. Based on likes/dislikes
2. No sharp edges
3. No small removable parts
4. No beads, marbles, coins
5. No flammable toys painted with lead (“BRAIN
DAMAGE”)
Toys
- pull and pull toys
- cars and trucks
- balls
- building blocks
- stuff toys and dolls (security objects)
- play telephone (this is the stage of language
training)
- play hammer, drums, pots and pans (an outlet of
aggressive behavior)
- wood simple puzzles
- large crayons (can draw a circle at 3 years)
H. Nutrition
- Caloric requirements: 1,300 calories per day;
100 cal/kg/day
- "Physiologic anorexia"
Eating behavior of a toddler

1. The child may develop food preference.
2. He may even refuse food for a short time.
3. He may be demanding in what he wants to eat and
dishes he uses and the way food is served.
4. He is slow and clumsy but he enjoys feeding
himself.
5. He may wander away from the table
Development of Eating Skills

12 - 15 months drinks from a cup which he
himself holds
15 - 18 months holds his own spoon with much
spilling

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24 months feeds himself fairly well
Specific Suggestions for Feeding

1. At 11/2 to 2 years, child can eat table food and 3
meals a day. 2. Serve food in small portions.
3. Chop or cut the food in small pieces.
4. The diet each day should be well balanced. (About
16 oz of
milk should be given daily).
5. Satisfy the child's appetite with nutritious foods.
6. A void sweets.
7. Give vitamins.
8. Do not force him to eat.
9. Allow the child to join others at the table.
10. Recognize ritualistic behavior.
11. Do not use food as reward (may cause obesity)
PRESCHOOL
- Traditionally defined to include 3-6 years of age.
- Physical growth slows considerably during the
period but personality and cognitive growth are
substantial.
PHYSICAL GROWTH
- There is definite change in the body contour during
the preschool years.
- The wide-legged gait, prominent lordosis, and
protuberant abdomen of the toddler change into a
slimmer, taller and much more childlike proportions
- Major step found is the child's ability to learn
extended language, which is affected not only by
motor but by cognitive development
A. Weight
- gains 4.5 lbs. per year
- slow growth rate
- appetite remains as it was during the toddler years

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B. Height
- only minimal gain is noticed about 2-3.5" (6-8 cm) a
year on the average
C. Head Circumference
- not routinely measured over 2 years of age
D. Body Systems
D.I Nervous System
- Handedness is beginning to be obvious
- There is relative ease in learning language
because of the increased cognitive ability.
D.2 Lymphatic System
- Lymphatic tissue begins to grow (ex: tonsils).
- IgG and IgA increase.
- Illness becomes more localized (an upper
respiratory infection remains
localized in the nose without systemic fever).
D.3 Cardiovascular System
- "Physiologic splitting" or innocent murmurs
may be heard on auscultation (due to changing
size of the heart in reference to the thorax).
- PR decreases to about 85 bpm.
- BP = 100/60 mmHg
D.4 Urinary System
- Bladder remains to be palpable above the
symphysis pubis
- Voiding becomes frequent (9-10x a day)
D.5 Muscular System
- Muscles are noticeably stronger
- Many children exhibit "genu valgus" (knock-
knees) which disappears with skeletal growth
DEVELOPMENTAL MILESTONE
.PERSONAL-SOCIAL-
AGE MOTOR LANGUAGE
ADAPTIVE
Stands on one foot for

3 years Repeats six syllables, Understands taking turns.
at
for instance: "'1 have
least one second.
a little dog”
Copies a circle (from model,
Jumps from bottom
without demonstration).
stair.

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Names three to more
Alternates feet going objects in a picture. Builds three-block pyramid.
upstairs.
Gives sex. ("Are you a Dresses with supervision.
Pours from a pitcher. boy or a girl?").
Puts 10 pellets into bottle in
30
Can undo two buttons. Gives full name. . seconds.
Pedals a tricycle. Repeats three digits Separates easily from mother.

(one of three trials).
Feeds self well.
Knows a few rhymes.
Plays interactive games,
such
Gives appropriate as "tag".
answer to: "What:
swims-flies-shoots-
boils-bites-melts"
Uses plurals.
Knows at least one color.
Can reply to questions in at least three

word sentences.
May have vocabulary of 750 to 1,000

words (3-31/2 years).
Repeats ten-word sentences without

errors.
4 years
Counts three objects, pointing correctly.

Stands on one foot
for at least five Copies cross (+) without
seconds (two of demonstration.
three trials
Repeats three to four digits (4-5 years). Imitates oblique cross (x)
Draws a man with four parts.

Hops at least twice
on one foot. Comprehends: "What do you do if:
you are hungry, sleepy, cold?"
Cooperates with other children in play.
Can walk heel-to-toe
for four or more Spontaneous sentences, four to five
steps (with heel one words long.
inch or less in
front of Likes to ask questions.
toe).
Dresses and undresses self (mostly
Understands prepositions, such as: on- without supervision). Brushes teeth,
under-behind, etc. ("Put the block on washes face
Can button coat or the table.").
dress; may lace
shoe Compares lines: “Which is longer?”
Can point to three out of four colors
(red, blue, green, yellow).
Speech is now an effective Folds paper two to three times.

communicative tool
Can select heavier from lighter

object.

