Piaget theory

Cognitive Theory
Schema Assimilation Accommodation
Frame of Work Incorporation of the new ideas Change scheme
- Organized information is the Adaptation (adjustment to the - Ability to change the mental
mental model to understand the world). structure so that new experience
world. Ability to incorporate new ideas can be added.
- Building block or framework of and experiences into framework.
knowledge.
- Mental representation of the world
- Infants

Piaget Stages
Sensorimotor stage (0-2 years)
→ Cordination of senses with motor responses, sensory curiosity about the word.
Lenguage used for demands and cataloguing
→ Object permanence is develop
→ Ex: Pressurable with lactation

Preoperaional stage (2-7 years)

→ Symbolic thinking, learns to think in term of pass, present and future, but is
unable to conceptualice
♦ Death =Reversible
→ Imagination and intuition are strong
♦ Imaginary friends and le dan vida a los juguetes
→ Egocentic expected
♦ Inability to understand another position or put him or her self in the place of
others
→ Concervation of substan is develop after 7 years (dinero y sustancias)

Concrete operational stage (7-11 years)

→ Concepts are attachet to concrete situation,
→ Time, space, and quantity are undertood and can be applied but not as
independent concepts

Formal operational stage (11 years and older)

→ Theorical, hypothentical, and cownter factual thinking
→ Abstract logic and reasoning
→ Concepts learned in one context can be apply to another

Sigmond Freud Psychosexual Development

ID (at birth) EGO (4-5months) SUPEREGO (3-6 years)
Source of driver present at birth Reality testing and problem solving. Necessary part of socialization

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According to the pleasurable Begins it development 4-5 month of Develop from interaction with
principle life. the child and parents during
Act immediately in an impulsive distinguished between things in the childhood.
irrational way and pay no minds and things in the external Include internalization of the
attention to the consequences. world. values, ideas and moral
Instinctive Ej: Coping mechanism to decrease standards of parents and
anxiety. society.
Voice of conscience
Capacity of self-evaluation and
criticisms. (muy estrictos)

Stages of Freud
1. Oral Stage: (birth – 1year)
The infant is concerned with self-gratification operating in the pleasurable. Ex:
swallowing and sucking).
2. Anal Stage: (1-3 years)
Toilet Training, a child gains pleasure from the elimination of feces or from retention.
3. Phallic Stage: (3-6 years)
Penis and clitoris pleasure (masturbation is ok). Electra Complex (girl sexual attraction
for her father). Oedipus Complex (boy sexual attraction for his mother).
Nota: Aquí También el varón puede sentirse atraído por el varón.
4. Latency Stage: (6-12years)
Little or no sexual motivation.
Sexual impulses are changed and elevated into a more culturally accepted level of
activity.
Boy plays with boys
Girl plays with girls
5. Genital Stage (> 12 years)
Sexual Intercourse
Sexual Emotion.
Emerges with onset puberty when genitals organs matured
The individual gains gratification from his/her own body.

Psychosocial Erickson
1. Trust and Mistrust (birth-18months)
Feeling a reliable care.
2. Autonomy vs Shame and Doubt (18-3 years)
Tantrum
Egocentrism (no sharing)
Everything is NO.
3. Initiative vs Guilt (3-5years)
Exploration of the world.
Imaginary Friends
Idea of reversible Death (or punishment)
4. Industry vs Inferiority (6-12years)

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 No friends at school or sport
5. Identity vs Role Confusion (12-19years)
Peer is Pressure
Soy o no soy
6. Intimacy vs Isolation (20-35years)
Love
Married
Children
7. Generativity vs Stagnation (35-65years)
Work
Society
Family
Balance.
8. Ego Integrity vs despair (+ 65 years)
Depression
Suicide

Growth and Development

Infant (0-1year)

