Unit 2 healthy child

SUBJECT: CHILD HEALTH NURSING UNIT NO:2 THE HEALTHY CHILD GROWTH & DEVELOPMENT OF CHILDREN (0-12 YEARS) PREPARED BY: SANJAY SIR LECTURER GOVT.CON NEW CIVIL HOSPITAL SURAT

INTRODUCTION Today's child is tomorrow's citizen. They are the nation building blocks. - Should it be desired that any nation/ country progresses towards development, it is to be ensured that the growth & development of the children of that nation/ country is executed initially with utmost care and attention. If the country neglects/ faulters on this aspect, it is doomed for a gloomy & unhealthy future of the country as a whole.

Objectives To observe and assess each child in terms of norms for specific levels of growth & development. To identify the developmental deviations. To plan for nursing management and to help in formulating the plan for the total care of each child. To understand better the reason for particular conditions and illnesses that occur in various age groups. To teach parents how to observe and to use their knowledge so that they may help their children achieve optimal growth and development .

GROWTH AND DEVELOPMENT OF CHILDREN Definition of Terms : Growth; Growth encompasses the biological and physiological basis of behavior through the multiplication of cells which results in increase in size The term ‘Growth’ denotes “ a net increase in the size or mass of tissues. It is largely attributed to multiplication of cells and increase in the intracellular substances. Hypertrophy or expansion of cell size contributes to a lesser extent to the process of growth.” --------Dr. O. P. Ghai , AIIMS, Delhi.

Cont’d.. “ Growth- an increase in the number and size of cells as they divide and synthesize new proteins; results in increased size and weight of the whole or any of its parts.” --- Donna L. Wong Nurse Consultant, Oklahoma. “ Growth is the physical increase in size and appearance of the body caused by increasing numbers of new cells.” --- Margaret G. Marks, Nurse Instructor, Pennsylvania.

Growth refers to an increase in physical size of the whole or any of its parts and can be measured in inches or centimeters or in kgs . Growth result because of cell division and the synthesis of protein. It causes a quantitative change in the child's body. Maturation; Maturation generally refers to changes in behavior resulting mainly from the individuals' genetic inheritance rather than from practice such as sequence of sitting, crawling and walking. Little direct learning from the environment involved in the behavior of maturation Cont’d..

Development; It refers to the process of psychological, social, intellectual and physical change that occurs throughout the life span of an individual. It causes a qualitative change in the child's functioning. Development is orderly not haphazard; there is a direct relation between each stage and the next. Development” specifies maturation of functions. It is related to the maturation and myelination of the nervous system and indicates acquisition of a variety of skills for optimal functioning of the individual.” —Dr. O.P. Ghai , AIIMS, New Delhi. Cont’d..

“ Development”- a gradual change and expansion; advancement from a lower to a more advanced stage of complexity; the emerging and expanding of the individual’s capacities through growth, maturation and learning.” ---Donna L. Wong, Nurse Consultant, Okalahoma . “Development is the progressive change in the child’s maturation” ---- Margaret G. Marks, Nurse Instructor, Pennsylvania Cont’d..

Factors Influencing Growth and Development Heredity ; The most important influencing on a child's growth and ultimate size i.e. heredity. Birth length is related primarily to maternal size and intrauterine environment. As the child grows genetic influences are gradually expressed. They are largely responsible for transmission of abnormal genes, familial illnesses etc.

CONTI… 2. Sex ; Sex is determined at conception. After birth, the male infant is both longer and heavier than the female infant. Boys maintain this superiority till 11 yrs of age, than girls mature. Again during pubertal spurt boys are taller than girls. 3. Race and Nationality; Nutrition ; Both prenatal and postnatal nutritional have long lasting effects on growth and ultimate size. At any age malnutrition results in decreased growth of the child.

Environment : a) Physical Surrounding - like of sunshine and poor hygiene may produces differences in rate of growth. b) Climate and Season; Climatic variations influence the child's health. c) Psychological Factors - like inter-relationships with parents, teachers and others may affect growth and development. d) Socio-Economic Factor - like poverty, is associated with poor nutrition. e) Cultural Influences Cont’d..