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Knows age ("How old are you?"). Cares for self at toilet
Balances on one
foot for eight to ten
seconds.
Skips, using feet

5 years alternately. Copies a square. Copies oblique cross
(x) without demonstration
May be able to tie a Performs three tasks (with one

knot. command) for instance: “Put pen on
table-close door bring me the ball.” May print a few letters (5-5112 years).
Catches bounced
ball with Knows four colors.
hands (not arm) in
two of three trials. Draws a man with at least six
Define use for: Fork-horse-key-pencil, identifiable parts.
etc.
Builds a six-block pyramid from
Identifies by name: demonstrations
Nickel-dime-peny.
Transports things in a wagon
Ask many “why” questions. Plays with coloring set,

Constructions toys, puzzles.
Relatively few speech errors remain – Participates well group play
90% of made correctly
Counts by rote to 10
Comments on pictures (description and

interpretations).
G. Accident Prevention
- Accidents are the leading cause of deaths 1 - 5 years
of age.
- Poisoning is a leading cause of morbidity.
Falls
1. Use stair guards; crib rails always up
2. Windows and door always screened
3. Supervise at playgrounds
4. Keep clothes properly cared for and fitted 5.
Avoid slippery floors
Poisoning
1. Make sure you don't give medications as
"candies."
2. Keep medications out of reach.
Burns

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1. Cover electrical outlets.
2. Turn pot handles toward back of stove.
3. Do not leave unattended in bathtub, near
stoves. 4. Keep electrical wires out of reach.
5. Teach child what "hot" means.
6. Check Bath water temperature.
Drowning
1. Teach swimming pool and water safety.
2. Do not leave child unsupervised near water or
bathtub.
3. Have swimming pool fence and gates with
childproof locks.
Cuts and Stabs
1. Keep knives out of reach.
2. Teach safety with sharp objects. 3. Lock up
guns and powder tools.
4. Keep scissors away.
Common Fears of the Preschooler

A. Fear of the Dark
- Due to vivid imagination and undue stress.
- A stuffed toy by day becomes a monster in the dark.
Interventions:
1. Monitor possible stimuli for such fear (TV shows,
adult discussions, . frightening stories).
2. Burn a dim night-light.
3. Reassure the child he is
safe.
4. No sleep medications please!
B. Fear of Mutilation
- Child has intense reaction to injury.
- He cries not from the pain only but also from the
sight of the injury.
- A void threatening the child about mutilation in order
to discipline him.
- POSTPONE SURGICAL PROCEDURES UNLESS
EMERGENCY
C. Fear of Separation or Abandonment

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- Sense of time is distorted.
- Sense of distance is limited.
- Common causes: hospitalization and going to new
school
Behavioral Problems of the Preschooler
A. Telling Tall Tales

- Arises from the child's overactive imagination.
- Help the child separate fact from fiction.
B. Imaginary Friends
- Make sure that child has exposure to "real"
playmates.
C. Regression
- related to STRESS
- Ignore behavior and investigate the cause of stress.
D. Bruxism
- "Night grinding”.
- A way of "letting go" to release tensions and allows
falling asleep.
- Identify and relieve source of anxiety.
- If extensive, crown of
teeth becomes abraded
E. Broken Fluency
- "Secondary Stuttering"
- Repeated words/syllables
- 2 to 6 years of age may typically have some speech
difficulty.
- Correction should not be emotional
Principles:
1. Do not label the child as "stuttering."
2. Listen with patience what the child is saying.
3. Talk to the child in a calm, simple way.
4. Protect space for him to talk if there are other
children in the family.
5. Do not force the child to speak if he doesn’t want to.
6. Do not reward for fluent speech or punish him for
confluent speech.
Play for the Preschooler

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Importance:
1. The child learns to express feelings.
2. The child develops concern for his playmates.
3. By play, the adult gains a view into the child's
world.
Kinds of Play: (ASSOCIATIVE PLAY)

- From solitary and parallel play, it shifts to simple
forms of:
1. Cooperative play - when the child begins to
exchange ideas with other children and gradually
interact with them.
2. Loosely organized play - activity which
continuous but membership can changes
3. Social play - child plays with other children.
4. Organized play - emerges at latter part of the
preschool period.
Toys
1. IMAGINATIVE - imaginary friends are normal at
this stage
- provide "real" playmates
- provide costumes (Superheroes)
- "dress-up" games
2. CREATIVE - sand bags

- cutting and pasting tools
- water colors/coloring books
- play clay
- simple jigsaw puzzles
3. DRAMATIC/IMITATIVE - play house

- dolls puppets
- housekeeping toys
- "doctor or .nurse" sets
4. ACTIVE - wagons
- tricycle
- playground equipments

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- skates
Special Needs of the Preschooler

A. Development of Initiative
Principles:
1. His parents and other adults in his environment
must encourage his plans and the use of his
imagination.
2. They must limit punishment to only those acts,
which are dangerous, morally wrong or so socially
unacceptable that the result would be unfortunate or
harmful) the child or his family.
3. Parents should encourage the child's efforts to
cooperate and let him share in the decisions and
responsibilities of family living.
B. Security and
Independence
Principles:
1. The parents must show love for him, must teach
him and guide him toward maturity.
2. From verbal interaction with parents, he learns how
to express himself so that he can communicate with
others on verbal level.
3. In the home, he learns to assume more
responsibility and more independence.4. The child
gains from the parents the knowledge he needs to
grow up with. (e.g., knowledge on sex and
religion).
C.Guid
ance
Sugges
tions:
1. Limits to the child's behavior must be set and
consistently maintained.
2. Suggestions, not commands, must be done in a
positive manner.
3. The child is not spoken to in a such a way that he
feels guilty or fearful rather, he is reassured by the
sense that he is being helped by his parents in

Page 46 of 75
solving his problems.
4. A choice of action may be given him only when he
actually may decide which. of two or more lines of
behavior he may take.
5. Adults should not make the mistake of playing for
the child. He is helped to make his own activities.
6. He is allowed freely to create his own work.
D. Sex Information
General Principles:
1. Information on sex should be given in response to
the child's interest in the subject but never as facts,
which have no connection with the family life.
2. The source of information is sincere and loving
parents.
3. Parents should answer the child's questions
directly and honestly, basing on the amount of
information given and the phraseology used on the
child's physiologic and developmental level.
4. Information should be given promptly, frankly and
unemotionally.
5. Emphasis is placed on the physical aspect of sex,
not moral implications.
E. Religious Development
General Principles:
1. In answering questions, parents must have genuine
understanding, be subjective and kind.
2. Child cannot be kept spiritually neutral.
3. The child does not follow any religion because he
understands it rather; he accepts it because it is
expected of him to do.
Two (2) Methods of Religious Development:
1. Indoctrination
2. Letting the child follow the religion of his choice.
Early training in the faith by parents is suggested. The
discussion of religion can be a shared experience
between parents and the child.
The Preschooler and His Family

