DEFINITION OF TERMS

GROWTH
 Refers to the increasing size of the physical structure of the body.
 It denotes quantitative change.
 It is measured by inches, centimeters, kilograms or pounds.
DEVELOPMENT
 Refers to the improvement in skill or ability to function.
 It denotes qualitative change.
CHRONOLOGICAL AGE
 Defined as age in years.
DEVELOPMENTAL AGE
 Refers to age based on functional behavior and ability to adapt to the
behavior.
INTEGRATION OF SKILLS
 Ability to combine simple movement or skills to achieve complex
tasks.
PEDIATRIC NURSE
 The nurse who works or cares for the children.
PEDIATRICIAN
 A medical doctor who specializes in pediatrics.
MATURATION
 Development of traits carried through the genes.
MATURITY
 Means full or complete growth
b. Physical Maturity – is normally complete by 20-25 years
of age.
c. Emotional and Intellectual Maturity – are not easily
measured in normal individuals; generally attained by the
age 25 years old.
 HISTORY OF PEDIATRICS
ANCIENT WORLD
 It is believed that childcare was somewhat like
that still found in isolated tribes living in the
world today.
 Psychologist consider childcare during those
times as almost ideal.
 Childhood is a period of relative freedom and
preparation for adulthood.
ANCIENT CIVILIZATIONS (3000 BC TO 500 AD)
 In the ancients of Egypt, India and China, children

were reared in the traditions passed down from the

previous generations.
 The practice of medicine combined both medical

knowledge and magic.

 In ancient Jews, hygienic measures greatly

influenced the maternal and childcare.

 Widespread acceptance of infanticide.
MEDIEVAL WORLD (450 TO 1350 AD)
 Prevalent diseases – Influenza, Leprosy

 Death rate was high among children

 In 787 AD, the first known infant

asylum or hospital was founded in

Italy.
RENAISSANCE AND EARLY MODERN WORLD
(1350-1800 AD)
 2 books influenced the practice of pediatric medicine in
16th century.
 Thomas Phaer, the father of English Pediatrics wrote the
“Broke of Children” and in Germany Felix Wurtz wrote
the “Children’s Book”.
 St. Vincent de Paul, the “Patron Saint of Orphans”
aroused the interest of the public in the care of children.
 In the early modern period – Industrial Revolution
 Many advances in science, medicine and literature.
 In England, Edward Jenner developed the small pox vaccine.
 William Harvey discovered the circulation of blood.
 Rosseau wrote his famous book “Emile” which included a
section on rights of children.
MODERN WORLD
 Remarkable changes happened
1. Scientifically gained knowledge
 People are curious about themselves and the world around them.
 The scientific method was applied.
 Purification of water supplies and sanitary waste and sewage
disposal.
 Pasteurization of commercial milk supplies.
 Testing of milk cows for tuberculosis.
 Immunization programs against communicable diseases.
 Development and mass production of antibiotics and other drugs.
 Maternal and child health programs that include free food and
medical care.
 Laws to control child labor and childcare facilities.
 Counseling and recreation programs.
2. Humanitarianism - is the idea that all people are created with
an inherit dignity and value.
 Childcare throughout the World
 1946 – the chief international organization concerned with
child welfare was established and was called United Nation
International Children’s emergency Fund (UNICEF)
 Goal: to meet the distress of children caused by widespread
disasters.
 Programs:
- Training primary health workers
- Providing vaccines for immunizations, drugs, medical supplies and
oral rehydration salts for supplemental nutrition.
- Assists with water and sanitation projects and indigenous food
procurement.
 1948, the World Health Organization (WHO) was
established as the major international organization.
 Various organizations and individuals within nations
have initiated projects to assist other people to the
world such as:
- Peace Corps: technical advisors, educators and
medical personnel are sent to underdeveloped
countries to work with people to improve their lives.
- Project Hope: is devoted to medical teaching and
treatment and is staff entirely by volunteers.
 Other milestone in child welfare
- 1959: Declaration of the Rights of the child adopted
by the UN General Assembly.
- 1979: International Year of the Child
- 1985: International Youth Year designated by the
UN
 FACTORS INFLUENCING G& D

