Principles of Growth and Development Infancy 1 month 1 year

Toddler 1-3 years

 As children mature, they pass through
Pre-schooler 3-5 years
predictable stages of growth and
School age child 6-12 years
development
Adolescent 13-17 years
 To establish a complete and effective
Late adolescent 18-21 years
nursing care plans for children, it is essential
to understand the normal growth and
development
 An understanding of growth and development
helps the nurses in achieving their goals for
health promotion and disease prevention,
health restoration and maintenance
 Maturity in children involves growth in their
ability to think, to relate to people and to
trust or have confidence in themselves not
just merely becoming taller and heavier as
they get older.

PRINCIPLES OF GROWTH AND

DEVELOPMENT

Terms:

- Growth
- Development
- Maturations
- Cognitive development

Development

 It is defined as an increase in skills or

the ability to function (qualitative FREUD’S PSYCHOSEXUAL THEORY
change)
Sigmund Freud (1856-1939)
 It is measured by observation, child
recording (by parents description of a  He was a physician in Australia, he
child progress), lab test (Denver test II) worked with adults experiencing a variety
of nervous disorders. It led him to
Psychosexual development refers to developing
develop the approach called
instincts or sensual pleasure (Freudian theory)
psychoanalysis.
Psychosocial development “ Erikson’s stages of  Psychoanalysis made him believe that
personality development early childhood experiences from the
unconscious motivations for actions in
Kohlberg’s theory of moral development is the later life
ability to know right from wrong and to apply
this to real-life situation He based his theory on:

Cognitive development refers to the ability to  His observations of he mentally ill

learn o understand from experience acquire and patients he dealth with
retain knowledge and respond to a new situation,  The basic human needs (Maslow’s
and to solve problem (Piaget) Heirarchy of Needs)
 His note of the personality structure
Development task model (Id,ego,superego

 Is skills or growth responsibility arising

at a particular time in an individual life.
 Children are blank pages can be shaped by
learning

Basic Divisions of Childhood

Stage Age of Period

Neonate First 28 days of
life
  Help children achieve bowel and bladder
control without undue emphasis on its
importance.
 If at all possible, continue vowel and
bladder training while child is
hospitalized.

Stage Three: Phallic Phase

Preschool

 The genital area is considered the

specific part in this phase. In which
1. The body site change in each stage development occur over three phases.
according to the changing of physical and  Phase One: child starts to develop a
sexual of the child strong desire to know his own sex
2. In each stage, both of the child and the identity as well as the other sex identity,
caregiver interact with these changes and it is associated with some practices
according to their culture and education such as masturbation, exhibitionism.
3. The child transfer from one stage to the Nursing Implications
nest completely.
4. If the child’s transformation is not  Accept child’s sexual interest, such as
completed, the child will be fixed in this fonding his or her own genitals, as a
stage as he develops in the next stage of normal area of exploration.
his life.  Help parents answer child’s questions
about birth or sexual differences.
Stage One: Oral Phase  Phase Two: in this phase, the development
Infant proceeds and child starts to love his
opposite sex and hate his own sex.
 The mouth is considered the specific part  For example: male child love his own
in this phase. In which all functions that mother and hate his own father (oedipal
mouth do is important to the infant in his or Oedipus comples) as well as the female
first year. child ( Electra complex)
 Phase three; child develop a special fear
from parents because of his bad thinking,
Nursing Implications which will cause smoothing of his feelings
and transfer the hostile feelings to love
 According to this theory, infant sucks for feelings.
enjoyment or relief tension as well as
nourishment. Nursing Implications:
 Provide oral stimulation by giving  The nurse must provide privacy and clear
pacifiers explanations during any procedures
 Do not discourage thumb sucking involving the genital area
 Breastfeeding may provide more
stimulation than formula feeding because Stage Four: Latency Phase
it requires the infant to expend more
energy School

Stage Two: Anal Phase  The children’s libido appears to be

diverted into concrete thinking
Toddler  They distracted in playing, school work in
promoting their skills.
 The anus is considered the specific part
in this phase; in which child begin toilet Nursing Implications
training.
 According to this theory, infant shift his  Helps a child have positive experiences so
interest from the mouth to the anus his or her self-esteem continues to grow
region and the child prepares for the conflicts
of adolescence
Nursing Implications  Provide gowns, covers and underwears at
hospital: knock the door before entering

Stage Five: Genital Phase

Adolescent

 The longest period (from adolescent to

adulthood)
 The suppression in the latent phase is
relieved in this phase due to the sexual
maturity resulted from the secretions of
the sex hormones
 The individual starts to establish a new
sexual aims and find a new love object
with the opposite sex

Nursing Information

 Provide appropriate opportunities for the

individual to relate with opposite sex
 Allow individual to verbalize feelings
about new relationships
What is Intelligence?

 According to Piaget, it is a basic life

function that enables an organism to
adapt to its environment
 All intellectual activity is undertaken with
one goal in mind: cognitive equilibrium

Piagetian Concepts

Example:

Toddler who has never seen anything fly but

birds thinks that all flying objects are birds

STAGES OF THE THEORY

1. The sensorimotor stage (birth to 2 yrs)

2. The preoperational stage ( 2 to 7 yrs)
3. The concrete-operational stage (7 to 11
yrs)
4. The formal-operational stage (11-12 yrs
and beyond)
  Weight
 Height
 Head circumference
 Body proportion
 Body systems
 Teeth
 Infants grow rapidly both in size and in their
ability to perform tasks during their first
year.
 Care visits schedule:
 24 weeks
 2nd month
 4th month
 6th month and
 12th month

Important of care visits:

1. Parent can ask questions about growth

pattern and developmental progress
2. Provider (nurse) can assess potential
problems
3. Immunization

Physical Growth

 Weight: birth weight doubles at 6 months

 It triples at 1 year
 (average 1 y/o boy weighs 10 kg (22 lb)
girl 9.5 kg ( 21lb)
 Height: infants height increases during
the first year by 50% or grows from the
average birth length (50.8 to 76.2 cm
or 20-30 in)
 Head Circumference: by the end of the
first year, the brain has already reached
two thirds of its adult sixe
New born:
 HC= 32-36 cm (12.5-14.1 in)

Body Proportion

 The mandible becomes more prominent

 The lower jaw is prominent
 Chest circumference is equal to head
circumference as early as 6 months and in
most by 12 months
 The abdomen remains protuberant until the
child has been walking well for some time
 Lengthening of the lower extremities during
the last 6 months of infancy readies the
child for walking and often changes the
appearance from “baby like” to “toddler
like”

Body system

 Cardiovascular System:
 Heart rate slows from 120-160
beats to 100 to 120 by the end of
Chapter 29
the first year
Nursing Care of a Family with an Infant  Lightly elevated BP from
80/40mmHg to 100/60mmHg
Growth and Development
  Develop a physiologic anemia 2-3 2: holds head up when prone
month
 Respiratory System: 3: Holds head, shoulders and chest up when
 Respiratory rate slows from 30-60 prone
to 20-30 breaths/min 4: turns back to front, no longer has head lag,
 GI neck righting reflex, able to bear partial weight
 Ability to digest protein is present on feet
and effective at birth
 Amylase, (CHO) deficient until 3 5: turns turn readily front to back, bears weight
month on forearms when prone
 Lipase, is decreased in amount during
6: beginning to show ability to sit
the entire first year
 Liver immature until possibly causing 7: reaches out to be picked up, can sit alone
inadequate conjugation of drug when hands are held, first tooth (central incisor)
 Extrusion reflex 3-4 (food placed on erupts
an infant’s tongue is thrust forward
and out of the mouth) prevents 8: sit securely without support
eating effectively.
9: creeps or crawls (abdomen off floor)
 Adjust to cold is mature by age 6
month 10: pull self to stand
 Immune system functional at 2
months of age; produce both IgG and 11: Crulses walks with support
IgM by 1 year
12: stands alone, some infant take first steps