A. The Family Romance - OEDIPAL PERIOD

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- The little girl becomes possessive of her father and
competes with mother for father's love (Electra
Complex).
- The little boy may compete with father for mother's
love (Oedipal Complex). - The parent of the same sex
provides a model for the child to imitate as he
develops and matures.
- By the end of preschool, the boy no longer wants to
take his father's place but simply wants to belike the
father; the little girl wants to grow up like the mother.
- The child becomes friends with both parents and the
family becomes a meaningful love-object.
B. Tile Only Child and tile Adopted Child
- The only child is the object of parental relations in
the home.
- The adopted child may be like the only child.
- It is considered best to tell the adopted child the
truth before this status has any meaning to him.
C. Effect of tile Birth of a Sibling (Sibling Rivalry)
Reaction of the Child:
1. The child feels rejected and jealous. Jealousy is
shown:
1.1 directly - open dislike for the baby or may love
the baby more than normal; hostility; derogatory
remarks; hit the baby.
1.2 indirectly - may become clumsy in his contact
with infant.
2. The child becomes hostile to mother:
2.1 attacks the mother
2.2 ignore mother
2.3 Hostile to other adult (teacher, father)
2.4 regress
Ways of meeting the Problem:
1. The baby's coming should be discussed with the
child even though he is too young to understand
the changes.
2. The older child may be sent to nursery school to
develop outside contact. . 3. Child should never be
left alone with the baby.

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4. Give the child a pet doll and encourage her to
take care of the doll just like what mother does to the
baby.
5. Discuss with the child the difference of his needs
and the baby's.
6. The child may stay with father when mother must
take care of the baby.
Special Problems of the Preschooler
A. Thumb sucking
Causes:
1. May have had too little sucking pleasure
2. Maybe a sign that the child feels unloved.
3. It may be an expression of dissatisfaction in life.
4. When pressure is exerted upon him to give up an
activity
Approaches:
1. Parents must observe the child and provide a
happier childhood experience for him.
2. At the time the child sucks his thumb, the parents
should provide more love and security.
3. Find the basis of the basis of the problem.
B. Food Likes and Dislikes
Approach:
1. Preschoolers are influenced by example and
expectation of parents in eating.
2. Children should not be coaxed, bribed, or forced to
eat.
3. The child should be allowed sufficient time to eat --
distraction should be avoided. .
4. The child should be allowed to eat with the family.
5. Serve food attractively.
6. Mid-morning and afternoon snacks may be given
C. Enuresis (Bedwetting)
Causes:
1. Lack of toilet training
2. Too early, too severe or over training
3. Stress
4. Environmental factors (e.g. dark hallways)
Approaches:

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1. Adults should not make an issue of bedwetting. Do
not use bribes or punishments, or threaten the child.
2. Give less fluid at night.
3. Adult should help the child achieve a positive
attitude toward enuresis -- to want to stay dry and
develop confidence in his ability to control urination. .
4. Physician and parents should analyze the situation
to determine the cause.
D. Encopresis
- Uncontrolled stool passages beyond the time when
bowel control is expected
- Causes: rigid training, stress, emotional problems or
pathologic conditions
E. Selfishness
Approach:
1. Adults can help the preschooler to learn to share
with others if they let him have possession, which
both the adult and he recognize as his.
2. He can be allowed to decide whether to give or
refuse to give his toy to another.
3. Help the child to enjoy playing with other children.
4. Expose the child to group play since it encourages
habit of sharing.
E. Bad Language
Approach:
1. Adults should feel relaxed and not be worried or
shocked.
2. The child should not be punished.
3. Substitute the bad word with more difficult word.
4. In nursery school - the teacher may suggest other
words, use distraction or playing with others.
5. Less attention is paid to use of the word.
F. Destructiveness
Causes: Much of the child's accidental
destructiveness is the result of his boundless energy
and endless curiosity.
To avoid this:
1. The parents should remove valuable objects
the child might break or damage.

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. Provide space for their child to play without
2
danger of breaking and harming furniture of the
house.
3. Toys are apt to be given rough use. Parents
should realize that material possessions do not mean
as much to a child as to adults. In the course of play
the child may break or tear the toys using them in way
they were not intended - parents should put up certain
restriction in the use of toys - he will soon learn to
value his own possessions and those of others. What
he "values he will learn to use with care."
G. Hurting Others
Causes:
1. He may be jealous or frustrated.
2. His behavior results from his mental state.
Approach:
1. The child should not be punished by having the
same injury inflicted in him.
2. The child should not be forced to apologize to
the child whom he hurt.
3. The child must not be made to feel rejected by
the adult. The adult must take positive action in
situation in which the child is likely to hurt others.
4. The child should be helped to identify with the
group accepting them and being identified with them.
5. Play will serve an outlet of his feelings of
frustrations with the group.
He must be praised for his achievement in the
group.
H. Masturbation .
- Infants realize that a pleasant sensation
accompanies handling of his genitals but this has no
significance to him and not accompanied by fantasies.
- Male preschoolers always assure themselves that
the genitalia is not "lost."
- Adolescents masturbate to fulfill sexual urges, which
in our culture generally do not have socially approved
release in heterosexual intercourse outside marriage.
Approach:

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. The child should not be punished; he should be
1
helped to solve the problem that is causing it.
2. The child should be given ample opportunity to
find another more socially acceptable pleasure
outside his body.
3. He must be assured that he is safe in his
parent's affection and should not be afraid or
ashamed.
4. Parents should answer all questions about sex.
5. Poor handling of the problem in the child is
likely to result in fixation an autocratic level, wherein
the child seeks pleasure in himself rather in relation
with others.
Two important aspects of masturbation that must be
kept in mind:
1. Masturbation focuses a feeling in the genital region,
this feeling is necessary for the health functioning of
men and women.
2. Shame and threats related to this activity can force
children to repress their sexual feelings. This might
eventuate in impotence in the male and frigidity in the
female.
Physical
Care
Daily schedule of activities should be planned e.g.
active play-quiet play and rest. The child is gaining
competency in self-care: He learns to feed himself
without spilling, to dress and undress, brush his teeth
and is toilet trained. Mother should encourage him to
use his abilities so he'll be more independent.
Sle
ep
The child at this time should have a room or a
portion of a divided room of his own. Privacy in his
sleeping is needed not only for sleeping but for social,
sexual, gender identity, fantasy and individual
development. He needs a place to store his treasured
possessions.
Sleep of 3 years old is disturbed at night because

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of frightening dreams due to his real or imaginary
daytime fears. He may sleep beside the room of a
brother.
By 5 years he now may sleep quietly and
peacefully but may still have nightmares.
Safety Measures
Preschoolers have more freedom than the toddler
has. Playing outdoors alone, being away from a safe
home environment are some factors that may prone
the child to more accidents.
Causes of Accidents:
1. Increased initiative and the desire to initiate the
behavior of the adult which lead the children into
situations hazardous for them e.g. - falls.
2. They may play with matches.
3. They may turn on hot water
4. Increased freedom may result in playing around
motor vehicles or swimming.
Approach:
1. Parents and adults should emphasize safety
measures in terms they can understand. .
3. Teachers in the nursery school must provide a
safe environment for the preschoolers.
• A void walking alone on lonely streets.
• To learn to know the local police.
• To refuse gifts and automobile rides from
strangers.
• To give information about sex offenders.
• To know own complete name, address and
telephone number of home and or parent's
place of work.
Health Supervision
- Purposes of visits to the health clinic every 6 months
- 1 year:
1. Complete physical exam including tests for visual
perception.
2. Advise mother on safety factors.
3. Appropriate immunization.

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4. Dental care - teeth is brushed after eating and
auditory
Nutrition
- Calories: 1700 cal per day /90 Kcal per kg per day
- Approach:
1. Serve meal using dishes; provide comfortaf.1le
chair; and give small feedings.
2. Consider likes and dislikes.
3. Parents should be models - e.g. enjoy eating
during mealtime.
4. The child should not be forced to eat -- distraction
should be avoided.
5. The child should not be permitted to nibble
between meals.
Nursery School
Reasons why a child is sent to nursery school:
1. When he needs the educational experience to
supplement what he receives at home.
2. When he needs the socializing experience with
other children.
Values of Nursery School:
1. Provides growth and development and
improves general health of the child.
2. Increases capacity for independence, his self-
confidence and feeling of security
3. Broadens his appreciation of the avenues of
self-expression through art, music and rhythm.
Criteria for Selection of School:
1. qualification of teachers
2. proportion of teachers to children
3. health facilities
4. physical set-up
5. educational method
Preparation for Nursery School:

1. The mother should take him to the school to
become familiar with the physical surroundings. The

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child should meet his teacher.
2. After seeing the school, decision is made as to
whether the child should attend school. He makes a
decision.
3. On the first day the mother should stay with the
child and may continue until the child feels secure.
SCHOOL AGE
- Refers to children between the ages of 6 to 12 years.
- This is usually the first time that children are making
truly independent judgments.
- The child of school age is more influenced by the
attitudes of his friends.
PHYSICAL GROWTH
- School age children mature slowly but steadily.
A. Weight
- Annual average weight gain is approximately 3-5 lbs.
(1.3-2.2 kg).
- Major weight gains occur @ 10-12 yrs for boys and 9-
12 yrs for girls.
- Girls are usually heavier.
B. Height
- At 6 years, both boys and girls are about the same
height.
- Before puberty, children of both sexes have a
"growth between 10-12 yrs; and boys between 12-14
yrs.
- Girls may well be taller than boys.

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- Posture becomes erect.
C. Nervous System
- Brain growth is complete.
- Fine motor coordination becomes refined.
- Eye globe reaches its final shape at this time.
- The adult vision (20120) level is achieved.
D. Lymphatic System
- IgG and IgA reach adult levels.
- Lymphatic tissue continues to grow in size up until
about age 9; the resulting abundance of tonsillar and
adenoid tissue in the early school years is often
mistaken for disease during respiratory illness.
- This tissue growth may also result in temporary
conductive deafness from Eustachian tube
obstruction.
- The appendix is also lined with lymphatic tissue and
the swelling of this tissue in the narrow tube can lead
to trapped fecal material and inflammation
(appendicitis).
E. Cardiovascular and Respiratory System
- Left ventricle of the heart enlarges so as to be strong
enough to pump blood to the growing body. .
- Innocent heart murmurs may become apparent
owing to the extra blood crossing heart valves.
- Pulse rate decreases to 70-80 bpm.
- BP increases to about 112/60 mmHg.
- Maturation of respiratory system leads to increased
02-C02 exchange which increases exertion ability and
stamina.
E. Dentition
- Deciduous teeth are lost at 5-7 years (Average: 6 yrs)
and permanent teeth erupt.
- The average child gains 28 teeth between 6-12 years
of age (central and lateral cupids; 1st, rd and 3rd
cupids; and 2nd molars).
- At 12 - all permanent teeth except the final molars
1. The age of dental caries - major problem of the

Page 56 of 75
stage.
auses: poor nutrition, inadequate dental
C
hygiene, increased intake of carbohydrates and
concentrated sweets.
2. Prevention of dental caries: good brushing
and flossing, good nutrition, fluoridated water,
regular dental check-up.
Sexual Maturation
- At a set point in brain maturity, the hypothalamus
transmits an enzyme to the anterior pituitary gland to
begin production of gonadotropic hormones, which
activate changes in the testes and ovaries.
- Timing of this maturity varies widely, between 10-14
years of age.
- Sexual Concerns:
A. Concerns of girls
• Females are usually conscious of breast
development. A girl who is developing ahead of
her peers may tend to slouch or wear loose
clothing to hide the fact.
• Other girls study themselves and wonder whether
their breasts are going to develop enough. Breast
development is usually NOT symmetric.
• Hips become broader.
• As part of preparation for menstruation, girls
should be told that vaginal secretions will appear.
• Some girls already menstruate (MENARCHE).
B. Concerns of boys
• Boys become concerned of increasing genital
size; testicular development precedes penis
growth.
• Males measure their 'manliness" by penis size,
which can make a male who develops late feel
inferior.
• Hypertrophy of breast tissue (GYNECOMASTIA)
occurs more often in stocky or heavy boys.