Intrauterine Environment ; The influence of the intrauterine environment on the child's future development is great. Fetus may suffer when there is: Nutritional deficiencies of mother during pregnancy. Mother is suffering from any endocrine disorder or infectious disease during gestation. Mother is Rh -ve . Mother smokes or takes alcohol or drugs . Faulty placental implantation. IUGR Congenital malformations etc. Conti.....

Deviations from Positive Health : This may be caused by hereditary or congenital conditions, illnesses or injury and may result in altered levels of growth and development. Ordinal Position in the family. 9. Intelligence ; Intelligence is correlated to some degree physical development. Also intelligence influences mental and social development. Cont’d..

10. Hormonal Influences/Endocrine factor like hypothyroidism and hypopituitarism causes retardation. 11. Emotional Factors ; Lack of love and security in childhood may distort the Childs personality and impede emotional maturity. Relationship with significant other persons, mother, father, siblings, teachers, peers play a vital role in the total development of the child. Cont’d..

12. Birth Injuries . 13. Socio-Psychological Factors ; Play an important part in the development of children. The balance between the socio-psychological and physical changes in the child and his environmental and social codes of conduct, determine his final development. Cont’d..

Factors of G & D

Development is Similar for All. All children follow a similar pattern of development with one stage leading into the next. e.g. the baby stands before he walks, the baby draws circle before a square. In no instance is this order normally reversed. The very bright child and the very dull child likewise follow the same developmental sequence as the average. The very bright child develops at a more rapid rate and the very dull at a slower rate. BLUE PRINT OF DEVELOPMENT: ( BASIC PREDICTABLE CHARACTERISTICS OF DEVELOPMENT )

2 Development Proceeds from General to Specific . In mental as well as motor responses general activity always precedes specific activity. Before birth the fetus moves the whole body but is incapable of making specific responses. Generalized body movements occur before fine muscle control is possible. At first the infant can make random movement of the arm. There is a normal sequence in the development of physical abilities just as it is for mental development and emotional and social adequacy. A child should be given an opportunity to practice the skills by either experience or instruction wherever readiness occurs. Cont’d. .

3. Development is Continuous. Development is continuous from the moment of conception to death but occurs at different rates sometimes slowly and sometimes rapidly. What happen at one stage has influence on the following stage. e.g. the speech, in a child does not develop overnight; the child coos, gurgles and babbling sounds are made by the child from the time of birth and keep getting refined into language. Cont’d..

4. Development Proceeds at Different Rates. During the period of growth and development of the total body and its subsystems, growth is sometimes rapid and at times it slows down. Rapid growth occurs during gestation and infancy. In the preschool years growth levels off. It slows down again during school years. A spurt of growth occurs in puberty and early adolescence. The pubertal growth broadens the physical difference among boys and girls. Women become the weaker sex but become physically attractive to men. Cont’d..

5. There is correlation in Development. Correlation in physical and mental abilities is especially marked. There is marked relationship between sexual maturation and patterns of interest and behavior. Cont’d..

6. DEVELOPMENT COMES FROM MATURATION AND LEARNING. The sudden appearance of certain traits that develop through maturation is quite common; for example a baby may start to walk literally overnight. Behavioral changes occur at the time of puberty suddenly without any reason. Cont’d..

Learning is development that comes from exercise and effort on the part of an individual . Unless the child had opportunity for learning, many of his hereditary potentials will never reach their optimum development. A child may have aptitude for musical performance because of his superior neuromuscular organization but if he is deprived of opportunity for practice and systematic training, he will not reach his hereditary potential. Maturation sets limits beyond which development cannot go even if learning is encouraged. Intrinsic growth is the gift of the nature. It can be guided, it can not be created. Innate capacities however should be stimulated by environmental factors. Cont’d..

7. There are Individual Differences: Although the pattern of development is similar for all children, each child follows a predictable pattern in his own way and at his own rate. Each child with his unique heredity and nurture (environment) will progress at its own rate in terms of size, shape, capacity and developmental status. Mental development too is influenced by heredity and environment. Therefore, we can not expect all children of the same age to be ready for the same learning experience at the same time. Cont’d..