 Heredity
 Life Experiences

 Health Status

 Cultural Expectations
PRINCIPLES OF GROWTH AND DEVELOPMENT
 Development occurs in cephalocaudal (head-to-toe) direction.
 Development occurs in a proximodistal manner.
 Development occurs in an orderly manner from simple to
complex and from general to specific.
 The pattern of G & D is continuous, orderly and predictable.
However, G & D do not proceed at a consistent rate.
 Every person proceeds through stages of G & D at an
individual rate.
 Every stage of development has specific characteristics.
 G & D may temporarily be stalled or regress during critical
periods.
 Each stage of development has certain tasks to be achieved or
acquired during that specific time. Tasks of one developmental
stage become the foundation for tasks in subsequent stages.
 Some stages of G & D are more critical than others.
 THEORIES OF G & D
THEORY
 A systematic statement of principles that
provides a framework for explaining some
phenomenon.
 Developmental theories provide road maps for
explaining human development.

DEVELOPMENTAL TASK – a skill or a growth

responsibility arising at a particular time in an
individual’s life, the achievement of which will
provide a foundation for the accomplishment of
future tasks.
 FREUD’S PSYCHOANALYTIC THEORY
 Freud based his theory on his observations of
mentally disturbed adults.
 He described adult behavior as being the result of
instinctual drives that have a primarily sexual nature
(LIBIDO) from within the person and the conflicts
that develop b/w these instincts.
 Three components of personality:
 ID – the unconscious mind
 EGO – the conscious mind
 SUPEREGO – the conscience
 FREUD’S STAGE OF CHILDHOOD
STAGES/AGE
INFANT (Birth to 18 months)
TODDLER (18 months to 3 years)
PRESCHOOLER ( 3 to 6 years)
SCHOOL-AGE (6 to 12 years)
ADOLESCENT (12 years to
adulthood)
PSYCHOSEXUAL STAGE
Oral Stage: Child explores the world
by using mouth especially the tongue.
Anal Stage: Child learns to control
urination and defecation.
Phallic Stage: Child learns sexual
identity through awareness of genital
area.
Latent Stage: Child’s personality
development appears to be non-active
or dormant.
Genital Stage: Adolescent develops
sexual maturity and learns to establish
satisfactory relationships with the
opposite sex.
 ERIKSON’S THEORY OF
PSYCHOSOCIAL DEVELOPMENT
 His theory stresses the importance of culture and
society in personality development.
 Main tenet of his theory – person’s social view of
himself/herself is more important than instinctual
drives in determining behavior, allows for a more
optimistic view of the possibilities for human growth.
 While Freud looked at ways mental illness develops,
Erikson looked at actions that lead to mental health.
 Erikson describes eight developmental stages
covering the entire life span.
 ERIKSON’S STAGES OF CHILDHOOD
STAGES/AGE DEVELOPMENTAL TASK

INFANT Sense of trust vs mistrust. Child learns to love and be loved.

(Birth to 18 months)
TODDLER Autonomy vs shame. Child learns to be independent and make
(18 months to 3 years) decisions for self.
PRESCHOOLER Initiative vs guilt. Child learns how to do things (basic problem
(3 to 6 years) solving) and that doing things is desirable.
SCHOOL-AGE (6 to 12 years) Industry vs inferiority. Child learns how to do things well.
ADOLESCENCE Identity vs role confusion. Adolescents learn who they are and
(12 to 20 years) what kind of person they will be by adjusting to a new body
image, seeking emancipation from parents, choosing a vocation
and determining a value system.
YOUNG ADULT Intimacy vs isolation.
(20 to 25 years) Develop commitments to others and to a life work (career)

ADULTHOOD Generativity vs self-absorption/Stagnation

(25 to 45 years) Establish a family and become productive

SENESCENCE Ego integrity vs disgust and despair

(45+ years) View one’s life as meaningful and fulfilling
 JEAN PIAGET’S COGNITIVE THEORY
He used several terms to describe cognitive development like:
Schema
 Interactions with the environment caused people to organize patterns of thought
which they used to interpret or make sense of their experience.
 Example – Young children who believed the sun is alive because it moves – are
operating on the schema that moving things are alive.