Page 57 of 75
• They have to be reassured that pubic hair growth
comes first before appearance of chest hair and
beard.
• As seminal fluid is produced, boys may begin to
notice ejaculation during sleep called
NOCTURNAL EMISSIONS (" Wet dreams").
Prepubertal Changes
A. Boys
1. Testes and Scrotum increase in size.
2. The skin over the scrotum changes color; it
becomes reddened and stippled.
3. the breasts may enlarge slightly, but this
growth disappears in a few months.
4. Sparse, downy pubic hair grows at the
base of the penis.
5. The penis gradually becomes wider and
longer.
6. The boy grows taller and his shoulders
widen.
7. Axillary sweating begins.
B. Girls:
1. The pelvis and hips broaden.
2. The breast tissues develop and may be
tender. At first, the
nipple is slightly elevated, @ 7Yr8 years of
age. The areolae become somewhat
protuberant and enlarged between the ages of
9 and 11 years.
3. Axillary sweating begins.
4. The initial growth of pubic hair occurs at 8-
14 years.
5. Vaginal secretions become milky and
change from an alkaline

Page 58 of 75
to an acid pH, and vaginal flora change from
mixed to Doderlein's lactic
acid producing bacilli.
DEVELOPMENTAL MILESTONES
A. Gross and Fine Motor Skills
1. There is increased strength and physical ability,
very energetic,develops greater coordination
and stamina.
2. Bone growth is faster than muscular and
ligament growth;
susceptible to fractures; looks lanky.
6 years - "transition year"

- jumps, skips, hops well
- prints
- ties shoe laces well
- cuts and pastes well
7 years - "assimilative age"; quieting
period
- rides a bicycle
- vision mature; hand-eye
coordination develops completely
- psychosomatic illnesses are
common
- can swim
- enjoys reading
8 year - "expansive age"
- writes rather than print
- More graceful movement
- increased smoothness and
speed
- since arms and legs begin to
grow, may
- stumble on furniture or spill his
milk at the table.
9 years - "on the go" constantly

- enjoys baseball or basketball

Page 59 of 75
1 0 years - start of "pre-adolescent
stage"
- begins to show secondary sex
characteristic changes
- girls usually taller than boys
- some girls menstruate, thus
decline activity
11 year - more active

- in constant motion; drumming
fingers; tapping pencils or feet
(nervous energy)
- awkward because of pre-
adolescent growth spurt
B. Language Development
1. With rapidly expanding vocabulary.
2. Likes name-calling, word games
3. With passwords/secret languages
4. With sense of humor; giggles a lot; laughs a
great deal; enjoys dirty jokes.
C. Psychosocial Skills
1. School occupies half of his waking hours
a. friends/classmates more important than
family
b. teacher becomes parent-substitute
c. school phobia - difficulty coping with school
demands
2. Increasing social sensitivity
3. More cooperative, with improved manners
4. Capable of good deal of responsibility
5. Modest; enjoys privacy (starting a.! 10 yrs
6. With "hero-worshipping."
D. Cognitive Skills
1. Period of industry: likes to explore, produce,
accomplish to have adventure
2. Develops confidence

Page 60 of 75
. Decentering: can consider more than one thing
3
at a time, which leads to ability to empathize,
sympathize
4. Conservation: can recognize matter even if the
form has changed; related to permanence of mass
and volume; knows that quantity remains the same
even though appearance differs.
5. Reversibility: recognizes events even in their
reverse for he can imagine a process in reverse.
6. With concrete, logical thinking
7. Acquires use of reason and understanding of
rules – allows greater use of language.
8. Names months and years, right and left, can tell
time.
E. Play (COMPETITIVE, team, rule-governed)

1. Number of play activities decreases while the
amount of time spent in one particular activity
increases.
2. Purposes of play:
a. To develop mental abilities, learn
nature of competition
b. To learn to bargain, cooperate and
compromise
c. To increase social activities
d. To increase motor abilities
e. To develop logical thinking/reasoning
abilities
3. In the beginning of school years, boys and girls
play together but gradually separate into sex
oriented type of activities (Normal Homosexual
Period).
4. Team play; rules and rituals dominate play;
individuality not tolerated by peers.
5. Types of Play/Games:
a. Quiet games: painting, collections,
reading, watching TV, listening to radio
b. Athletic activities: swimming, hiking,
bicycling, basketball

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c. 6-9 yrs : housekeeping toys, doll
accessories,
needlework, collection and hobbies;
physical games
tree-climbing, jump rope, bicycling
d. 9-12 years: handicrafts, science toys,
magic sets,
chess, scrabble, model kits, video
games,
radio/records; books and comics,
mystery, adventure story; joke books
F. Morality
- Morality develops in the school- before age 9:
1. with strict superego
2. rule dominance - things are black or while; right
or wrong
- After 9 years old, autonomous morality develops;
recognizes differing points of view; may see "gray
areas.'
G. Concept on Death
6- 9 years Understands that death is final
Believes own death can be avoided
Associates
death with aggression or violence
Believes wishes
or unrelated actions can be
responsible for death
9-12 years Understands death as the

inevitable end
of life Begins to understand own
mortality, expressed as
interest in afterlife or as fear of
death
Expresses ideas about death
gathered from 'parents and other
adults