8. Early development is more significant than later development. In building the house the foundations are more important than the superstructure, so is the development of physical and mental traits. Unfavorable environmental conditions during prenatal and postnatal period can have damaging effect on the later growth and development of the child. Cont’d..

9. Development proceeds in stages. Development is not abrupt; it proceeds in various stages such as fetal, infancy, babyhood, childhood and adolescence. Cont’d..

10. Predictable patterns of Development. Both during the prenatal and postnatal period, two laws of predictable pattern of development emerge. The Cephalocaudal law. The Proximodistal law. Cont’d..

According to the cephalocaudal law development spreads over the body from the head to foot. This means that improvement in structure and functions of the body comes first in the head region than in the trunk and last in the leg region. According to the proximodistal law development takes placed from near to far that is outward from the central axis of the body towards the extremities. In prenatal period the head and trunk are fairly well developed when the limb buds appear. Slowly the arms lengthen followed by hands and fingers. Functionally too the baby can use his arms before his hands and child can use the whole hand before his fingers. Teeth also follow the predictable pattern of physical development. The lower teeth erupt before the upper teeth Cont’d..

Patterns of Growth Both growth and development proceed in an orderly manner. The development proceeds in a cephalocaudal manner with the CNS leading the other systems and developing far ahead of them.

Neural Growth ; The CNS growth rapidly and the nervous tissues may be a quarter of the adult size by the end of a year. Most of the growth of the brain, spinal cord, eyes etc. are almost complete by the age of 6-7 yrs. Somatic Growth or General Body Growth - follows an entirely different course. The whole process is characterized by a slow and steady growth pattern with the spurts - One in the prenatal period and other at adolescence. Some peak of a middle spurt somewhere between the age of 6 and 7 yrs. Lymphoid Growth ; The lymphoid tissues also show a very rapid growth in infancy and childhood, so that the adult size is doubled by about 10 yrs. Cont’d..

Genital Growth ; This is the opposite of the neural growth pattern. The genital organs continue to grow at a very slow pace until adolescence, when they grow rapidly. Cont’d..

Physical Growth and Development Physical growth can be divided into three areas: 1. Biologic Growth ; Changes in size and form - Height - weight - Head and chest circumference - Changes in body proportions - Changes in body systems 2. Motor Development 3. Sensory Development .

1) Biological Growth; a) Height; Growth of skeletal system is rapid during the first years of life and then decelerates to a slow, steady growth through school age until pubescent growth spurt. b) Weight; Childs body weight is a good indicator of nutritional status. Birth weight is doubled within 3 months after which it correlates fairly closely with the height curves.

c) Head Circumference; Head circumference is an important measurement since it is related to intracranial volume. d) Chest Circumferences; At birth chest circumference is 30 cm. Barrel-shaped chest at birth becomes elliptical, the transverse diameter increases with growth and exceeds AP diameter. e) Change in Body Proportions; Infants appear to have big heads, large trunks and short extremities up to 2 yrs. In infancy midpoint of the body falls slightly above the umbilicus and in adult it is at the symphysis pubis. Cont’d.. HC = 1/2 BL + 10 in cm.

f) Change in Body System; i ) Cardiovascular system; The heart is more transversely placed in the young infant. The apex being in the 4th Lt. intercostals space till 4 yrs of age. It gradually moves down to become more vertical due to assumption of the real position and growth the chest and by 7-8 yrs the apex lies in the 5 th ICSpace in mid- clavicular line. ii) Lymphatic System; This is more hyperplastic during childhood and after puberty the lymphatic tissue undergoes involution. iii) Nervous System; The brain grows rapidly during infancy, specially in the first year of life. 80% of total brain growth is achieved by 4th yr. At birth brain weight is 250-300 gms constituting 10 per cent of body wt. The correlation of the skull size and the pattern of brain growth has a definite and close relationship. H.C. can be estimated during birth . Cont’d..

iv) Special Senses: Eyes; The full-term newborn can distinguish between light and darkness. Has defective binocular fixation. Binocular fixation achieved by 4th - 5th months. Withhead control comes the perception of small objects by 7th month. Ears :The normal newborn exhibits his auditory acuity to loud noises by crying. With head control child is capable of turning the head towards the source of a sound. Cont’d..