Assimilation
 Interpreting new information in terms of existing information.
 As they get older, children continually encounter animate and inanimate objects and
learn all objects are not alive.
 Example: Trees do not move from one area of the yard to another even though they
are alive.
Accommodation
 Adequate understanding of differences b/w nonliving and living objects.
 Revising, readjusting or realigning existing schema to accept this new information.
Equilibrium
 Results in equilibrium or harmonious relationship b/w thought processes and the
environment.
 PIAGET’S PHASES OF COGNITIVE DEVELOPMENT
PHASE AGE DESCRIPTION
Sensorimotor Birth to 2 yrs Sensory organs & muscles become more
functional
Stage 1: Use of reflexes Birth to 1 mon Movements are primarily reflexive
Stage 2: Primary circular 1 to 4 months *Perceptions center around one’s body.
reaction *Objects are perceived as extensions of the
self
Stage 3: Secondary circular 4 to 8 months *Becomes aware of external environment
reaction *Initiates acts to change the environment
Stage 4: Coordination of 8 to 12 months Differentiate goals and goal-directed
secondary schemata activities.
Stage 5: Tertiary circular 12 to 18 *Experiments w/ methods to reach goals
reaction months *Develops rituals that become significant
Stage 6: Invention of new 18 to 24 *Uses mental imagery to understand the
means months envi.
*Uses fantasy (make-believe)
 PIAGET’S PHASES OF COGNITIVE
DEVELOPMENT
PHASE AGE DESCRIPTION
Preoperational 2 to 7 years Emerging ability to think

Preconceptual stage 2 to 4 years *Thinking tends to be egocentric

*Exhibits use of symbolism
Intuitive stage 4 to 7 years *Unable to break down a whole into
separate parts.
*Able to classify objects according
to one trait
Concrete operations 7 to 11 years Learns to reason about events in the
here and now
Formal operations 11+ years Able to see relationships and to
reason in the abstract
 KOHLBERG’S STAGES OF
MORAL DEVELOPMENT
 Developed a theory on the way children gain
knowledge of right and wrong or moral reasoning.
 He described changes in thinking about moral
judgments and reflected social norms and values.
 He was interested in the underlying rationale for the
moral decisions rather than the decision itself.
 He also believed the process of moral development
was influenced by:
 Internal factor includes: empathy, intelligence, impulse
control, ability to judge.
 External factors includes: rewards, punishment, family
structure, parent/perr contracts.
 KOHLBERG’S STAGES OF MORAL
DEVELOPMENT
LEVEL AND STAGE DESCRIPTION
Level I: Preconventional Authority figures are obeyed
(self-centered orientation)
Age 4 to 10 years Misbehavior is viewed in terms
of damage done.
Stage 1: Punishment & A deed is perceived as “wrong”
obedience orientation if one is punished; the activity
is “right” if one is not punished.
Stage 2: Hedonistic and “Right” is defined as acceptable
instrumental orientation to and approved by the self.
When actions satisfy one’s
needs, they are “right”.
 KOHLBERG’S STAGES OF MORAL
DEVELOPMENT
Level II: Conventional
Age 10 to 13, but can go into
adolescence
Stage 3: Good boy/girl
orientation
Stage 4: Law-and-order
orientation
Cordial interpersonal
relationships are maintained.
(able to see victim’s
perspective)
Approval of other’s is sought
through one’s action.
Authority is respected.
Individual feels “duty-bound”
to maintain social order.
Behavior is “right" when it
conforms to the rules.
 KOHLBERG’S STAGES OF MORAL
DEVELOPMENT
Level III: Postconventional
Adolescence and beyond
Stage 5: Social contract orientation
Stage 6: Hierarchy of principles
orientation
Individual understands the morality of
having democratically established
laws. (underlying ethical principles
are considered that include societal
needs)
It is “wrong” to violate others’ rights
Judgments based on principles of
justice, respect for dignity of human
beings as individuals- do to others as
you would have them do to you.
The Healthy Child: Stages of G & D
INFANT (1 month to 1year)
B. Psychosocial
Development
 Depends on the quality
of relationship b/w
caregiver and infant.
 If needs are met
consistently, it results
in feelings of physical
comfort and emotional
security.
 Infants to love and be
loved.
INFANT (1 month to 1year)
B. Physical Growth and Development – there is rapid
gain in physical size & maturation.
 Length – grows 20 inches at birth; 30 inches at 1 year
(50% increase by 1 year): grows 1 inch every month for 6
months, then ½ inch every month during the last 6 months.
 Weight – gains 1 ½ Ibs/month; doubles body weight by 5-6
months; triples body weight by 1 year.
 Head Circumference – HC is greater than chest
circumference until age 2.
 Vital Signs – PR=80-150/min (ave=100/min); RR=20-
50/min
Fontanels
 Anterior – diamond shaped; closes at 12-18 months
 Posterior – triangle shaped; closes at 2 months
Teeth
 4-8 months: central mandibular incisors
 By 1 year – has 8 teeth
Sleep
 0-6 months – sleeps thru the night
 8-9 months – sleeps 10-12 hours at night
Play
 Solitary – purpose is to stimulate sensorimotor
development.
 Toys: safe, simple, stimulating, easily handled, washable
 Types: mobiles, musical, rattles, squeeze & sponge toys
9-12 months: activity box, balls, blocks, pots & pans
 Games: peek-a-boo
Nutrition: breast milk – 0-6 months
 Caloric needs: NB needs 400 kcal/day; 1 year needs 1,200
kcal/day.
 Cereals/solids: introduced at 4-6 months; then at 6-7