1. Birth weight
✓ 2x BW→ 6 months
✓ 3x BW→12 months
2. Fontanelle
✓ Anterior close 12-18 months
✓ Posterior close 3-4 months
3. Dentition
✓ Drooling 4 months
✓ First teeth 6-9 months
✓ After 1st teeth appear start dental evaluation
1st Lower central incisors
Next upper central incisor
Last upper and lower incisor
✓ 1 year →6-8 Teeth
✓ No toothpaste should be USED
✓ Never put to sleep with a bottle filled with formula or milk.
4. Pseudo strabismus expected until 6 months
5. Nutrition
✓ 1st Food 4-6 months
✓ Rice-Cereal or Fortified Cereal

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 ✓ Breast. Feeding for at least 6 months
✓ Whole milk 1 year
✓ Introduce one food at a time per week.

6. Steady head control 3-4 months

7. Social Smile 3 months
8. Sit supported 6 months
✓ Sit unsupported 8 months
✓ Rolls from back to side 4 months
✓ Rolls from abdomen to back 5 months
✓ Rolls from back to abdomen 6 months
9. Say mama/dada 8months
✓ Monosyllabic bubbling 3-6 months
10. Pincer Grasp 9-10 months

11. Crawls 9-10 months

12. Standing alone and walking with help 12 months
Solitary Play
o 1-2 months music hanging mobiles
o 3-4 months Rattles (no pewter) (maracas)
o 5-6 months play: pick a boo
▪ Pat a cake (tortica de manteca)
▪ Mirrors (metal o plastic)
▪ Nesting blocks (suavecitos)
▪ Soft Toys.
o 9 months Pats and Pans
o 12months Push and pulls toys.
Hospitalization (after 6 months)
₪ Separation Anxiety (until toddlers)
₪ Fear of stranger
₪ During Physical examination put sucrose in the pacifier.
Nota: Do not give honey before 1 year old.

Safety
1. Car Seat back in the middle rear facing until 1 year or 20 pounds.
2. Forward facing until 40 pounds.
3. After 40 pounds booster seat.
4. No balloons or plastic bag.
5. Use a one-piece pacifier.
6. Raise up crib rails (fijos) and rails no more than 2-3 inches apart.
7. Cover all electrical sockets

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 8. Place it away windows and curtains.

Toddlers (1-3 years)

▪ Walk without help 13-15 months

▪ Goes up stairs with both feet in each step (24months)
▪ Play Parallel= One to side of other imitate but not share.
▪ Push and Pulls
▪ Large balls
▪ Puzzle 4 blocks

Toilet Training 18-24 months (pathology after 24 months)

▪ Readiness for toilet training:
1. Stay dry for 2 hours
2. Waking up dry after a nap
3. Able to sit, squat and walk.
4. Able to remove clothing.
5. Recognizes the urge to urinate or defecate.
6. Express willingness to please parents.
7. Able to sit on toilet for 5-10 minutes without getting up.

Separation Anxiety (after 6 months)

✓ Place favorite blanket or toy in crib or bed.
✓ Schedule activities like home.
✓ During physical examination toddler allow patter rooming with the child

Prevention of ritualistic behavior (like NO or Tantrum)

1. Avoid abrupt end of playing.
2. Schedule activities.
3. Only allow 2 choices.
4. Ignoring behavior During Tantrum, do not leave them lock in the room or by
themselves.
Nutrition
✓ Finger Food
✓ Physiologic decreased of appetite (cuando lo embute provoca Milk Anemia or
Iron deficiency) (decreased milk intake at 32 oz x day)
Animism: Belief than things such as toys and dolls have human abilities.

Safety
1. Syrup Ipecac is contraindicated
2. Secure Staircase (up and down)

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 3. Medicine, poison, house hold plants lock in a cabinet.
Board: ask what kind of plant.
4. Keep bathroom lock.
5. Turn pat handles inward and toward in the middle of the stove.
Board: Fallow up pot handle outward.
6. Keep dangling from small appliances away from toddlers.