Nose: The nose is fully developed at birth and functions perfectly. Sinuses and mastoids; The maxillary, ethmoidal and sphenoidal sinuses are present at birth, but the frontal sinuses begin to develop only after about 5-6 yrs. Digestive Systems :The month and oropharynx are well developed to sucking and swallowing. Oesophagus is variable in length and extends from 5-9 thoracic vertebra. The stomach lies in transverse position in first month of life. The intestines are underdeveloped in its musculature as compared to adult. The ascending colon is shorter while the transverse colon and rectum are longer in neonates than older children and adults.> Cont’d..

Liver: The liver is normally palpable below the costal margin in infancy and early childhood. The liver increases in weight more than 12 times from birth to childhood. Pancrease ; Islet cells are noticeable from the 3rd foetal month and no new Islet cells are formed after after 4th, 5th yrs. Cont’d..

Dentition : Eruption of teeth usually begins at about 6 months but there may be variations also upto I yr. 1 yr. All the 20 temporary teeth should have erupted by 3 yrs of age. Permanent teeth starts coming from 6-7 yrs of age till 12-13 yrs of age. Ossification Centres A t birth 5 ossification centres are present - 2 in each knee (distal femur and proximal tibial epiphysis) and 3 in each ankle. At 6 months 2 Carpal bones in wrist develops ossification centre. Cont’d..

2) Motor Development: Motor development depends on the maturation of the muscular, skeletal and nervous systems. Motor development is usually termed as gross and fine. a) Gross motor development means acquisition of mobility and independent locomotion. It includes turning, sitting, standing and walking. b) Fine Motor development evolves as the reflexes give way to the acquisition of motor dexterity. The child learns to use the fingers and thumb, pincer grasp etc.

3) Sensory Development Although the sensory system is functional at birth, the child gradually learns the process of associating meaning with a perceived stimulus. Most acute at birth-are the senses of taste and smell.

DEVELOPMENTAL THEORIES Personality and cognitive skills develop in much the same manner as biologic growth—new accomplishments build on previously mastered skill. Many aspects depend on physical growth and maturation. First we will see the summary of personality, cognitive and moral development theories of various Psychologists.

Stage/Age Psychosexual Stage(Freud) Psychosocial Stage(Erikson) Radius of Significant Relationship (Sullivan) Cognitive Stage (Piaget) Moral Judgment Stages (Kohlberg) I Infancy Birth to 1 Year Oral sensory Trust vs mistrust Maternal Person ( Unipolar- bipolar ) Sensori- Motor Birth to 2 Year. II Toddler hood. 1-3 year. Anal-urethral Autonomy vs shame and doubt Parental persons (tripolar ) Pre- operational thought, Preconceptual phase (transductive reasoning) e.g. specific- to specific) ( 2-4 years) Pre- conventional (premoral) level punishment and obedience orientation . III Early Childhood 3-6 years . Phallic- locomotion Initiative vs guilt. Basic family Pre- operational thought, intuitive phase (transductive reasoning) ( 4- 7 years) Pre- conventional (premoral) level Native instrumental orientation. IV Middle Childhood Stage/Age Latency Psychosexual Stages (Freud) Industry vs Inferiority Psychosocial Stages (Erikson) Neighbour- hood. Radius of significant Relationship (Sullivan) Concrete Operations (inductive reasoning and beginning logic. (7-11 years) Cognitive Stages (Piaget) Conventional level Good-boy, Nice-girl orientation Law and order orientation Moral judgment Stages. (Kohlberg)

V Adolescence 12-19 years. Genitality Identity and Repudiation vs Identity confusion. Peer group and out groups. models of leadership partners in friendship, sex, Competition, cooperation Formal operations (deductive and abstract reasoning) ( 11-15 years) Post Conventional or principled level Social contract orientation. VI Early adult hood. Intimacy and solidarity vs isolation. Divided labour and shared house- hold VII Young and middle adult hood. Generativity and self absorption. Mankind “my kind” VIII Later adult hood. Ego integrity Vs despair. Stage/Age Psychosexual Stage(Freud) Psychosocial Stage(Erikson) Radius of Significant Relationship (Sullivan) Cognitive Stage (Piaget) Moral Judgment Stages (Kohlberg)

PSYCHOSEXUAL DEVELOPMENTAL STAGE ( SIGMUND FREUD) : Most modern psychologist base their understanding children at least partly on the work of Sigmund Freud. His theories are concerned primarily with the libido (sexual drive or development). Although Freud did not study children, his work focused on childhood development as a cause of later conflict. Freud believed that a child who did not adequately resolve a particular stage of development would have a fixation (compulsion) that correlated with that stage.