Page 62 of 75
Health Promotion during School Age
A. Nutrition
1. Calories: needs 2100 - 2400 calories per day
2. Breakfast is the most important meal.
3. More likely to eat junk foods and take zero-
caloric foods (soft drinks).
4. To make the child take the needed calories:
WELL-PLANNED SNACKS.
5. Tends to choose own foods, influenced by
mass media, needs nutritional education -
nutritious snacks, cooking, meal planning
6. Displays good table manners.
B. Safety Concerns
1. Safety education is essential; accepts
increasing responsibility for own safety.
2. Motor vehicle accidents - leading cause of
injuries/accidents
a. Be role model as safe driver
b. Use of safety belts
c. Teach rules of pedestrians
d. No playing in streets or alleys
e. Practice bike safety
3. Provide supervision during sports activities.
4. Provide adult supervision during swimming
and boating activities; provide teachings.
(Supervision and education are key elements in
the prevention of accidents in this stage.)
5. Teach respect for fire and its dangers. 6.
Teach on prevention of sexual abuse. "Private
parts" are those parts of the body covered by a
bathing suit.
C. Dressing
- This is the right age to teach children the importance
of caring for their own belongings.
- School age children have definite opinions about
style or clothing, often based on the likes of their
friends rather than the preferences of their parents. A
child who wears different clothing may become the
object of exclusion from a school club or group.

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D. Sleep
- 10-12 hours of sleep a night
- prolonged telephone conversation ensues which
may deprive them of adequate sleep at night.
E. Exercise
- This need not involve organized sports.
Common Health Problems

A. Anxiety Related to Beginning School
-The biggest task of the 1st year of formal school
is learning to read.
- Urge parents to spend some time with the child
after school or in
evening, family and does not feel pushed out
by being sent to school;
or else, counseling may be done.
B. School Phobia
- Refers to fear of attending school
- Child may develop physical signs of illness.
- Causes:
a. anxiety of separation from home
b. teacher factor
c. particular school-related activities
- Parents should treat the situation matter-of-
factly.
- This requires coordination among the
school, school nurse and health care provider
who diagnose the problem.
C. Latchkey Children
- Refers to schoolchildren who are without
adult supervision for a part of each weekday.
The term alludes to the fact that they
generally carry a key so they can let
Themselves into their homes after school.
- A major concern is that these children feel
lonely and have an increased tendency to
have accidents, delinquent behavior and

Page 64 of 75
decreased school performance from lack of
homework supervision.
- For those children who feel safe, a short
period of independence may actually
be beneficial because it encourages problem
solving in self-care.
D. Stealing
- This happens @ around 7 years of age- they
discover the importance of money.
- If stealing persists beyond 9 years of age -
counseling may be required.
- Interventions:
1. Explore the cause of stealing.
2. Handle the situation without a great deal
of emotion.
3. Importance of property rights must be
emphasized.
4. Parents must set good examples.
E. Recreational Substance Use
- Illegal substances are available nowadays to
children even during Grades V to VI.
- Commonly abused substances:
a. rugby (toluene)solvents
b. cigarettes
c. alcohol
d. marijuana
ADOLESCENCE
- The period between 12-18 years old .this serves as a
transition period between childhood and adulthood.
- The whole period can be divided into:
a. Early Adolescence (12-14 yrs)
b. Middle Adolescence (Females: 13-16 yrs;
Males: 13-17 yrs)
c. Late Adolescence (Females: 16-21 yrs; Males:
17-21 yrs)
- Period of "storm and stress."
- Second "rapid growth period."

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Definition of Terms
1. Pubescence - the time span during which
reproductive functions begin to mature; ends with the
attainment of full maturity or reproductive capacity
and is characterized by:
a. rapid growth of the body
b. full genital development
c. sexual awareness
2. Puberty - period of full reproductive maturity.
a. Girls: Before, this period was believed to be
heralded by the first
menses (Menarche). Studies, however, have
shown that most
young girls are NOT FERTILE for about 1-2 yrs
after menarche.
b. Boys: Puberty approaches at or near the first
ejaculation. True
reproductive maturity is attained when viable
sperms appear in the semen.
Pubescence and puberty deal with the
physical/biological aspects of development of the
young boy or girl.
3. Adolescence - social and behavioral maturation
from the beginning of pubescence to beyond the time
of reproductive maturity.
PHYSICAL GROWTH
- The major milestones of development in the
adolescent period are the onset of puberty and the
cessation of body growth.
- Physiologic growth is rapid and the development of
adult coordination is slow.
- Growth stops with closure of epiphyseal lines of
long bones (16-18 yrs in females; 18-21 in males).
A. Weight
- With pubertal "growth spurt."
- Females: 381bs mean weight gain (10-14 yrs)
- Males: 52 lbs mean weight gain (12-16 yrs)
B. Height

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- With pubertal "growth spurt."
- Females: 20.5 cm mean height gain (10-14 yrs)
• 95% of mature height is achieved by the onset
of menarche.
- Males: 27.5 cm mean height gain (12-16 yrs)
• 95(% of mature height is achieved by skeletal
age of 15 yrs.
C. Body System
1. Skeletal System
- First, gain is mostly in weight, leading to stocky,
slightly obese
appearance, then the thin appearance of late
adolescence.
- Skeletal system grows faster than the muscles.
- These differences lead to:
a. lack of coordination
b. poor posture
- They appear long-legged and awkward because
extremities
elongate first followed by trunk growth.
2. Cardiovascular and Respiratory System
- Heart and lungs increase in size more slowly
than the rest of the
body - insufficient energy left for activity -
CONSTANT
FATIGUE
(*Fatigue is also due to protein depletion, with protein
being used up for body growth.)
- PR= 70 bpm
- RR= 20 cpm
- BP = 120170 mmHg (reaches adult levels @ late
adolescence)
- BP in males> BP in females (due to large body
mass in males)
3. Endocrine System
- Androgen stimulates sebaceous glands to
extreme activity- ACNE.
-The formation of apocrine sweat glands (glands