Fine motor development

0-1: keeps hands fisted, able to follow object to

midline with eyes

2: holds object in few moments and drop,

Typical Eruption pattern of Decidous Teeth demonstrates social smile

3: follow object past midline with eyes

4: brings hands together and pulls clothes;

thumb opposition begins

5: can grasp objects handed using whole hand

6: uses palmar grasp

7: transfers objects hand to hand

10: uses pincer grasp (thumb and finger) to pick

up objects

12: holds cup and spoon well, helps to dress

(pushes arm into sleeve) can hold crayon

Reflexes
Motor Development
2: grasp reflex fading
 Gross motor development
 Ventral suspension position 3: landau reflex develops
 Prone position
4: stepping fading
 Sitting position
 Standing position 6:moro and tonic neck reflex fading
 Fine motor development
 Thumb opposition 12: landau reflex fade
 Pincer grasp
 Rooting reflex
0-1: Large reflex action  Baby’s cheek is stroked
 They respond by turning their head
1: can lift head for a while towards the stimulus
  They start sucking, thus allowing for  Failure of this reflex to appear indicates a
breastfeeding cerebral lesion
 When corner of mouth is touched  Gallant’s reflex
lower lips is lowered, tongue moves  Firm sharp stimulation along sides of the
towards the point stimulated spine with the fingernails or a pin
 When finger slides away head turns procedures contraction of the underlying
to follow it muscles and curving of the back
 When center of lips is stimulated lip  Response is easily seen when the infant is
elevates held upright and the trunk movement is
 Plantar/grasp reflex unrestricted
 Placing objects or finger beneath the  Best seen in the neonatal period and
toes causes curling of toes around the thereafter gradually fades
object
 Present at 32 weeks of gestation Socialization and language
 Disappears at 9-12 months 2: makes cooing sounds, differentiates cry
Clinical significance 3: loughs out loud
 This reflex is referred to as the 6: may say vowel sounds (oh-oh)
readiness tester
 Integrates at the same time that 7: shows beginning fear of strangers
independent gait first becomes possible
8: fear of strangers peaks
 Sucking/swallowing reflex
 Touching lips or placing something in 9: says first word (da-da)
baby’s mouth causes baby to draw liquid
into mouth by creating vacuum with lips, 12: says two words plus ma-ma and da-da
cheeks and tongue
Play
 Babinski’s reflex
 Stimulus consists of a firm painful 0-1: Enjoys watching face of primary caregiver,
stroke along the lateral boarder of the needs play time in prone position
sole from feet to toe
 Response consists of movement 2: enjoys bright colored mobiles
( flexion or extension) of the big toe
3: spends time looking at hands, “tummy time”
and sometimes movement (fanning) of
important during the day
the other toes
 Present at birth, disappears at approx. 4: needs space to practice turning
9-10 months
 Presence of reflex later many indicate 5: handles rattles well
disease
6: enjoys bathtub toys, rubber ring for teething
 Parachute reflex
 Reflex appears at about 6-9 months 7: likes objects that are good size for
and persists thereafter transferring
 Elicited by holding the child in ventral
suspension and suddenly lowering him to 8: enjoys manipulation, rattles, and toys of
the couch different textures
 Arms extend as a defensive reaction
9: needs safe space for creeping
Clinical significance
10: play games like patty-cake and peek-a-boo
 Absent or abnormal in children with
11: crusing can be main activity
cerebral palsy
 Would be asymmetrical in spastic 12: likes toys that fit inside each other (pot and
hemiplegia pans)
 Doll’s eye reflex (Oculocephalic reflex)
 Passive turning of the head of the SOLITARY PLAY
newborn leaves the eye “behind”
 A distinct time lag occurs before the eyes
move to a new position in keeping with the Senses Development
head position
 Disappears at within a week or two of  VISION
birth  1ST month see object in the midline directly
in front of closer than (46 cm)
  Binocular vision 2nd month focus well, so 12 months, most children have overcome their
encourage and teach parent to make a point fear of strangers and responds when approached
of eye to eye contact for vision and
socialization  Primary Circular Reaction by the 3rd month
 Up until 6 months infants may experience of life, an infant explores objects by
difficulty in establishing eye coordination grasping them with the hands or by mouthing
but after 3 months, if eyes still cross them
should be examined by a physician  Secondary Circular Reaction 6 month can
 HEARING initiate pleasurable sensations
 1st month hearing is demonstrated  Coordination of Secondary Schema infants
 10 months, infants recognize their name and of 10 months discover object permanence, r
listen acutely when spoken to become aware an object out of sight still
 By 12 months. Infants can easily locate exists. Infants are ready for peek-a-boo
sound in any direction and turn toward it once they gained the concept of permanence
 A vocabulary of two words plus “mama” and
“dada” also demonstrates an infant can hear
 TOUCH
 An infant needs to be touched to
experience skin to skin contact
 To handle infants with assurance and HEALTH PROMOTION OF AN INFANT AND
gentleness FAMILY
 Advised parents to cuddle an infant next to
their bare chest ( skin to skin contact) 1. Promoting Achievement of Development
 Clothes should feel comfortable and soft Task: Trust vs. Mistrust (Erikson)
 Diapers should be dry rather than wet. 2. Promoting Infant Safety
Teach parents  Aspiration prevention
 TASTE  Fall prevention
 Infants have taste by turning away from or  Car safety
spitting out a taste  Safety with siblings
 SMELL  Bathing and swimming safety
 Infants can smell accurately within 1 or 2  Childproofing
hours after birth 3. Promoting Nutritional Health of an
 They respond to an irritating smell by Infant
drawing back from it  Recommended dietary allowance for an
 They enjoy and learn early in life to infant
identify the familiar smell of breastmilk  Introduction of solid food (between 4
 Teach parents keep irritating odors out of to 6 months) chewing 7-9 months.
the child’s environment Introduce food one at a time every
(3-4 days to identify any allergies)
 Quantities and types of food (cereal,
vegetables, fruit, meat and eggs)
Emotional development
 Establishment of healthy eating
 Cognitive development patterns
 Primary circular reaction  Weaning 6-9 month
 Secondary circular reaction  Self-feeding 6 month
 Object permanence  Vegetarian diet (continue breastfed
or ingest an iron fortified formula
1st month socialization, learning how to interact 4. Promoting Infant Development in daily
with others, is an extensive phenomenon Activities
6 weeks of social smile, it is a major milestone  Bathing
 Diaper area care
Major milestone for assessing  Care of teeth
 Dressing
a- Vision  Exercise (early morning and late
b- Motor control afternoon outside)
c- Intelligence  Sleep (10-12 hours night and several
4 month crying when playing person leave him naps)
5. Promoting Healthy Family Functioning (a
6 month recognize stranger from care giver primary task of parents during the
infant’s need to meet that need)
8 month stranger anxiety (eight month anxiety)
 PARENTAL CONCERNS AND PROBLEMS Physical Growth
RELATED TO NORMAL INFANT
DEVELOPMENT  Weight, height, head circumference, and
body mass index
 Teething  Body contour
 Thumb-sucking  Body systems
 Use of pacifiers  Teeth
 Sleep problems
 Constipation Children in this age (1-2 years) have a growing
 Loose stools sense of autonomy (independence).
 Colic Parents must also grow during this period
 Spitting up
 Diaper dermatitis The parent’s task is
 Baby bottle tooth decay syndrome
 To support their child’s growing
 Obesity in infant
independence with patient and sensitivity
 To learn methods for handling the child’s
frustrations that arise from the search
for autonomy.