months strained fruits and vegetables.

Note: does not need solid food before 4 months because
salivary enzymes and intestinal antibodies to aid digestion
are not present until 4-6 months; extrusion reflex lasts
until 3-4 months and chewing movement begin at 7-9
months.
 Ground/pureed meat: given at 8-9 months, chewable finger

foods introduced when teething begins.

 Egg yolks: delay egg whites until 12 months due to

allergies. At 10 months, baby can drink independently from

a cup.
 MAJOR NEONATAL REFLEXES
REFLEX DESCRIPTION

Rooting Turning the mouth and nose in the direction of any facial
touch
Sucking Using the tongue and mouth to take in liquid or food

Swallowing Movement of throat muscles to push food from mouth to

esophagus
Grasp Firm contraction of hand muscles around an object

Babinski When foot stroked, toes fan upward and outward

Moro When startled, arms and legs swing quickly out, then
immediately back and neonate curls up into a ball
 REFLEX DESCRIPTION

Smiling Turning lips upward; neonate looks “happy”

Blinking Rapid closing and opening of eyelids

Sneezing A violent, spasmodic, sudden expiration of breath

Coughing Explosively expelling air from the lungs

Crying Making a loud, wailing sound

Tonic neck When head is turned to side, arm and leg on same side are
extended in a fencing posture
Extrusion Tongue pushes outward when touched by an object at the
tip
Head turning Moving face to one side or the other when airway is
blocked by a surface such as a bed or pillow
TODDLER (1 TO 3 YEARS OLD)
B. Psychosocial
 G & D is a period of exploration, negativism and
ritualism
 All activities attribute to independence
C. Physical G & D
 Birth weight – quadruples, general appearance: pot-
bellied, wide-based gait
 Vital signs – pulse & respiration decrease, BP
increases with size and age
 Teeth – all 20 deciduous teeth present by 2 ½ - 3
years.
Play (parallel)
 Child will play beside but not with another child.
 Purpose: stimulate motor development and help
make transition from solitary to cooperative play.
 Types: should allow for self-play and be action-
oriented. Ex: Push & pull toys, blocks, balls, dolls,
stuffed toys, clay, paints, crayons, coloring, wood
puzzles.
 Games: “rough and tumble play”, like to throw
and retrieve objects.
Nutrition: needs an average of 1,300 kcal/day
 Has “physiological anorexia” – eats a great deal one day
& little the next. Growth slows, has ritualistic food
preferences like finger foods.
 Prone to Iron Deficiency Anemia (IDA), dehydration,
Upper Respi Infection (URI), tonsillitis & Otitis media.
 Guide to parents: recognize ritualistic needs (same utensils,
chair); don’t force child to eat; don’t give bottle as a
substitute for solid foods.
Dental Care
 2 ½ to 3 years – first visit to dentist as soon as all primary
teeth have erupted.
 Brush teeth 2x/day; limit concentrated sweets, don’t allow
child to take a bottle containing milk or juice at night since
bottle mouth caries may result.
Toileting Practices – learning bowel & bladder control
is one of the major tasks of toddler hood. Uses
toileting activities to control self & others.
 18 months – has bowel control
 2 to 3 years – has day time bladder control
 3 to 4 years – has night time bladder control