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present in the
axilla and genital area) occurs shortly after
puberty - strong body odor.
D. Dentition
- 2nd Molars: 12-13 yrs (Upper); 11-13 yrs (Lower)
- 3rd Molars (Wisdom Teeth) : 17-21 yrs but may erupt
as early as 14-15 years
- Jaw reaches adult size toward the end of
adolescence. As a result, adolescents whose 3rd
molars erupt before the lengthening of the jaw is
complete may experience pain and may need these
molars extracted because they do not fit the jawline.
E. Secondary Sex Changes
(See Tanner's Sexual Maturity Ratings)
Psychosocial
Patterns
A. Early
Adolescence
1. Physical body changes can result to altered
self-concept - FEAROF REJECTION.
2. Early and late developers may also have
anxiety regarding fear of rejection.
3. May have mood swings.
4. With fantasy and daydreaming
5. Needs consistent discipline LIMIT
BEHAVIOR
B. Middle Adolescence
1. Emancipated from parents (except financially)
2. Identifies own values
3. Finds increasing interest in heterosexual
relationship; may find a mate or form "love"
relationship
4. With peer group
- One of the strongest motivating forces of
behavior
- Finds importance to be a part of a group and be
like everyone else in the group
conforms to values/fads of the group.

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- Clique formation ("Barkada")- may be
determined by race social class, special interest.
C. Late Adolescence
1. Physically and financially independent from
parents
2. Finds identity
3. Finds a mate
4. Develops morality
5. Increasing social and moral interest
participates in society 6. Completes physical and
emotional maturity
D. Adolescence and Independence
1. By 15-16 yrs, adolescents feel they should be
treated as adults.
2. Ambivalence: adolescent wants freedom but is
not happy with corresponding responsibilities
that come with it.
3. Parental ambivalence is also present; they try
to give the adolescent freedom but continue to offer
constructive guidance and enforce discipline.
Emotional Development
A. Sense of Identity
- Deciding who they are and what kind of person they
will be.
- Four (4) main areas of concern to establish identity:
a. accepting changed body image
b. establishing a value system
c. making a career decision (may wait until 2ndYr
College)
d. being emancipated from parents
- Some develop delinquent behavior - better to be
socially unacceptable than to be nobody at all.
B. Sense of Intimacy
- Starts toward the end of adolescence and continues
into early adulthood.
- The ability to form intimate relationships is strongly
correlated with a sense of trust. Infants who are
unable to from a sense of trust may be unable to
relate to others on a deep enough level to form lasting

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and close relationships as adults
- They need to be helped to differentiate between
sound relationships and those that are based only on
sexual attraction. .
- It is important for parents to keep the lines of
communication open on the subject of sexuality.
They should be taught to have a monogamous
relationship and use contraceptives (e.g. condom,
pills) to prevent teenage pregnancy and sexually
transmitted diseases.
- Intimacy involves:
a. developing sense of compassion or concern for
other persons
b. discerning when words will hurt
c. determining when companion us unhappy and
needs encouragement d. knowing when a friend
needs support (EMPATHY)
C. Socialization
12 year§ *full of "self-doubt"
13 years *loud and boisterous particularly

when they
want to attract an opposite sex
nearby
*start to "fall in love" (a painful kind
of love; they, have too
little experience with life, too limited
frame of reference to
know how to offer deep commitment)
14 years * quieter and more introspective

*used to their changing bodies; have
more
confidence in themselves; feel more
self:' esteem
*"Idol worship"(film star, rock star,
writer, scientist, doctor or
athlete) starts

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15 years *fall in love 5-6 times a year
(attraction is
physical rather than the inner
qualities)
16 years *"Sweet Sixteen" phenomenon

*both sexes trust their bodies 17 years
*They leave childish behavior they
used in early adolescence (shoving
and punching to get attention of the
opposite sex)
Cognitive Development/Skills
- Formal Operations: child is capable of:
a. abstract thinking
b. scientific reasoning and formal logic
c. views problems comprehensively
d. increasing intellectual abilities, .
e. learning through intuition, inference and
surmise rather than
imitation and repetition
f. making a hypothesis
Play
Girls social functions
romantic TV shows
reading romance books cooking,
sewing
art and poetry
outings, movies
daydreaming
lengthy telephone conversations
Boys group activities predominate (e.g.
drinking sessions)
sports
mechanical and electrical devices
part-time employment
outings, movies, parties

Page 71 of 75
Health Promotion during Adolescence
A. Nutrition
- 2,200 calories in girls; 2,700 in boys
- Appetite increases with rapid growth.
*Inadequate diet results to retarded growth and
delay in sexual maturity.
- Increased need for CHON, Ca++, Fe++, Zn++ for
sexual maturation;
WATER is the most important element in his diet
and in the diet of all age groups.
- Sports activities increase nutritional requirements.
- Eating habits are influenced by peer group:
a. junk foods
b. overeating and decreased activity
OBESITY
c. fad diets and false dieting ANOREXIA
NERVOSA and BULIMIA
B. Dress and Hygiene
- Capable of "self-care"
- Overly conscientious about appearance and
personal hygiene
- Money is usually spent for clothing.
C. Care of the Teeth
- Individuals with braces must be extremely
conscientious in tooth brushing to prevent plaque
buildup on tooth surfaces.
D. Sleep
- Need an average of 8 hrs sleep
- "Growth spurts" happen during sleep CHON
synthesis and release of
somatotropic hormone happen when a person
sleeps.
E. Exercise
- Needed to maintain muscle tone and to provide an
outlet for tension.
F. Safety Measures
1. Accidents are the leading cause of death: motor