Physical Growth begins slow, while developmental

tasks is rapid

1. Weight:
 Child gain only about 2.5 kg (5-6 pounds)
per year
 The subcutaneous fat starts to disappear
at the end of the second year
 They show decrease appetite, so
adequate intake of all nutrients is still
essential to meet energy needs.
Nursing Diagnoses: Infant Growth and
 Weight is calculated for children from 1-
Development
5 years of age by the equation (age 2+8)
 Ineffective breastfeeding related to 2. Height: child gain 12 cm (5 inches) per
maternal fatigue year
 Disturbed sleep pattern (maternal)  Height is calculated for children from 1-5
related to baby’s need to nurse every 2 years of age by the equation (age 5+80)
hours 3. Head Circumference
 Health seeking behaviors related to  Equals or less than chest circumference
adjusting to parenthood at 6 months to 1 year of age
 Delayed growth and development related  By 2 years chest circumference has
to lack of stimulating environment grown greater than that of the head
 Ineffective role performance related to  It increases only about 2 cm during the
new responsibilities within the family second year
4. Body Contour
HEALTH PROMOTION: ACHIEVEMENT OF  Toddlers tend to have a prominent
DEVELOPMENTAL TASK abdomen
 Toddlers have a forward curve of the
Trust versus mistrust
spine at the sacral area (lordosis)
 Met needs  Toddlers walk with a wide distance
 Routines between their feet.
 Rituals
Body systems continue to mature during this
 Consistent caregiver
time:

 Respiration slow slightly but continue to

be mainly abdominal
 The heart rate slows 90 bpm; BP
Chapter 30 increases to about 99/64 mm Hg
 The brain develops to about 90% of its
Nursing Care of a Family with a Toddler
adult size
Growth and Development of Toddler  Stomach secretions become more acid
Developmental milestones  15 month-old children are excited about
interacting with people
 Language development  By 18 months, toddlers imitate the things
 Emotional development they see a parent doing
- Autonomy  Children become aware of gender
- Socialization differences and may point to other
- Play behaviour children and identify them as boy or girl
 Stomach capacity increases to the point a
child can eat three meals a day Play Behavior
 Control of the urinary and anal sphincters
becomes possible with complete  Side by side play (parallel play)
myelination of the spinal cord.  Caution parents that if two toddlers are
 IgG and IgM antibody production going to play side, they must provide
becomes mature at 2 years of age duplicate toys or an argument over one
 The passive immunity obtained during toy is likely to occur.
intrauterine life is no longer operative  The toddlers enjoy toys that require
 Teeth: eight new teeth (the canines and action (dolls that can be squeezed, pulled)
the first molars ) erupt during the second Health promotion of a toddler
year
 All 20 deciduous teeth are generally  Toddlers tend to develop many upper
present by 2.5 to 3 years of age respiratory and ear infections, it is
recommended to have a schedule visits
Language Development 15-18-24 months of life
 A child who is 2 years old should talk two-  This scheduled visits provides an
word and noun-verb simple sentences opportunity for health promotion and
 A word that is used frequently by early detection of any growth and
toddlers is “No” which reflect their development delays.
autonomy development Promoting Toddle Safety
Toddlers use it to when  Accidents are the major cause of death
 They are refusing a task in children of all ages
 They do not understand it  Accidental ingestions (poisoning) are the
 They practice a sound that they have type of accident that occurs most
notices has potent effects on those frequently in toddlers (medication and
around them cleaning products)
 Other accidents that occur frequently in
Language develops most quickly if parents: toddlers include motor vehicle accidents,
burns, falls and playground injuries
 Respect what toddlers have to say
 Make conversation with toddler Activities to ensure toddler safety
 Answering their questions (simple and
brief) 13 to 18 months
 Naming objects as they play with their  Supervising child outdoors
child  Educating child about dangers of throwing,
 When they give their toddler something, hitting
they must name it  Preventing access to electrical outlets,
 Children should not be made to name an chords
object before they can have it. They  Securing gates and doors
should say the word in right way  Maintaining water heater temperature at
 The toddler learn language from imitating 120 to 130 F.
what they hear
 Pronouns are difficult to use, up to 3.5-4 25 to 36 months
years to recognize
 Instructing child on dangers of weapons
Emotional Development and fires, and also how to get help when
feeling scared or in danger
Autonomy versus shame or doubt.  Selecting toys carefully
 They start to do what they want because  Storing matches and lighters out of
they want that and they can do it child’s reach

Socialization
  Instructing child about stranger danger  Healthy food choices for the child,
and good touch/bad touch supervising including raw and cooked vegetables
child closely when in public settings  Healthy snacks between meals, foods
from all food groups, and iron-fortified
Lead Screening cereals use of small portions
 All children between the ages of 6  Limitation of fat content in foods
months and 6 years should be tested  Avoidance of high sugar cereals
periodically for the presence of too much  Child participation in food preparation
lead in their body (lead poisoning)  Avoidance of food as a reward
 Elevated lead levels are caused by eating, Promoting Toddler Development in Daily
chewing, or sucking n objects (such as Activities
windowsills, paint chips, or furniture) that
are covered with lead-based paint. Or Dressing
colored print in newspapers; old water
pipes.  Toddler try to dress themselves but most
 Lead is toxic to body tissue, ingestion of of time in wrong way
it can lead to serious damage to the  Instruct parents to give up from
brain and nervous system, kidneys, and perfection in order to enforce the child’s
red blood cells sense of autonomy.
 Levels as low as 5 ug/dL can cause Growth and Development of a Toddler
learning and behavioural problems
 10ug/dL standard to define lead toxicity Developmental milestone
 High levels may result in seizures,
Cognitive development
cognitive challenges, coma and even death
 Beginning symptoms of lead poisoning  Deferred imitation
include irritability, headache, fatigue, and  Preoperational thought
abdominal pain  Assimilation
Promoting Nutritional Health of a Toddler Parental Concerns During the Toddler Year
 A toddler’s appetite becomes lesser than  Toilet training
the infant  Ritualistic behaviour
 They should consume 1,000-1,400 kcal  Negativism
daily  Discipline
 Protein and carbohydrate needs are often  Separation anxiety
easily met during the toddler period  Temper tantrums
 Diets in high in sugar should be avoided
(to prevent toddler obesity) Toilet Training
 Fats should generally not be restricted
 Toilet training is an individualized task
for children under 2 years old
for each child. It should begin and be
 Adequate calcium and phosphorus intake
completed according to a child’s ability to
is important for bone mineralization
accomplish it, not according to a set
Teaching, Toddler Nutrition schedule.
 Before children can begin to be toilet
13 to 18 months trained, they must have reached three
important developmental levels, one
 Discontinuation bottle feeding
physiologic and the other two cognitive
 Offering of textured solids as small
1. They must have control of rectal and
portions and frequent feedings
urethral sphincters, usually achieved at
 Continued used of spoon and self-feeding
the time they walk well.
 Avoidance of force feeding
2. They must have a cognitive understanding
 Use of healthy snacks
of what it means to hold urine and stools
19-24 months until they can release them at a certain
place and time.
 Use of drinking water for thirst 3. They must have a desire to delay
 Limitation of fluids before meals immediate gratification for a more
 Inclusion of foods high in iron and protein socially accepted action.
 Regularity of meal times
Temper Tantrums
25 to 36 months
  Temper tantrums occur most often when  This universal fear of this age group is
children are: known as separation anxiety. For this
1. Tired reason, toddlers have difficulty accepting
2. May be a response to an unrealistic being separated from their primary
request by a parent caregiver
3. May occur if parents are saying “no” too
frequently with regard to such Temper Tantrums