Limit Setting & Discipline

 Help child to learn self-control and socially appropriate
behavior
 Discipline should occur immediately after wrongdoing; be
firm and consistent when enforcing limits; disapprove of
the behavior not the child.
 Positive approach is best

Common Accidents – falls, poisonous ingestion, burns

and drowning.
PRE-SCHOOLER (3-6 YEARS)
b. Psychosocial development
 A period of curiosity, discovery, imaginary fears and
fantasies.
 Child learns to do things, derives satisfaction from
activities.
 Imitates role models; has active imagination; may
have imaginary friends; has exaggerated fears
c. Physical G & D
 Gains 4-5 Ibs/year
 Thinner, taller, more erect
Stuttering
 Is fairly common among toddlers and pre-schooler.
 Parents should ignore stuttering so that the child does not
become anxious.
Sleep
 Requires 9 to 12 hours sleep each night.
 Sleep problems are most common.
 Child may awaken with nightmares and may have fears of
the dark.
Play (cooperative)
 Purpose – help child to share and play in small groups;
learns simple games & rules, language concepts & social
roles. Play maybe creative, imitative and dramatic
 Types: dolls, dress-up clothes, housekeeping toys, wagons,
tricycle, picture books, jigsaw puzzles, materials for
cutting, pasting and painting.
Nutrition
 Needs an average 1700 kcal/day.
 A slow growth period, appetite remains decreased; has
definite food preferences.
Sexuality
 Knows sex differences by 3 years
 Imitates feminine or masculine behavior
 Gender identity well established by 6 years
 Masturbation is normal – may increase in frequency when
under stress.
Guidelines for Caregivers
 Answer questions – simple, honestly and matter of fact
 For masturbation – redirect child’s attention w/out
punishing or verbally reprimanding.
SCHOOL AGE (6 TO 12 YEARS)
A. Psychosocial Development – develops a sense of
competency and esteem academically, physically &
socially; assumes more responsibility. Gains competency
in mastering new skills and tasks.>
 More responsive to peers; has best friends; desire for
accomplishment so strong that young school child may try to
change rules of game to win.
 School phobias may occur as a result of increase competition
and desire to succeed.
B. Physical G & D
 Height: growth is slow & regular (1-2 inch gain in height per
year); Females usually taller than males.
 Weight: 3 to 6 Ibs weight gain per year.
Play (cooperative)
 Team, rule-governed; same sex together.
 Purpose – learn to cooperate, compromise, develop logical
reasoning abilities, to bargain and increase social skills.
 Types – entertainment, play figures, trains, model kits,
games and jigsaw puzzles, storybooks, adventure-mystery,
riding a bike, sports, music, dancing lessons.
Nutrition
 needs an average of 2,400 cal/day. Appetite increases
 Breakfast is important for school performance and more
likely to eat junk foods.
Dental health
 5 to 7 years – loss of deciduous teeth & eruption of
permanent ones; dental caries are a major dental problems.
ADOLESCENT (12-20 YEARS OLD)
 Begins at puberty and ends when physical

maturity is achieved.
 It is an essential period in sexual

development and formation of personality.

 Asks, “Who am I?” “What do I want to do

with life?”
Nutrition
 Girls need 2,200 cal/day. Boys need 2,700 cal/day

 Appetite increases with rapid growth; increased

need for protein, iron, calcium & zinc

 Eating habits are easily influenced by peer group

 Intake of junk foods, fad diets can lead to obesity,

bulimia, anorexia nervosa, iron deficiency anemia.