PSYCHOSEXUAL DEVELOPMENTAL STAGE ( SIGMUND FREUD) : Freud described three levels of consciousness: the id , which controls physical need and instincts of the body; the ego , the conscious self, which controls the pleasure principle of the id by delaying the instincts until an appropriate time; and the superego , the conscience or parental value system. These consciousness levels interact to check behavior and balance each other. The psychosexual stages in Freud’s theory are the oral, the anal, the phallic, the latency and the genital stages of development.

Oral sensory stage: ( Infancy – Ages 0- 1 year ) The newborn first relates almost entirely to the mother (or someone taking a motherly role), and the first experiences with body satisfaction come through the mouth. Not only of sucking but also of making noises, crying, obsessive eating and often, breathing. Through the mouth baby expresses needs and finds satisfaction and thus begins to make sense of the world. Cont’d..

Anal stage : ( Toddlerhood, 1-3 years ) Interest during the second year of life centers in the anal region as sphincter muscles develop and children are able to withhold or expel fecal material at will. At this stage climate surround toilet training can have lasting effects on children’s personalities. Cont’d..

Phallic stage : ( Early childhood, 3-6 years ) During the phallic stage the genitals become an interesting and sensitive area of the body. Children recognize differences between the sexes and become curious about the dissimilarities. This is the period around which the controversial issues of the Oedipus (desire to be a male) and Electra complexes (girls’ attraction with father). Penis envy and castration anxiety are centered. Cont’d..

Latency stage : ( Middle childhood, 6-12 years ) During the latency period children elaborate on previously acquired traits and skills. Physical and psychic energy are channeled into the acquisition of knowledge and vigorous play. Cont’d..

Genital stage: ( Adolescence, 12-19 years) The last significant stage begins at puberty with maturation of the reproductive system and production of sex hormones. The genitals become the major source of sexual tension and pleasure, but energies are also invested in forming friendships and preparing for marriage. Cont’d..

PSYCHOSOCIAL DEVELOPMENTAL STAGE (ERIK ERIKSON): The most widely accepted theory of personality development is that advanced by Erikson (1963). Although built on Freudian theory, it is known as the theory of psychosocial development and emphasizes a healthy personality as opposed to a pathologic approach. Erikson also uses the biological concepts of critical periods and epigenesist, describing key conflicts or core problems that the individual strives to master during critical periods in personality development.

Each psychosocial stage has two components—the favorable and the unfavorable aspects of the core conflict—and progression to the next stage depends on resolution of this conflict. No core conflict is ever mastered completely but remains a recurrent problem throughout life. No life situation is ever secure. Each new situation presents the conflict in a new form. For example, when children who have satisfactorily achieved a sense of trust encounter a new experience (e.g. hospitalization), they must again develop a sense of trust in those responsible for their care in order to master the situation. Cont’d..

1. Trust vs mistrust (birth to 1 year) The first and most important attribute to develop for a healthy personality is a basic trust; establishment of basic trust dominates the first year of life and describes all of a child’s satisfying experiences at this age. Corresponding to Freud’s oral stage, it is a time of “getting” and “taking in” through all the senses. Trust exists only in relation to something or someone; therefore consistent, loving care by a mothering person is essential to its development. Mistrust develops when trust-promoting experiences are deficient or lacking or when basic needs are inconsistently or inadequately met. Cont’d..

2. Autonomy vs shame and doubt (1 to 3 years) Corresponding to Freud’s anal stage, the problem of autonomy can be symbolized by the holding onto and letting go of the sphincter muscle. The development of autonomy during the toddler period is centered around children’s increasing ability to control their bodies, themselves, and their environment. Cont’d..