Temper Tantrums Management  Almost every toddler has a temper

tantrum at one time or another. The child
1. Try to determine the reason for the may kick scream, stamp feet, shout, NO,
behaviour lie on the floor, flail arms and legs and
2. Be certain it seems like a tantrum, not bang the head against the floor
something more  Children may even hold their breath until
3. Think through what you do when the child they become cyanotic and fall to the
has a tantrum floor.
 Don’t give either material r emotional
bribes Nursing Diagnosis: Toddler growth and
 Don’t punish the child development
 Don’t demonstrate adult behaviour in  Deficient knowledge related to best
managing temper tantrums method of toilet training
 Risk for injury related to impulsiveness of
toddler
Discipline  Interrupted family process related to
need for close supervision of 2 year old
 Discipline means setting rules or road  Readiness for enhanced family coping
signs so children know what is expected related to parent’s ability to adjust to
of them new needs of child
 Punishment is a consequence that results
from a breakdown in discipline, from the
child’s disregard of the rules that were
learned
 Timeout is technique of helping children
learn that actions have consequences. To
use timeout effectively, parents first
need to be certain their child understand
the rule they are trying to enforce: for
instance, if you hit your brother, you’ll
have timeout.

Negativism

 As part of establishing their identities as

separate individuals, toddlers typically go
through a period of extreme negativism
 They do not want to do anything a parent
wants them to do
 Their reply to every request is a very
definite “no”
 Parent need some help to realize this is
not only a normal phenomenon of
Toddlerhood but also a positive stage in
development
 This change indicates their toddlerhood
has learned he or she is a separate
individual with separate needs.

Separation Anxiety

 Fear of being separated from parents

begins at about 6 months of age and
persists throughout the preschool period
  The preschool period includes ages 3, 4, and 5
years
 Physical growth slows considerably during this
period, personality and cognitive growth are
significant.
 Most children of this age want to do things
for themselves, which puts them at risk of
injury
 Parent’s role is to promote the safety for
their child because they still need help.

Physical Growth

 A definite change in body contour occurs

during the preschool years
 The wide gait, prominent lordosis, and
protuberant abdomen of the toddler change
to slimmer, taller, and much more childlike
proportions
 Contour changes are so definite that future
body type ectomorphic (slim body build) or
endomorphic (large body build) becomes
apparent. Handedness begins to be obvious.
 A major step forward is a child’s ability to
learn extended language, which is achieved
not only by motor but also by cognitive
development.

Body Systems

 Lymphatic tissue begins to increase in size,

particularly the tonsils, and levels of IgG
antibodies increase.
 These changes tend to make preschool
illnesses more localized
 Physiologic splitting of heart sounds may be
present for the first time on auscultation.
 Innocent heart murmurs may also be heard
for the first time. Due to the changing size of
the heart in reference to the thorax as the
chest reach adult proportions.
 Pulse rate decreases to about 85 bpm
 Blood pressure holds at about 100/60 mm Hg
 The bladder is easily palpable above thr
symphysis pubis; voiding is frequent enough (9
or 1 times a day)
 Muscles are noticeably stronger and make
activities such as gymnastics possible
 Many children at the beginning of the period
exhibit genu valgus (knock-knees) this
Chapter 31 disappears with increased skeletal growth at
the end of the preschool period.
Physical growth
Weight
- Height, weight, body mass, and head
circumference  Average weight gain 4.5 lb (2 kg) a year
- Teeth
Height
Assessing Average Preschool
 An increase of about 2 to 3.5 inches (6 to 8
cm ) a year on average
Head circumference 1. Initiative
 The developmental task of the preschool
 Is not routinely measured at physical
years, according to Erikson, is to form a sense
assessment on children over 2 years of age
of initiative versus guilt

Teeth  A child with a well-developed sense of

initiative has discovered that learning new
 Children have all 20 decidous teeth by 3 years things is fun
of age generally  To gain a sense of initiative, pre-schoolers
need exposure
 A wide variety of experiences and play
materials so they can learn as much about the
world as possible.
Language Development

 3 year old child has a vocabulary of about 900

words 2. Imitation
 These are used to ask questions constantly,  Pre-schoolers need free restraint to imitate
up to 400 a day, mostly how and why the roles of the people around them. Role
questions playing should be fun and does not have to be
 A child needs simple answers to such accurate
questions to encourage curiosity, vocabulary  Parents should help and engage in playing or
building, and questioning activity but should not ask the child to
 They enjoy participating in mealtime imitate them
conversation and imitate language exactly 3. Fantasy
 Pre-schoolers begin to make differentiation
between fantasy and reality
 Becomes afraid that they have lost their own
identity or have become “stuck” in their
Preschools are egocentric, they define objects
fantasies
related to themselves.
 So the parents should not both supporting the
What can be done to promote language development: fantasy and yet reassuring a child she is still
himself.
 Engage in play and bath with language
4. Gender roles
 Converse using descriptions, simple questions
 They should exposure to an adult of opposite
and expansion
gender specially the single parent. So they
 Use playful songs
become familiar with opposite gender roles.
 Use correct names
5. Socialization
 Ask open ended questions
 A child who live with other child or exposed
 Express feelings in words
to other children than his parent, have more

Play socialization than other child who live just

with his parents
 Preschools enjoy games that use imitation  Although 4 year olds continue to enjoy groups,
 Many pre-schoolers have imaginary friends as they may become involved in an argument
a normal part of having an active imagination more than they did at age 3.
 Four and 5 year olds divide their time  Five year olds begin to develop best
between rough-housing and imitative play friendships.
 Five year olds are also interested in group 6. Oedipus and Electra Complexes
games or songs they have learned in nursery  An Oedipus complex refers to the strong
school or preschool. emotional attachment a preschool boy
demonstrates toward his mother
Emotional development
 An electra complex is the attachment of a
Developmental tasks preschool girl to her father.

- Initiative Cognitive Development

- Imitation
 Because pre-schoolers do not have mental
- Fantasy
substitution skills, they feel they are always
- Oedipus and electra complexes
right
- Gender roles
 Also, pre-schoolers are not yet aware of the
- Socialization
property of conversation
  Warning a child never to talk with or accept a
ride from a stranger
Moral and Spiritual Development
 Teaching a child how to call for help in an

 Children of preschool age determine right emergency (yelling or dialling the emergency

from wrong based on their parents rule number)

 They have little understanding of the  Describing what police officers look like and

rationale for these rules or even whether the explaining that police officers can help in an

rules are consistent. emergency situation.

 Preschoolers begin to have an element  Explaining the good secret and the bad one.

concept of God if they have been provided

Motor Vehicle and Bicycle Safety
some form of religious training. Belief in an
outside force aids in the development of Head injury is the major cause of death in the
principles. preschool age. Educate parents to put their children
in the back with seat belts on.
Nursing Outcome Evaluation
Promoting Nutritional Health
4 years old
 Offering small servings of food is a good idea,
 Walking, climbing, jumping, and running
so a child is not overwhelmed by the amount
 Riding a tricycle or bicycle with training
on a plate.
wheels
 Encourage parents to make snacks nutritious
 Building a tower of 10 blocks
 Teach parents to make mealtime a happy and
 Drawing a person with 3 parts
enjoyable part of the day foe everyone
 Using short paragraphs with sentences of 4
or 5 words Promoting the Preschool in Daily Activities
 Distinguishing fantasy from reality
Dressing;
 Giving first and last name
 Singing a song  Dressed themselves
 Exposure to experience to choose their
5 years old
clothes
 Walking, climbing, jumping, and running with  They may have mismatched clothes
coordination
Sleep:
 Dressing self independently
 Drawing a person with head, body, arms, and  They do not want nap at morning
legs  Refuse sleep because fear of dark
 Copying a triangle or square  Night walking from nightmares reaches its
 Counting using fingers peak. This means that prechoolers may need a
 Speaking in short paragraphs, with night light.
recognition of most alphabet letters
 Giving own address and phone number Exercise:
 Following rules of interactive peer games
 The preschool period is an active phase
Preschooler Promoting Safety
Bathing:
 By age 4, children may project an attitude of
 As needed, day over day
independence and the ability to take care of
their own needs. Care of teeth
 They still need supervision to be certain they
do not injure themselves or other children.  The tooth brush should be started