Pre-Schooler (3-5years)
1. Ride a Tricycle 3-5 years.
2. Copy a circle 3 years.
3. Walk backwards and downstairs after 3 years without assistant.
4. Hop 1 one 4 years.
5. Catch and throw a ball 4 years.
6. Use scissors 4-5 years.
7. Undress without help 4-5 years.
8. Transient Stuttering (tartamuedo) 3-5 years.
✓ Do not repeat correct word in front of child.
9. Magical Thinking (imaginary friend) 5 years, pre-schooler.
✓ Do not reinforce.
✓ Ignore behavior.
10. Nightmares.
✓ Check the room with child.
✓ Sit with the child and provide comfort until the child is ready to sleep.
11. Play Associative.
✓ Share but don’t follow rules.
✓ Roles Plays:
o Nurse, teacher, police, casitas
o House instrument.
o Dolls
o Trucks
o Coloring books/ finger paints
o Sands box, play ground
o Tricycle/slider board
o Construction toys (legos).
Hospitalization
▪ Regression is expected.
▪ Allow to play with medical equipment:
✓ Stethoscope
✓ Syringe without needle.
Safety
▪ Basic Rules:
✓ Swimming.
✓ Helmet during bicycle.
▪ Teach his/her full name, address, parent’s name and phone number.
▪ Teach them how to dial 911

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School Age (6-12)

▪ High increased 2.5-5cm= 2 inch/year.

▪ Vision 20/20 → 6-7 year.
▪ Susceptible to greenstick fracture.
▪ Check weight (5-95 percentile).
▪ Secondary sex characteristic:
• Girls begin 9-10.
✓ Less than 8 is early puberty (precoz)
• Boys begin 11-12.
✓ Less than 9 years is early puberty (precoz).
▪ Losses 1 deciduous teeth 6 years.
st

• 12 years has all permanent teeth, except final molars.

▪ Play cooperative (comprehends)
• Roles of ritual games:
✓ Swimming ✓ Baseball ✓ Erector sets (de armar)
✓ Soccer ✓ Basketball ✓ Video with PC games
✓ Bicycling ✓ Construction toys ✓ Enjoy Adventure Stories

Hospitalization
▪ Fear to loss control
▪ Explain in simple terms
✓ Draw pictures
✓ Diagrams
✓ Muppets
▪ High risk for child abuse.
Safety
1. Introduce Sex Education
2. Teach proper use of sport equipment.
3. Smoking alcohol risk taking (teaching).

Tanner Stages (girls)

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Breast (Mnemonic)
No Body Elevates 2 Mountain in Adulthood.
1. No glandular tissue.
2. Breast Bud or Budding (9-13 years)
3. Breast Elevation (separation of the contour)
4. Secondary Mount (separation de la areola del peson)
5. Adult Hood (contour).

Pubis Hair (Mnemonic)

She is not small Cat
1. No
2. Small amount
3. Coarse curly (extended bilateral)
4. Adult like Hair
5. Spread to the thighs.

Tanner Stages (Males)

1. Prepuberal.
2. Testicular enlargement plus breast enlargement.
3. Penis growth in length, voice change (+/- 1 year)
4. Penis growth in length/breadths, scrotum darkens.
• Facial hair, ejaculation.
5. Hair growth extends to the thighs, genitals reach adult size and shape.

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Adolescent (11-19years)
1. Peer pressure and separation cause anxiety.
2. Body Imagine disturbance, low self-stem:
✓ Suicide
✓ Anorexia
✓ Bulimia
3. Sebaceous and sweat glands become active and fully functional.
4. Menstrual periods occur 2 ½ years after onset of puberty.
5. Nutrition: High risk for Anemia
✓ Acid Folic
✓ Iron
6. Hospitalization: Choice to participate
✓ Involved in plan of care.
✓ let peer call and visit to the hospital.
✓ Accept emotional outburst (perretas).
Safety
1. Injury prevention
2. Alcohol drugs, pregnancy, STDS. HIV prevention
3. Explain about complications associated with body piercing, tattooing and Sun
tanning

Nota: Ecopraxic= repetir movimientos