Children want to do things for themselves by using their newly acquired motor skills of walking, climbing, and manipulating and their mental powers of selection and decision making. Much of children’s learning is acquired through imitating the activities and behavior of other. Negative feelings of doubt and shame arise when children are made to feel small and self-conscious, when their choices are disastrous, when others shame them, or when they are forced to be dependent in areas in which they are capable of assuming control. The favorable outcomes are self-control and willpower. Cont’d..

3. Initiative vs guilt (3 to 6 years) The stage of initiative corresponds to Freud’s phallic stage and is characterized by vigorous and intrusive behavior, enterprise, and a strong imagination. Children explore the physical world with all of their senses and powers. They develop their conscience. Children sometimes undertakes goals or activities that are in conflict with those of parents or others, and being made to feel that their activities or imaginings are bad produces a sense of guilt. Children must learn to retain a sense of initiative without impinging on the rights and privileges of others. The lasting outcomes are direction and purpose. Cont’d..

4. Industry vs inferiority (6 to 12 years) The stage of industry is the latency period of Freud. Having achieved the more crucial stages in personality development, children are ready to be workers and producers. They want to engage in tasks and activities that they can carry through to completion; they need and want real achievement. Children learn to compete and cooperate with others, and they learn the rules. It is decisive period in their social relationship with others. Feeling of inadequacy and inferiority may develop if too much is expected of them or if they believe they cannot measure up to the standards set for them by others. The ego quality developed from a sense of industry is competence. Cont’d..

5. Identity vs role confusion (12 to 18 years) Corresponding to Freud’s genital period, the development of identity is characterized by rapid and marked physical changes. Previous trust in their bodies is shaken, and children become overly preoccupied with the way they appear in the eyes of others as compared with their own self-concept. Adolescents struggle to fit the roles they have played and hope to play with the current roles and fashions adopted by their peers, to integrate their concepts and values with those of society and to come a decision regarding an occupation. Inability to solve the core conflict results in role confusion. The outcome of successful mastery id devotion and fidelity to others and to values and ideologies. Cont’d..

INTERPERSONAL DEVELOPMENTAL THEORY (SULLIVAN) Also built on Freudian theory, the interpersonal development theory by Sullivan emphasizes the interpersonal relationship in which children engage and the importance of social approval and disapproval in developing a self-concept. What children interpret as unfavorable interactions results in tension and anxiety; the outcome of favorable relationships is a sense of comfort and security. Through repeated interactions children acquire a repertoire of actions and behaviors that produce a feeling of security and avoid anxiety.

The first interactions are those between infants and their “mothering” figure, usually the mother, who gratifies and comforts. This bipolar relationship gradually extends to include others in the family group. Between ages 2 and 5 , children not only become more outgoing but also direct their social gestures to a wider audience outside yet still near the home land family, such as relatives and neighborhood children. They engage in peer play, family events, and other aspects of social learning. Observational studies suggest that 2 to 3 years olds are more likely than older children to remain near an adult and to seek physical affection, whereas the sociable behaviors of 4 to 5 year olds normally consist of playful bids for attention or approval that are directed at peers rather than adults. Cont’d..

During the school years, children enter into a wider range of relationships with other persons and authority figures at school and in the community. They develop “chump ships,” a special relationship between two peers—the shared intimacy and common interests of genuine friendships that are lacking in earlier relationships. Personal identity in adolescence is an outgrowth of intimate relationships, first with friends of the same sex then friends of the opposite sex. Cont’d..

COGNITIVE DEVELOPMENT (JEAN PIAGET) Cognitive development consists of age-related changes that occur in mental activities. The best-known theory regarding children’s thinking, and a more comprehensive developmental theory than those already described, has been developed by the Swiss psychologist Jean Piaget. According to Piaget, intelligence enables individuals to make adaptations to the environment that increase the probability of survival; through their behavior individuals establish and maintain equilibrium with the environment. Piaget proposes three stages of reasoning : (1)Intuitive, (2) concrete operational, and (3) formal operational.

When children enter the stage of concrete logical thought at approximately 7 years of age, they are able to make logical inferences, classify, and deal with quantitative relationships about concrete things. Not until adolescence are they able to reason abstractly with any degree of competence. Cont’d..

