Problems:

1. Possible dehydration from diarrhea

2. Fever
3. Malnourishment can be manifested by Loss of appetite and being underweight
PYSCHOLOGICAL EFFECTS
1. Abandonment  Childhood trauma
 Childhood trauma is correlated with poor developmental, behavioral and health
outcomes. Early trauma and chronic stress adversely affect the neurobiology of the
developing brain, especially those areas involved in attention, emotional regulation,
memory, executive function, and cognition. As a result, shortened attention span,
hyperactivity, poorer cognitive function, aggression, and memory issues are problems
encountered frequently encountered among children in foster care
 Removal from the family of origin may compound trauma although some children
experience relief at removal from a chaotic, abusive, or dangerous home. Most children
miss their family, worry about their parents and siblings, and long for reunification.
Separation, loss and grief, unpredictable contact with birth parents, placement changes,
the process of terminating parental rights, and the sheer uncertainty of foster care may
further erode a child’s well-being
2. Abandonment  Maternal Deprivation  Developmental delay
 when the child is removed from her mother’s care, is hospitalized or institutionalized or
remains home while she is absent
 infant’s lack of warm relationship
 the mother or her substitute cannot give love and care even though the infant lives with
her
 CLINICAL MANIFESTATIONS: period of depression occurs, critical change in infant’s life,
depressed, cries, sad, withdrawn, refuses to eat and may lose weight, delay in the
response to the parents, suffers anorexia and sleep disturbance, emotionally isolated
from the adults and activity restricted, shows signs of retarded mental development,
rigid facial expression and has poor resistance/contracts infection readily
3. Oral and emotional deprivation  Failure to thrive
 Failure to thrive (FTT) results from inadequate usable calories necessary for a child’s
metabolic and growth demands. No single set of growth parameters provides the
criteria for a universal definition. FTT has classically been grouped into organic and
nonorganic types; this construct is outmoded and not useful to clinicians seeking to
address underlying causes, which are often multifactorial
 Many children with FTT will be solely categorized because of deprivation and/or
psychological problems and rarely just because of child neglect. These families often
share risk factors with neglect, such as poverty, social isolation, and caregiver mental
health issues.
 CLINICAL MANIFESTATIONS: Inadequate weight for corrected age, weight for height,
and body mass index, as well as failure to gain adequate weight over a period of time,
help define FTT . Growth parameters should be measured serially and plotted on growth
charts appropriate for the child’s sex, age, and, if preterm, post conceptual age. Growth
 charts are also available for some known chromosomal abnormalities, such as Down
syndrome and Turner syndrome.

PSYCHOSOCIAL

Erik Erikson’s psychosocial theory is concerned with acquiring a sense of trust while overcoming a
sense of mistrust. The trust that develops is a trust of self, of others, and of the world. Infants “trust”
that their feeding, comfort, stimulation, and caring needs will be met. The crucial element for the
achievement of this task is the quality of both the relationship between the parent (or caregiver)
and child and the care the infant receives. The provision of food, warmth, and shelter by itself is
inadequate for the development of a strong sense of self. The infant and parent must jointly learn to
satisfactorily meet their needs for mutual regulation of frustration to occur. When this synchrony
fails to develop, mistrust is the eventual outcome. Frustration is heightened in situations in which
the parent is emotionally immature and does not understand the infant’s behavioral cues because of
his or her own self-centered phase of development. The trust acquired in infancy provides the
foundation for all succeeding phases. Trust allows infants a feeling of physical comfort and security,
which assists them in experiencing unfamiliar, unknown situations with a minimum of fear. Erikson
has divided the first year of life into two oral-social stages.

 Developing a Sense of Trust-- develops when the infant’s needs are met consistently
 Formation of developmental tasks
 The trust acquired in infancy provides the foundation for all succeeding phases.
 The infant receives stimulation and pleasure through his mouth.
 Nurses must watch out for fixation in patients which rests the GI system due to medical
condition
 Frustration is heightened in situations in which the parent is emotionally immature and does
not understand the infant’s behavioral cues because of his or her own self-centered phase
of development.
 Primary narcissism (total concern for oneself) is at its height.
 Failure to learn delayed gratification leads to mistrust

Separation of infant and parent may prevent attachment and the emergence of a trusting
relationship for the infant. Lack of pleasant sensations can result in an irritable and unhappy
indicative of their inadequacy in satisfying the child’s emotional and physical needs by the parent/s

COGNITIVE Sensorimotor stage:

During the sensorimotor phase, infants progress from reflexive behaviors to simple repetitive acts to
imitative activity. Three crucial events take place during this phase. The first event involves
separation, in which infants learn to separate them-selves from other objects in the environment.
They realize that others besides themselves control the environment and that
 certain adjustments must take place for mutual satisfaction to occur. This coincides with Erikson’s
concept of the formation of trust and mutual regulation of frustration. The second major
accomplishment is achieving the concept of object permanence, or the realization that objects that
leave the visual field still exist. A typical example of the development of object permanence is when
infants are able to pursue objects they observe being hidden under a pillow or behind a chair This
skill develops at approximately 9 to 10 months of age, which corresponds to the time of increased
locomotion skills. The last major intellectual achievement of this period is the ability to use symbols,
or mental representation. The use of symbols allows the infant to think of an object or situation
without actually experiencing it. The recognition of symbols is

the beginning of the understanding of time and space.

 can discriminate rhythmic patterns in native vs non-native language.

 can recognize facial expressions (smiles)
 Progresses from reflex activity,
 simple repetitive behaviors, imitate behaviors;
 object permanence, causality, and spatial relationships
 differentiate among patterns, colors, and consonants
 primitive understanding of Cause-and-effect relationships

The 6 mo old infant has discovered his hands and will soon learn to manipulate objects. At first,
everything is mouthed. In time, novel objects are picked up, inspected, passed from hand to hand,
banged, dropped, and then mouthed. Each action represents a nonverbal idea about what things are for
(in Piagetian terms, a schema; see Chapter 6). The complexity of an infant’s play, how many different
schemata are brought to bear, is a useful index of cognitive development at this age. The pleasure,
persistence, and energy with which infants tackle these challenges suggest the existence of an intrinsic
drive or mastery motivation. Mastery behavior occurs when infants feel secure; those with less secure
attachments show limited experimentation and less competence. A major milestone is the achievement
by 9 mo of object permanence (constancy), the understanding that objects continue to exist, even when
not seen. At 4-7 mo of age, infants look down for a yarn ball that has been dropped but quickly give up if
it is not seen. With object constancy, infants persist in searching. They will find objects hidden under a
cloth or behind the examiner’s back. Peek-a-boo brings unlimited pleasure as the child magically brings
back the other player. Events seem to occur as a result of the child’s own activities.