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Maternal & Child Nursing Care

Second Edition

Marcia L. London Patricia W. Ladewig Jane W. Ball Ruth C. Bindler

Lecture Notes

Chapter 33
Growth and Development
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Developmental Theory: Freud


Early childhood experiences form unconscious motivation for action later in life Sexual energy is centered in specific parts of the body at certain ages Unresolved conflict at a certain stage leads to a fixation of development at that stage
2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Freuds Stages of Development


Oral (birth to 1 year): Derives pleasure from mouth Anal (1 to 3 years): Control over body secretions Phallic (3 to 6 years): Works out relationships with parents Latency (6 to 12 years): Sexual energy is at rest Genital (12 years to adulthood): Mature sexuality

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Developmental Theory: Erikson


Eight periods of psychosocial development Occur from birth through old age Two possible outcomes

Healthy: Move on to next stage Unhealthy: Problem with future relationships

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Eriksons Stages of Development (Pediatric)


Trust versus mistrust (birth to 1 year) Autonomy versus shame and doubt (1 to 3 years) Initiative versus guilt (3 to 6 years) Industry versus inferiority (6 to 12 years) Identity versus role confusion (12 to 18 years)
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Developmental Theory: Piaget


Childs view of the world is largely influenced by

Age Experience Maturational ability

Focuses on cognitive (or intellectual) development


2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Piagets Stages of Development


Sensorimotor (birth to 2 years) Preoperational (2 to 7 years) Concrete operational (7 to 11 years) Formal operational (11 years to adulthood)

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Developmental Theory: Kohlberg


Examines moral development Three levels of moral reasoning Described age guidelines - many people never reach highest stage

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Kohlbergs Stages of Moral Development


Preconventional (4 to 7 years) Conventional (7 to 12 years) Postconventional (12 years and older)

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Social Learning Theorists


Children learn attitudes, beliefs, and customs through social contact Children imitate behaviors they see If positively rewarded, they repeat behaviors Concept of self-efficacy - expectation that someone can produce desired event
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Behaviorism Theories
Applied ideas of Pavlov and Skinner to children Can elicit behaviors through positive reinforcement Can extinguish behaviors through negative reinforcement

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Nursing Interventions: Infants


Encourage parents to hold and stay with infant Provide opportunities for sucking Provide toys that give comfort or stimulate interest Pain control (trust)

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Nursing Interventions: Toddlers


Toilet-training procedures

Do not begin toilet-training in hospital Accept regression during hospitalization

Encourage independent behaviors feeding, hygiene, dressing self Give short explanations Reward appropriate behavior
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Nursing Interventions: Preschoolers


Encourage parental involvement Provide safe versions of medical equipment for play Give clear explanations about illness explain that child is not responsible for the illness Allow child to draw
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Nursing Interventions: SchoolAge


Provide gowns, covers, and underwear Explain treatments and procedures Encourage school work Encourage hobbies, favorite activities

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Nursing Interventions: Adolescents


Provide privacy Interview separately from parents when possible Encourage participation in care and decision-making Encourage peer visitation Provide information on sexuality
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Ecologic Theory (Bronfenbrenner)


Each child is unique Emphasizes presence of mutual interactions between child and various settings Neither nature nor nurture is more important Levels and systems
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Temperament Theory
Focuses on wide spectrum of behaviors in children How children respond to daily events Based on New York Longitudinal Study (1956 to present)

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

TABLE 335
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Nine Parameters of Personality


2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

TABLE 336
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Patterns of Temperament
2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Resilience: Basic Ideas


Resilience: Ability to function with healthy responses, even when faced with stress and adversity Protective factors

Provide strength Examples Contribute to the challenge Examples


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Risk factors

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Resiliency Theory
All individuals experience crises that lead to adaptation and development of inner strengths Increases ability to handle future crises

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Development During Infancy


Time of rapid growth and change Birth weight

Doubles by 5 months Triples by 1 year

Begins to understand meanings of sounds and words By 1 year, able to feed self
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Major Developmental Milestones During Infancy


Rolls over Sits up Stands Able to say 1 or 2 words Uses pincer grasp well

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Development: Toddlers
Typically independent and negative Proud of new accomplishments Rate of growth and food intake slows Birth weight quadruples by 2 years At 2 years, child is one-half of adult height

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Major Developmental Milestones: Toddlers


Walks up and down stairs Undresses self Scribbles on paper Kicks a ball Has a vocabulary of 1,000 words - uses short sentences

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Development: Preschoolers
Most children in daycare or school Increased social activities and contacts Language skills well-developed Writing ability improved Physical skills developed

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Major Developmental Milestones: Preschoolers


Uses scissors Rides bicycle with training wheels Throws a ball Holds a bat Writes a few letters All parts of speech are well-developed

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Development: School-Age Children


Very industrious Find activities they enjoy and excel in Contributes to sense of achievement, self esteem Peers becoming more important

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Major Developmental Milestones: School-Age Children


Possesses reading ability Rides a two-wheeled bike Jumps rope Plays organized sports Mature use of language

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Development: Adolescents
Transition: End of childhood and beginning of adulthood Identity formation: Who am I? Puberty and rapid growth changes New activities Less dependent on parents for transportation Peers are important
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Major Developmental Milestones: Adolescence


Fine motor skills well-developed Gross motor skills improve due to growth spurts Able to apply abstract thought and analysis

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Assessing Growth and Development


Use combination of developmental theories and assessments Holistic approach Categories of Assessment

Physical growth Cognitive development Psychosocial development Personality and temperament Communication Sexuality
2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Children at Play
Play is the work of childhood Play contributes to:

Cognitive growth Physical development: Gross motor skills and fine motor skills Social interaction

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Infants at Play
Primarily enjoy solitary play Others may teach infants how to play with new objects Progress from reacting to objects (rattle) to manipulating them Once they become mobile, sphere of play enlarges
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Toddlers at Play
Increased motor skills allow new types of toys and play Play becomes more social, often with other toddlers - parallel play Imitates behavior Manipulating objects helps them to learn about their qualities (Example: Square block will not fit in round hole)
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Preschoolers at Play
Interacts with others during play Enjoys large motor activities Increased manual dexterity Fantasy play

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

School-Age Children at Play


Increased physical abilities allow for wide variety of play Understanding of rules of a game - like for rules to be followed during play Cooperative play

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Adolescents at Play
Increased maturity leads to new activities and ways to play Peer group becomes focus of activities Less reliant on parents for transportation Social interactions important

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Nursing Interventions and Development


Assess growth and development - holistic approach Tailor nursing interventions based on this data

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

General Principles: Interventions and Development


Discuss proper nutrition and feeding techniques Conduct health teachings and screenings based on childs age Encourage family to discover childs personality and temperament Instruct parents about expected language skills
Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

General Principles: Interventions and Development


Give parents information about normal sexual behavior of children Instruct school-age children about expected changes of puberty Give adolescents information about

Birth control Sexually transmitted diseases

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458