 Because pre-schoolers imitate adult rules so  Drink fluoridated water or receive a

well they may imitate taking medicine if they prescribed oral fluoride supplement

see family members doing so  Try to decrease candy and sweet intake

 A good rule for parents is never to take

Night Grinding
medicine in front of children.
Grinding the teeth at night ( usually during sleep), is a
Keeping Children Safe, Strong, and Free
habit of many young children. It can be caused by:

Preschool age is a good time to educate children

 Present of tension
about their safety, which includes:
 Child anxiety
  Child with cerebral palsy of spasticity of jaw FEAR OF SEPARATION
muscles
 Fear of separation continues to be a major
Discipline concern for pre-schoolers.
 Their sense of time is still so distorted
 Pre-schoolers have opinions on things such as
 Relating time and space to something a child
what they want to eat, where they want to go,
knows such as meals, television shows, or a
and what they want to wear
friend’s house, is most effective.
 This may bring them into opposition with their
 For example, stating “mommy will pick you up
parents. So timeout is a good technique to
from preschool after you have had your
correct behaviour for parents throughout the
snack” or showing a child the work site might
preschool years.
be more comforting
 Beating should be never use as a disciple
method can be used such as letting the child
taking responsibilities of his own action
Behavior variations
Possible Unintentional Injury
TELLING TALL TALES
 Motor vehicles
 Stretching stories to make them seem more
 Falls
interesting is a phenomenon frequently
 Drowning
encouraged in this group
 Animal bites
 Caution parents not to encourage this kind of
 Poisoning
storytelling but instead help a child separate
 Burns
fact from fiction by saying
 Community safety
 ”That’s a good story, but now tell me what
really happened”. This conveys the idea a child
has not told the truth, yet does not squash
Parental Concerns During the Preschool Years
imagination or initiative.

Common Fears of the Preschooler

IMAGINARY FRIENDS

 Because preschoolers’ imagination is so active,

 Many pre-schoolers have an imaginary friend
this can lead to a number of fears
who plays with them.
 Fears of dark, mutilation, and separation or
 Parents can help their pre-schooler separate
abandonment are all very real to a pre-
fact from fantasy about their imaginary
schooler.
friend by saying, “ I know rasha is not real,

FEAR OF DARK but if you want to pretend, I’ll set place for
her.” This response helps a child understand
 The tendency to fear the dark is an example what is real and what is fantasy without
of a fear heightened by a child’s vivid restricting a child’s imagination or creativity.
imagination: a stuffed toy by daylight
becomes a threatening monster in the dark. DIFFICULTY SHARING

 Children awaken screaming because of

 Sharing is a concept that first comes to be
nightmares. They may be reluctant to go to
understood around the age of 3 years. Before
bed or to go back to sleep by themselves
this, children engage in parallel play
unless a light is left on.
 Around 3 years of age children begin to

FEAR OF MUTILATION understand that some things are theirs, some

belong to others, and some can belong to
 Fear of mutilation is also significant both. For the first time, they can stand in line
during the preschool age, as revealed by to wait for a drink, take turns using a shovel
the intense reaction of a pre-schooler to at a sandbox, and share a box of crayons.
even a simple injury such as falling and  Sharing does not come easily, however;
scraping a knee. children who are ill or under stress have even
 A child cries afterward not only from the greater difficulty with it than usual.
pain but also from the sight of the injury  Assure parents that sharing is a difficult
 Part of this fear arises because pre- concept to grasp and that, as with most skills,
schoolers do not know which body parts preschoolers need practice to understand and
are essential and which ones like an inch learn it."
 Defining limits and exposing children to these
of scrapped skin can be easily replaced.
three categories (mine, yours, ours) helps
 them determine which objects belong to
which category.
REGRESSION Preparing for a New Sibling

 Some preschoolers, generally in relation to  Introduction of a new sibling is such a major

stress, revert to behavior they previously happening that parents need to take special
outgrew, steps to be certain their preschooler will be
 Help parents understand that regression in prepared.
these circumstances is normal, and a child's  There is no rule as to when this preparation
should begin, but it should be before the time
thumb sucking is little different from the
a child begins to feel the difference the new
parents' reaction to stress (smoking many
baby will make. This is perhaps when the
cigarettes, nail biting, overeating), to make it
mother first begins to look pregnant.
easier for them to accept and understand.
 Removing the stress is the best way to help a Preparing a Child for School
child discontinue this behavior.
 At the end of the preschool period, children
will begin a formal school experience as they
SIBLING COMPETITION
enter kindergarten.
 Jealousy of a brother or sister may first
become evident during the preschool period,
SEX EDUCATION
partly because this is the first time that
children have enough vocabulary to express  Children during the preschool age become
how they feel (know a name to call) and partly
acutely aware of the difference between boys
because preschoolers are more aware of
family roles and how responsibilities at home and girls
are divided.  Explanations should be just as simple: boys
 parents find the problem of jealousy is bigger look different from girls
than they anticipated and welcome a few  An important part of sex education for pre-
suggestions about how to provide more time schoolers is teaching them to avoid sexual
for their preschooler during the day and
abuse, such as not allowing anyone to touch
which activities a preschooler would especially
their body unless they agree it is all right.
enjoy.
BROKEN FLUENCY
 Developing language is such a complicated
process that children from 2 to 6 years of
age typically have some speech difficulty that
parents may interpret as stuttering
 A child may begin to repeat words or
syllables, saying, "I-I- I want a n-n-new spoon
spoon-spoon." This is called broken fluency
(repetition and prolongation of sounds,
syllables, and words).
 It is often referred to as secondary School Age Child
stuttering because a child begins to speak
 The term “school age” is commonly refers to
without this problem and then, during the
preschool years, develops it. children between ages of 6 to 12
 It is a part of normal development and if  Although these years represent a time of
accepted as such, will pass it is resolved most slow physical growth, cognitive growth and
quickly development continue to proceed at rapid
rates.
Broken Fluency resolved quickly if parents follow few
 Children of school age may also be more
simple rules
influenced by the attitudes of their friends
 Do not discuss in the child's presence that he
or she is having difficulty with speech. than previously.