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vehicular accidents and sports injuries.
2. Drugs and alcohol become serious problems in
this stage.
3. Suicide may also be a cause of death.
4. Counsel against swimming alone and other
risky behaviors.
Common Health Problems of the Adolescent
A. Hypertension
- Causative factors:
1. obesity
2. black race
3. diet high in salt and fat
4. family history of HPN
- BP should be taken routinely in children over 3 yrs of
age.
B. Poor Posture
- Detect difference between normal posture and the
beginning of scoliosis.
C. Fatigue
- Diet, sleep patterns and activity schedules must be
assessed.
- May be a sign of boredom.
- RIO Anemia or other related illnesses
D. Menstrual Irregularities
- Check ups with an OB
-Gynecologist should be done if irregularities persist.
E. Acne ("Pimples")
- A common skin disorder which is a self-limiting
inflammatory disease that
involves the sebaceous glands that empty into hair
shafts (pilosebaceous unit).
- More common in boys than girls.
- Peak ages:
14-17 years (females)
16-19 years (males)
- Caused by abnormal keratinization, obstruction of
ducts and trapping of sebum.
- Proprionibacterium acnes (a bacterium) cause
papular lesions to appear.

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- Fatty acids from triglycerides causes the dermal
inflammation.
- Locations: face, neck, back, upper arms and chest
- Categories:
a. Mild - comedones
b. Moderate - papules and pustules
c. Severe - cysts
- Causes of flare-ups:
a. humidity
b. emotional stress
c. menstrual periods
d. greasy hair creams/make-ups
e. lack of sleep or irregular sleep patterns
-No relationship to food intake (e.g., peanuts,. chocolates or fatty foods) or dirt (Wash face only 2-3x a day).
- Treatment goals:
a. decrease sebum production
b. prevent comedone formation
c. control bacterial proliferation
F. Substance Abuse
- Use of chemicals to improve mental state or induce euphoria.
- Substances commonly abused:
a. cigarettes
b. alcohol
c. anabolic steroids
d. marijuana
e. amphetamines
f. cocaine
g. hallucinogens
h. opiates
- Results:
a. school failure
b. poor reasoning ability
c. decreased school attendance
d. frequent mood swings
e. deteriorating physical appearance
f. recent change in peer group
g. expressed negative perceptions of parents h. delinquent behaviors (crimes)
G. Suicide
- A deliberate self-injury with the intent to end one's life.
- More frequent in males than females (Ratio 8:1).
- Ranks as 3rd cause of mortality among adolescents.
- Cause: LOSS OF A LOVED OBJECT
- Danger signs of suicide:
a. giving away prized possessions
b. organ donation questions
c. sudden, unexplained elevations of mood
d. accident proneness, carelessness, death wishes
e. statement such as, "This is the last time you'll see me."
f. decreased verbal communication
g. withdrawal from peer activities or previously enjoyed events
h. previous attempt at suicide
i. preference of art, music and literature with themes of death
j. recent increase in interpersonal conflict with significant others
k. running away from home
l. inquiry about hereafter
m. asking for information about suicide prevention and intervention n. almost any sustained deviation from the
normal pattern of behavior.
G. Running Away
- This is usually preceded by an argument with parents that is often the last straw after a number of long-term
disagreements.
- They are usually "throw-aways" or have been rejected by families.
- Other reasons:
a. loneliness
b.pregnancy
c. problems with friends, school and police

d. incest or parental abuse
- School history usually reveals frequent truancy, failing grades, possible deluge use, running away behavior by friends.

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CONCEPTS OF GROWTH AND DEVELOPMENT

• DEVELOPMENT ​- ​increase in the complexity of

PRINCIPLES OF GROWTH AND DEVELOPMENT:

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FACTORS INFLUENCING GROWTH AND

PERIOD OF GROWTH TIME RANGE

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GROWTH AND DEVELOPMENT THEORIES:

I. PSYCHOSEXUAL THEORY (by Sigmund Freud)

- Freud proposes that the underlying motivation to

AGE RANGE GROWTH PERIOD STAGE/S

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- I​ f the individual does not achieve a satisfactory

II. PSYCHOSOCIAL THEORY (by Erik Erikson)

- Reflects both positive and negative aspects of the

AGE RANGE GROWTH PERIOD STAGE/S

III. COGNITIVE THEORY (by Jean Piaget)

- Cognitive development refers to the manner in which

Stage of Age Nursing Implications

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IIII. MORAL THEORY (by L. Kohlberg)

V. SPIRITUAL THEORY (by James Fowler

DEVELOPMENT OF CHILDREN'S CONCEPTS AND

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1. Establish and maintain a patent airway

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2. Gestational Age Assessment (BESTS)

Criteria 0.36 weeks 37-38 weeks 39 weeks & above

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Abnormal skin findings:

- Treatment of Pathologic Jaundice:

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Common skin marks of the newborn:

7. Erythema toxicum - aka fleabite.rash; pink

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D. H ​ ead - forehead prominent; chin receding

Criteria Caput succedaneum Cephalhematoma

E. Eyes (Assess by putting infant in upright

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Criteria Breastfed Infant Bottlefed Infant

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Table 6.1 COMPOSITION OF MATURE HUMAN MILK AND COW MILK

% Of total nitrogen) 15 6 Chromium (ug) --- 8-13

Amino acids (mg/dl) Manganese (ug) 7-15 20-40

Essential Copper (ug) .400 30

Glutamic acid 230 680 Vitamin D (LV.) 22 14

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Common Health Problems Needs:

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SGA < 1Oth percentile

LGA > 90 percentile

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- Traditionally designated as the period 0 - 1 year of

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- average height: 30 inches (76.2 cm) at 1 year old

- Should be taken with the child lying supine or

• DEVELOPMENT - increase in the complexity of

- I f the individual does not achieve a satisfactory

D. H ead - forehead prominent; chin receding

TASTE - Infants turn away or spit out a

SMELL - infants smell accurately within 1-

2. CREATIVE - sand bags

3. DRAMATIC/IMITATIVE - play house