YOUNG AND MIDDLE ADULTHOOD
 Developmental state and function characterized by self-

sufficiency in pursuit or occupation/vocation and defined

interpersonal relationships.
 Physical/cognitive

 Stabilized growth rate (weight is variable) and

functioning
 Refines formal operational abilities

 Undergoes menopause

 Begins physical degeneration

 Psychosocial

 Develops self-sufficiency

 Pursues vocation/occupation

 Has intense interpersonal relationships (most frequently

marriage and children)

LATE ADULTHOOD
Physical / cognitive
 Has general slowing of physical and cognitive

functioning
Psychosocial
 Needs to establish highest degree of independence

(self-sufficiency) physically possible by adopting

environment to ability.
 Reflects on life accomplishments, events and

experiences
 Continues interpersonal relationships despite

changes and loss.

 PROMOTING HEALTHY G & D
Ensuring the health of the child, the growing
years is accomplished in the following ways:
 Providing adequate nutrition
 Providing for dental health
 Meeting basic emotional needs
 Immunizing against infectious diseases
 Protecting from harmful accidents
 Giving continuous health supervision
Health promotion during infancy
Feeding milestones:
 At birth, the full term infant has sucking, rooting and

swallowing reflexes.
 Newborn feels hunger and indicates desire for food by crying,

expresses satisfaction by contentedly falling asleep.

 At one month, has strong extrusion reflex

 By 5-6 months, can use fingers to eat, teething crackers.

 By 6-7 months is developmentally ready to chew solids.

 By 8-9 months, can hold a spoon and play with it during

feedings.
 By 9 months can hold bottle.

 By 12 months can drink from a cup.

 Guidelines for infant feeding
 Breast milk is the most complete diet for the 1st 6 months of
life. Iron fortified formula is an acceptable alternative to
breastfeeding.
 Water or milk requirement is 125-150 ml/kg/day from 0-6
months.
 Solids are not recommended before 4-6 months because
salivary enzymes are not present and chewing movements
begins at 7-9 months.
 Rice cereals are given because of its low allergic potential.
First solids are strained, pureed, mashed.
 Finger foods are toast, crackers; fruits are introduced at 6-7
months.
 Chopped table food can be started at 9-12 months.
 Fruit juices should be offered from a cup ASAP to reduce the
development of nursing bottle carries.
 Methods
 Feed when the baby is hungry, hold or cuddle the
baby when feeding.
 Introduce one food at a time usually at intervals of 4-
7 days to allow for identification of food allergies.
 Use small spoon with straight handle, begin spoon
feeding by placing food at the back of the tongue.
 Gradually reduce milk as solid food increases to
prevent overfeeding. Never mix food with formula
bottle.
 Weaning
 Readiness develops during 2nd half of the
first year because of pleasure from
receiving food by a spoon and desire for
more freedom and control over body and
environment.
 Gradually replace one bottle at a time

with cup and finally end with a nighttime

bottle. After 6 months, wean directly to a
cup.
 Immunizations against diseases
 Immunizations – the process whereby a person
becomes immune or able to resist diseases.
 It serves to be the safest, most effective and least
expensive, method of preventing illness.
 Active immunity – the person produces its own
antibodies.
 Passive immunity – when readymade antibodies are
injected into an individual to provide immediate
immunity to some diseases, which is temporary.
 Contraindications
 Severe febrile illness
 Has an altered immune system