 Listen with patience rather than interrupt or

ask the child to speak more slowly or to start
Physical Growth
over.
 Always talk to the child in a calm, simple way  General growth is slow until puberty. The
to role model slow speech.
child show progressive lower in growth in
 Protect space for the child to talk if there
height and rapid again in weight
are other children in the family
 Do not force a child to speak if he or she  School age children’s annual average weight
does not want to, gain is approximately 1.3 to 2.2 kg. the
 Do not reward a child for fluent speech or increase in height is 2.5 to 5 cm.
punish for nonfluent speech
  As the eye globe reaches its final shape about  At 8 year: understand past, present future
this same time, an adult vision level is  At 10-12 year: vocabulary depend on
achieved. intelligent
 At 6 year 117 cm and 22kg in weight
Development of sexuality in the school age
 At 12 year 150 cm and 44 kg
 Posture becomes more erect. Lordosis and  School age is a process of resolving oedipal
knock-knee appearance disappear. situation
 Scoliosis may become apparent for the first  Less egocentric direct his energy to others
time in late childhood  Child engage in activities they receive
 By 10 years of age, brain growth is complete, satisfaction
so fine motor coordination becomes refined.  Failure lead to sense of inferiority or
inadequacy

Sexual Maturation
Physiological Growth

 Puberty is provoked in this period in response

 Vital signs T: 37 degree Pulse 70-80 bpm
to gonadotropin hormones
 BP:112/60 Respiration 20 Breath/min
 Sexual maturation in girls occurs between 12
 GIT mature to digest food
and 18 years; in boys, between 14 and 20
 Kidney system mature to concentrate urine
 Prepubertal girls usually taller, by about 2
30 cc or ml per hour
inches ( 5 cm) or more, than preadolescent
 Circulatory system heart beat are shifts
boys because their typical growth spurt
from fourth to fifth intercostals space
begins earlier.
 Neurological system are improved memory and
ability to understand Concern of boys
 Immunological sysystem: the main function of
this system is elimination of substance that  Boys are aware of increasing genital size.
are foreign to the body. So lymphoid tissue Hypertrophy of breast tissue (gynecomastia)
reach of greater amount in school than adult. can occur in prepuberty, most often in heavy
 IgG and IgA reach adult levels boys.
 Lymphatic tissue continues to grow up until  They become worried about their chest and
about age 9frontal sinuses develop at about 6 facial hair that not appear yet, so they must
years, so sinus headache becomes a possibility be assured that this hair will be developed
(before that, headache in children is rarely latterly in the puberty years.
caused by a sinus infection).  As seminal fluid is produced, boys begin to
notice ejaculation during sleep, termed
nocturnal emissions.

The left ventricle of the heart enlarges to be strong Concern of Girls

enough to pump blood to the growing body
 A girl notices the change in her pelvic contour
 the innocent heart murmurs may become when she tries on a skirt or dress from the
apparent due to the extra blood crossing year before and realizes her hips are
heart valves becoming broader.
 maturation of the respiratory system leads to  She may misinterpret this finding as a gain in
increased oxygen-carbon dioxide exchange weight and a tempt a crash diet. She can be
reassured that broad bone structure of the
Mental Development
hips is part of an adult female profile
 At 6 year: count to 20, obey command as open  Girls are usually conscious of breast
door, know right arm development. Breast development is not
 At 7 year read clock always symmtrical
 At 8 year know month, days, number count  Preparation for menstruation is important
from 1-20 preparation for future childbearing and for
 At 10-12 year write short letter to friends, the girl’s concept of herself as a woman
use telephone read story, books  Most girls have some menstrual irregularity
during the first year or two after
Vocalization
menarche( the start of menstruation)

 At 6 year: talk full sentence  Girls also need to know that vaginal secretions

 At 7 year: orient time and place, season, will begin to be present.

month
 have enough coordination to walk a straight
line. Many can ride a bicycle.
Age Boys Girls
 6 year old. Gender differences usually begin
9-11 Prepubertal weight Breast: elevation of
to manifest in play: there are “girls games”
gain occurs papilla with breast
bud formation; such as dressing dolls, and “boy games,”
areolar diameter  A 7 year old appears quiets
enlarges  The movement of 8 year olds are more
11-12 Sparse growth of Straight hair along refined than those of younger children, they
straight, downy, the labia. Vaginal ride a bicycle well and enjoy sports such as
slightly pigmented epithelium becomes gymnastics, soccer, and football
hair at base of cornified
 Nine year olds are on the go constantly, as if
penis
they always have a deadline to meet
Scrotum becoming pH of vaginal
textured; growth of secretions acid;  By 10 years of age, they are more interested
penis and testes slight mucous in perfecting their athletic skills than they
begins vaginal discharge were previously
present  Twelve year olds fall into activities with
Sebaceous gland Sebaceous gland intensity and concentration
secretion increases secretion increases
Perspiration Perspiration
increases increases
Dramatic growth Fine Motor Development
spart
 By 6 years, easily tie their shoelaces. They
can cut and paste well and draw a person with
Teeth good detail
 By 7 years this has been called the server
 Deciduous teeth are lost and permanent teeth
“eraser year” because children are never
erupt during the school-age period at 6 years
quiet content with what they have done
of age
 By 8 years, children’s eyes are developed
 The average child gains 28 teeth between 6
enough so they can read regularize type.
and 12 years of age: the central and lateral
 By age 9, their writing behind to look mature
incisors; first, second, and third cuspids; and
and less awkward
first and second molars
 Older school-age children begin to evaluate
Socialization their teachers ability

 Six year old children play in groups, but when

they are tired or under added stress, they
prefer one-to-one contact
 Seven year olds are increasingly aware o Play
family roles and responsibility. Promises must
be kept, because 7 year olds view them as  Play continues to be rough at age 6 years
definite, firm commitments. Child aware to  By 7 years of age, children require more
family, family roles, responsibilities, less props for play than when they are younger.
resistance, less stubborn  To be a police officer, a 7 year old needs a
 Eight year olds actively seek the company of badge and gun, whereas before a pointed
other child. They like the reward system. finger sufficed.
 Nine year olds take the values of their peer  Most girls and boys of this age also enjoy
group very seriously helping in the kitchen with jobs such as
 Although 10 year olds enjoy groups, they also making cookies and salads or frosting cakes
enjoy privacy. Girls become increasingly  8 year olds like table games but hate to lose,
interested in boys and vice by 11 years of age so they tend to avoid competitive games
 Twelve year olds feel more comfortable in  9 year old play hard. They wake in the
social situations than they did the year morning squeeze in some activity before
before school and plan something the moment they
arrive home again
Developmental Milestone  Many 10 year olds spend most of their time
playing hand-held or television remote control
Gross Motor Development
games. Boys and girls play separately at age
 At the beginning of the school age period (age 10, although interest in the opposite sex is
of 6) children endlessly jump and hop. They apparent
  Eleven and 12 year old children enjoy dancing  Most children are hungry after school and
to popular music and playing table games and enjoy a snack when they arrive home
are accommodating enough to be able to play
Needs
with younger siblings who need the rules
modified to their advantage.  Sleep and rest
 Bathing
 Nutrition
Language Development  Exercise and activity
 Dental health
 6 year old talk in full sentences, using
 Education
language easily and with meaning
 Sex education
 Most 7 years old can tell the time in hours,
 Religious education
but they may have trouble with concepts such
as “half”
 At about age 9, they use swear words to
Promoting Development of a School Age Child in
express anger or just to show other children
Daily Activities
they are growing up.
 By 12 years of age, a sense of humor is Dress
apparent. They can carry on an adult
conversation, although stories are limited  Although school age children can fully dress
because of their lack of experience. themselves, they are not good at taking care
of their clothes until later in the school age
Emotional Development years
 This is the right age to teach the children the
 They should have learned to share, to have
importance of caring for their own belongings
discovered that learning is fun and on
adventure, and have learned that doing things Sleep
is more important and more rewarding than
watching things being done.  Younger school age children typically require
10 to 12 hours of sleep each night, and older
ones require about 8 to 10 hours
 Night time terrors may continue during the
Learning to Live with Others
early school years and may actually increase
 A good time to urge children to learn during the first grade as a child reacts to the
compassion and thoughtfulness toward others stress of beginning school.
is during the early school years
Exercise
 Learning to give a present without receiving
one in return or doing a favour without  Exercise need not involve organized sports. It
expecting a reward is also a part of this can come from nighborhood games, walking
process with parents, or bicycle riding
 Children may show empathy toward others as
early as 20 months, but gain cognitively they Hygiene
cannot relate others experiences to their own
 Children of 6 or 7 years of age still need help
until about 6 years of age.
in regulating the bath water temperature and
in cleaning their ears and fingernails
 By age 8, children are generally capable of
Promoting School-Age Safety bathing themselves but may not do it well
because they are too busy to take the time or
School age children are ready for time on their own
because they do not find bathing as important
without direct adult supervision
as their parents do
Promoting Nutritional Health
Care of teeth
 Most school age children have good appetites,
 School age children should visit a dentist
although any meal is influenced by the day’s
atleast twice yearly for a checkup, cleaning,
activity
and possibly a fluoride treatment to
 School age children need breakfast to provide
strengthened and harden the tooth enamel.
enough energy to get them through active
mornings at school. Health Problems of School Age
 1. Phobia from school manifested by vomiting  Adolescents gain their second molars at about
abdominal pain, regression 13 years of a e and their third molars
2. Learning difficulties: reading and writing (wisdom teeth) between lg and 21 years of
problems age.
3. Behaviour problems: Lying, cheating, stealing
Puberty
4. Sexual problem
5. Nutritional problems  Puberty is the stage at which the individual
6. Communicables disease as hepatitis first becomes capable of sexual reproduction.
7. Allergy as asthma, sinusitis, streptococcal  A girl has entered puberty when she begins to
infection menstruate (12 to 18) a boy enters puberty
8. Dental problems when he begins to produce spermatozoa (14-
9. Skeletal problems as bone fracture and 20)
scoliosis  Puberty: period of rapid physical maturation
10. Accident electric shock, drowning, motor involving hormonal & bodily changes that occur
accident primarily during early adolescence
 Menarche: girl's first menstruation, occurs at
approximately age 12 to 13, but has been
declining an average of about 4 months per
decade for past century.
Growth and Development of Adolescence
 Key factor in puberty’s occurrence is body
 Adolescence is the period between 12 and 18 mass-body weight approximating 106 (plus or
to 20 years, a time that serves as a transition minus 3 pounds) can trigger menarche.
between childhood and adulthood.  Puberty's determinants include nutrition,
 It can be divided into an early period (13 to health, heredity & body mass
14 years), a middle period (15 to 1b years),
Growth and Development of an Adolescent #2
and a late period (17 to 20 years).
 Developmental milestones
Physical growth
 Play or recreation
 The major milestones of development in the  More adult forms of recreation
adolescent period are the onset of puberty.  Team loyalty becomes intense
 Adolescents both growth rapidly and mature  Much time talking with peers, face to face or
dramatically during this period electronically
 At first the gain in physical growth is mostly  Part-time job
in weight, feadinq to the stocky, slightly  Charitable endeavors
obese appearance of prepubescence: later
Vital Signs:
comes the thin, tall appearance of late
adolescence. Temperature= 97.5-98.6 degree F
 Individual gain about 30 to 50% of adult
Apical rate= 55-90 bpm (PR 60-100)
weight during adolescence
 On average, girls gain between (7-25 kg) on Respirations= 12-20 breaths/min
the other hand boys gain (7-30 kg)
Blood pressure= 121/70 mmHg (average)
Height
Secondary Sex Changes
 Growth stops with closure of the epiphyseal
lines of long bones. This occurs at about 16 or • The secondary sex characteristics that begin in the
17 years of age in females and about 18 to 20 late school-age period continue to develop during
years of age males adolescence.
 Girls grow 5-20 cm. and cease at about age
Gender differences:
16-17
 Boys grow 10-30 cm. ane ceases at about age  Girls experience increase in height, weight,
18-20 breast development, and pelvic girth with
 Pulse rate and respiratory rate decrease expansion of the uterine tissue. Menarche
slightly (to 70 bpm and 20 breaths/min (onset of the menstrual period) Typically
respectively), and blood pressure increases occur about 2.5 years after secondary sex
slightly (to 120/70 mmHg), reaching adult characteristics begin
levels by late adolescence  Boys experience increase in height, weight,
muscle mass, penis and testicle. Nocturnal
Teeth
 emission of seminal fluid is an overt sign of Major Endocrine Glands Involved in Pubertal Change
puberty. Pituitary gland The

Tanner stages of male sexuality maturity

 13-15 pubic hair abundant and curly, testes,

scrotum, and penis enlarginq further, axillary
hair present, facial hair fin and-downy, voice
change happen.
 15-16 genitalia adult, facial and body hair
present sperm production mature.
 16-17 pubic hair may extend along medial
aspect of thighs, testes. scrotum, and penis
adult size, may have some degree of facial
Developmental Task: Identity Versus Role Confusion
acne (gynecomastia faded)
In late adolescence, the task is to form a sense of
 17-18 end of skeletal growth.
intimacy or form close relationships with persons of
Pubic hair (male & female) development: the opposite as well as the same sex. It is the
concentration on these two tasks that leads to
I- stage I is the prepubertal stage. typical adolescent behavior

2- stage 2 is characterized by sparse, long, The four main areas in which adolescents must
straight downy hair. make gains to achieve a sense of identity

3- stage 3 is characterized by darker, curly hair 1. Accepting their changed body image
that is sparse over the entire pubis.
2. Establishing a value system or what kind of person
4- stage 4 is characterized by dark, curly, and they want to be
abundant hair in the pubic hair in pubic area only.
3. Making a career decision
5- stage 5 is characterized by an adult pattern.
4. Becoming uncontrolled by their parents
Developmental changes resultiæ from hormonal .
influences: • If young people do not achieve a sense of identity,
they develop a sense of role confusion or can have
Body mass increase to adult size. little idea what kind of person they are

 Sebaceous glands are activated.

 Eccrine sweat glands become fully functional.
 Apocrine sweat glands undergo development.
 Body hair is distributed in a characteristics
Body Image
adult-like pattern.
 Adolescents who developed a strong sense of
Hormonal Changes
industry during their school-age years have
 Hormones: powerful chemical substances learned to solve problems and are best
secreted by endocrine glands & carried equipped to adjust to their new body image.
through body by bloodstream  Nurses who care for adolescents can do much
 Hypothalamus: structure in higher portion of to educate them about their bodies and help
brain that monitors eating, drinking & sex them to accept the changes that mark
 Pituitary gland: important endocrine gland maturity.
controls growth & regulates other glands
Self-Esteem
 Gonads: sex glands - testes in males & ovaries
in female  Like body image, self -esteem may undergo
major changes during the adolescent years
Two primacy classes of hormones
and can be challenged by all the changes
 Androgens: male sex hormones that occur during adolescence, including:
 Estrogens: female sex hormones
1. Changes ain one's body and physiologic functioning
 Testosterone: androgen plays important role
in male pubertal development 2. Changes .in feelings and emotional focus
 Estradiol: estrogen plays important role in
3. Changes 'in social relationships ( including
female pubertal development
relationships with both family and friends)
4. Changes 'in family and school expectations wrong to steal from your neighbor’s house?”
with “ it would hurt my neighbour by requiring
All of these factors can have an effect on an
him to spend money to replace what I stole
adolescent's feelings about himself or herself
rather than with the immature response of
sometimes resulting in crisis.
the school age.

Value System
Promotion of an Adolescent and Family

 Adolescents develop values through talking to

Promoting Adolescent Safety
peers. They also need an attentive adult ear ,
someone who will listen to their fears, hopes,  Accidents, most commonly those involving
dreams, and the pressure they feel to be motor vehicles are the leading cause of
somebody, the pressure Of wanting to do death among adolescents.
something and yet not knowing what or how.