 Has a history of allergic response prior to

vaccination
 Recently acquired passive immunity like

blood transfusion, immunoglobulin

(antibodies).
 Common vaccines
 BCG – preliminary dose: 1-14 months; booster dose: school
entry.
 Diphtheria, Pertusis, Tetanus (DPT) – P: 2, 4, 6 months / B1: 1
year after / B2: 4-6 years.
 Hepa B vaccine – P: 0,1,6 months / B: 5 years after.
 Polio – P: 2,4,6 months / B1 – 1 year after / B2 – 4-6 years.
 Measles – P: 9 months as order / B1 – 15 months / B2 – 5-12
years.
 Mumps, Rubella (German measles) – MMR – 12 months as
order / B – 5 to 12 years after.
 Varicella (Chicken pox) – 1st dose: 9 months to 12 years / 2nd
dose: 13 years.
 Meningococcemia
 Hemophilus Influenza B (HIB) – 2 months to 5 years.
 Dental health
 Usually starts from lower front incisors at about 6
months of age.
 It’s normal to see teething begins as early as 3-4
months or as late as 1 year old.
 The child will experience some discomforts when
teething like: crankiness, restlessness, temporary loss
of appetite.
 Management: give the child something to chew on
such rubber teething ring in order to relieve sore
gums.
 During this period multivitamins containing fluoride
maybe given.
 THE IMPORTANCE OF PLAY
 Play is an excellent stress reducer and tension
reliever.
 Play provides a source of diversional activity,
alleviating separation anxiety.
 Play provides the child with a sense of safety and
security.
 Developmentally appropriate play fosters the child’s
normal G & D, especially for children who are
repeatedly hospitalized for chronic conditions.
 Play puts the child in the driver’s seat, allowing him
to make choices and giving him a sense of control.
 FUNCTIONS OF PLAY
1. Physical and motor development
2. Social development
3. Emotional expression
4. Intellectual education
5. Development of moral values
6. Recreational
 Criteria for judging the suitability of toys:
1. Safety – the most important
2. Compatibility or suitability to:
 Child age
 Level of development
 Experience
3. Usefulness
 Challenge to the development of the child
 Enhancing personality, social and moral development
 Expressing emotions
 Achieving mastery
 Developing creativity
 Implementing therapeutic procedures
 Means to cope with fears
ILLNESS AND HOSPITALIZATION
A. REACTIONS TO ILLNESS
 There are no general findings regarding the response

of preverbal children to illness or fear of bodily

injury.
 Younger infants respond to pain with generalized

body responses including, loud crying and some

facial gestures.
 Older infants respond with generalized body

responses and deliberate withdrawal of the stimulated

area, loud crying, facial gestures and anger and
physical resistance.
B. REACTIONS TO HOSPITALIZATION
 Infants under age 3 months tolerate short-term

hospitalization well if provided with a

nurturing person who meets their physical
needs consistently.
 Between 4 and 6 months infants begin to

recognize mother and father as separate from

self (known as “stranger anxiety”); therefore,
infants at this age may also experience
separation anxiety when hospitalized.
 NURSING MANAGEMENT
1. Provide general interventions
 Spend time with parents within the infant’s sight so the
baby identifies you as safe person.
 Allow the parents to provide as much of the care as
possible.
 Follow the infant’s home schedule (eg, feeding times and
bedtime) as closely as possible.
 Provide sensorimotor stimulation
2. Provide physical comfort and safety interventions
 Keep the infant warm and dry
 Meet hunger needs consistently
 Ensure safety
3. Provide cognitive interventions
 Provide a variety of stimulating toys (eg, mobiles, music
boxes, busy boxes, rattles)
 Promote language development (eg, make sounds and
talk to infants)
 Encourage learning through sensorimotor experience (eg,
allow repetition of acts and a variety of toys and textures
for manipulation)
4. Provide psychosocial and emotional interventions
 Maintain a good relationship with parents of children in
all age groups, encouraging them to give care, hold the
child, play with the child and room in with the child as
appropriate.
 Maintain consistent staffing
 Promote a sense of security (eg, handle gently, cuddle,
talk and respond to cues)
 CONCEPTS OF DEATH IN CHILDHOOD
Developmental Stage Concept of Death
Infancy None

Early childhood Knows the words “dead” and “death”

•

* Reactions are influenced by the attitudes of

parents.
Middle childhood *Understands universality and irreversibility of
death
*May have a fear of parents dying
Late childhood *Begins to incorporate family and cultural beliefs
about death
*Explores views of an afterlife
*Faces the reality of own mortality

Adolescence *Adult perception of death, but still focused on the

“here and now”