Career Decisions

 Part of the feeling of knowing what kind of

person you are is knowing what kind of job you
can do. Promoting Nutritional Health for an Adolescent
 Because of the thousands of opportunities
available today makinq a career decision  Adolescents may always feel are hungry.
becomes more and more difficult. experiencing If adolescents so much growth
eating they habits are unsupervised, they
Emancipation from Parents tend to eat faddish or quick snack foods
rather than more nutritionally sound ones
 Emancipation from parents can become a
because of both hunger and peer pressure.
major issue during the middle and late
Some adolescents turn away from the five
adolescent years or two reasons. Some
pyramid food nourished despite their large
parents may not yet be readv for their child
intake.
to be totally independent. and some
adolescents may not yet be sure they want to Promoting Development of an Adolescent in Daily
be on their own. Activities
 They may fight bitterly for a right- for
example, to stay out until midnight or later • Maintaining adequate nutrition to support rapid
on a weekend- then never use the privilege adolescent growth is essential to continued healthy
once they have gained it. development

Sense of Intimacy • Adequate sleep, hygiene, and exercise are also

important and should become an adolescent's
 Once adolescents have achieved a sense of responsibility rather than the parents'.
identity in early or mid-adolescence, they are
ready to work on a second developmental task • Parents can, however, encouraqe adolescents to
that of achieving a sense of intimacy engage in healthy patterns of riving—primarily
(erikson, 1993 The ability to form intimate through role modeling.
relationships is the sense of trust, the first
Dress and Hygiene
developmental task in infancy.
 Adolescents are capable of total self-care
Cognitive Development
and, because of their body awareness may
 The final stage of cognitive development, the even be overly conscientious about personal
stage of formal operational thought begins at hygiene and appearance.
the age 12 or 13 years and grows in depth
Sleep
over the adolescent years (piaget, 1969). This
step involves the ability to think in abstract  Although it is widely believed adults need 8
terms and use the scientific method to arrive hours of sleep a night some need more and
at conclusions others can adjust to considerably less.
Protein synthesis occurs most readily during
Moral and Spiritual Development
sleep. Because adolescents are buildinq so
 Because adolescents enlarge their thought many new cells, adolescents may need
processes to include formal reasoning, they proporfionately more sleep than school -age
are able to respond to the question, “why is it children during this time.
Exercise  These acts have become a way for
adolescents to make a statement I am
 Adolescents need exercise every day both to
different from you"). Be certain they
maintain muscle tone and to provide an
know the symptoms of •infection at a
outlet for tension.
piercing or tattoo site ( redness, warmness,
drainage, swelling, mild pain) and to report
these to a health care provider if they
occur.

Parental Concerns During the Adolescent Years #1 Fatigue

 Health problems  So many adolescents comment they feel

 Hypertension fatigued to some degree that this can be
 Poor posture considered normal for the age group.
 Body piercing and tattoos  Because fatigue may be a beginninq symptom
 Fatigue of disease, however , it is important be
 Menstrual irregularities investigated as a legitimate concern and not
 Acne underestimated.
 Obesity  Assess an adolescent’s diet, sleep patterns,
and activity schedules, because all can
Parental Concerns During the Adolescent Years #2
contribute greatly to fatigue.
 Sexuality and sexual activity
Menstrual Irregularities
 STDs
 Pregnancy  Menstrual irregularities can be a major
 Homosexuality health concern of adolescent girls as they
 Date rape learn to adjust to their individual body
 Stalking cycles.
 Hazing or bullying  Dysmenorrhea is painful menstruation, it was
thought to be mainly psychological, needing
Parental Concerns During the Adolescent Years #3
no treatment other than reassurance that it
 Substance use disorders was a normal phenomenon and something
 Depression and self-injury women should endure.
 Today, it is known that the pain is caused by
Common Health Problems of an Adolescent the release of prostaglandins in response to
tissue destruction during the ischemic phase
Poor posture
of the menstrual cycle. Prostaglandins
 Many adolescent demonstrate poor posture, a release causes smooth muscle contraction in
tendency to round shoulders and a shambling, the uterus
slouchy walk. This is due in part to the  Dysmenorrhea can also be a symptom of an
imbalance of growth, the skeletal system underlying illness such as PID, uterine
growing a little more rapidly than the muscles myomas (tumors) or endometriosis (abnormal
attached to it. formation of endometrial tissue)
 Poor posture particularly seems to develop in
Management of dysmenorrhea
adolescents who reach adult height before
their peers. They slouch to appear no taller 1. Warm bath
than anyone around them
 Girls especially may slouch to diminish the 2. Heating pads applied to abdomen
appearance of their breast size if they are
3. Exercise
developing more rapidly than their friends
 This also can occur from carrying backpacks 4. Good posture
that are too heavy.
5. Mild analgesic
Body Piercing and Tattoos
6. Diuretics to relieve fluid retention
 Body piercing and tattoos are becoming a
mark of adolescence. Both sexes have ears, 7. Psychotherapy

lips, chins, navels, and breasts pierced and

Pre-menstrual syndrome: immediately preceding
filled with ear rings, or tattoos applied to
menstruation as
arms, legs, or their central body.
  Nervous tension parents, because is not only harmful but also
 Depression illegal.
 Irritability
Assessment of Substance Abuse
 Leg pain
 Anxiety  If adolescents trust health care personnel,
 Headache they will generally admit they have engaged in
 Tender abdomen and breast drug experimentation. Some common findings
 These symptom lead to poor achievement in on the health history that suggest an
schools and emotional upset adolescent is abusing some substance are

Acne
1. Failure to complete assignments in school
 Acne is a self -limiting inflammatory disease
2. Demonstration of poor reasoning ability
that involves t e sebaceous g an s a empty
into hair shafts ( the pilosebaceous unit 3. Decreased school attendance
mainly of the face and shoulders.
 It is the most common skin disorder of 4. Frequent mood swings
adolescence, occurrinq slightly more
5. Deteriorating physical appearance
frequently in boys than girls. The peak age
for the lesions to occur in girls is 4 to 17 6. Recent change in peer group
years: for boys, 16 to 19 years.
 Although not proven, genetic factors may play 7. Expressed negative perceptions of parents

a part in their development Cigarette smoking

Concerns Regarding Attempted Suicide
may also increase the number of
Inflammatory lesions. Leading Causes of Death in Adolescence.

Therapeutic Management  3 leading causes of death in adolescence:

accidents, suicide, & homicide
 The goal of therapy for acne is threefold: (1)
 Suicide is deliberate self -injury with the
decrease sebum formation, 2 prevent
intent to end one's life. Successful suicide
comedones, and (3) control bacterial
occurs more frequently in males than in
proliferation.
females, although more females apparently at

Obesity tempt suicide than males (about 8:1)

 Most overweight adolescents have obese Sexually Transmitted Diseases

parents, suggesting that both inheritance

 Teenagers tend to believe that:
and environment play a part in the
 Sexually transmitted diseases (STD)
development of adolescent obesity.
always happen to someone else.
 Most obese adolescents continue to be obese
 STDs Can be easily cured without any
adults. It can be difficult for adolescents to
harm done
learn to like themselves (achieve a sense of
 STDs are too horrible for a nice young
identity) if they do not like their reflection
person to even hear about.
in a mirror.
Eating disorder
Substance abuse:
 Eating disorder are complex, involving genetic,
 refers to the use of chemicals to improve a
inheritance, physiological factors, cognitive
mental state or induce euphoria,
factors and environmental experiences
 This is so common among adolescents that as
 Anorexia nervosa: is disorder that involve
many as 50% of high school seniors report
voluntary refusal to eat, accompanied by
having experimented with some form of drug
severe loss of body weight without an organic
use occurs in adolescence from a desire to
cause
expand consciousness or to feel more
 Bulimia: individual consistently follow binge
confident and mature
and purge eating pattern (episodes of binge
 It also can be a response to peer pressure or
eating followed by self-inducing vomiting.
a form of adolescent rebellion. This type of
rebellion is more emotionally charged than
acts such as staying out late or wearing
clothing other than those approved by