According to Piaget, children proceed through the stages of mental activity in an orderly and sequential manner. The mechanisms that enable them to adapt to new situations and to move from one stage to the next are assimilation and accommodation. By assimilation children incorporate new knowledge, skill, ideas, and insights into cognitive schemes (Piaget uses the term ‘schema’=pattern of action and / or thought.) already familiar to them. For new situations that do not fit into an established schema, children accommodate. They change and organize existing schemas to solve more difficult tasks and form new schemas, children’s understanding of a new experience is based on all relevant previous experiences. Cont’d..

Thus children achieve an accurate understanding of reality and come to deal with increasingly complex problems in an increasingly effective manner. Piaget believed there are four major stages in the development of logical thinking. Each stage is derived from and builds on the accomplishments of the previous stage in a continuous, orderly process. Cont’d..

Sensorimotor (birth to 2 years) The sensorimotor stage of intellectual development consists of six sub stages and that are governed by sensation in which simple learning takes place. Children progress from reflex activity through simple, repetitive behaviors to imitative behavior. They develop a sense of “cause and effect” as they direct behavior toward objects. Problem solving is primarily trial and error. They display a high level of curiosity, experimentation, and enjoyment of novelty and begin to develop a sense of self as they are able to differentiate themselves from their environment. They become aware that objects have permanence—the objects exist even when no longer visible. Toward the end of the sonsorimotor period, children begin to use language and representational thought. Cont’d..

Preoperational ( 2 to 7 years ) The predominant characteristic of the preoperational stage of intellectual development is egocentrism, which in this sense does not mean selfishness or self-centeredness but rather the inability to put oneself in the place of another. Children interpret objects and events not in terms of general properties but in terms of their relationships or their use to them. They are unable to see things from any perspective other than their own; they cannot see another’s point of view, nor can they see any reason to do so. Preoperational thinking is concrete and tangible. Children cannot reason beyond the observable, and they lack the ability to make deductions or generalizations. Thought is dominated by what they see, hear, or otherwise experience. Cont’d..

Through imaginative play, questioning, and other interactions, they begin to elaborate concepts and to make simple associations between ideas. In the latter stage of this period their reasoning is intuitive (e.g. the stars need to go to bed just as they do). Reasoning is also transductive—because two events occur together, they cause each other or knowledge of one characteristic is transferred to another. (E.g. all women with big bellies have babies.) Cont’d..

Concrete operations (7 to 11 years ) At this age thought becomes increasingly logical and coherent. Children are able to classify, sort, order, and otherwise organize facts about the world to use in problem solving. Develop new concept of permanence—conservation i.e. they realize that physical factors such as volume, weight, and number remain the same even though outward appearances are changed. Cont’d..

They are able to deal simultaneously with a number of different aspects of a situation. They do not have the capacities to deal in abstraction; they solve problems in a concrete, systematic fashion based on what they can perceive. Reasoning is inductive . Through progressive changes in thought processes and relationship with others, thought becomes less self-centered. Children can consider points of view other than their own. Thinking has become socialized. Cont’d..

Formal operations ( 11 to 15 years ) Formal operational thought is characterized by adaptability and flexibility. Adolescents can think in abstract terms, use abstract symbols, and draw logical conclusions from a set of observations, e.g. they can solve “ if A is larger than B, and B is larger than C, which symbol is the largest?” ( the answer is A) They can make hypotheses and test them; they can consider abstract, theoretic, and philosophic matters. They may confuse the ideal with the practical; most contradictions in the world can be dealt with and resolved. Cont’d..

MORAL DEVELOPMENT (KOHLBERG) It is theorized that children develop moral reasoning in an invariant developmental sequence. To understand the stages in the development of moral judgment, it is important to be aware of the stages of logical thought and its relationships to cognitive development and moral behavior. Moral development is based on cognitive developmental theory and consists of three major levels, each with two stages (Kohlberg, 1968) Kohlberg’s theory allows for prediction of behavior but pays little attention to individual differences. Questions arise relative to observed sex differences in attainment of the various sequences of moral development. It has been argued that the theory was derived from interviews with male adults and may not reflect feminine moral reasoning.

The preconventional level of morality parallels the preconceptual level of cognitive development and intuitive thought. At this level morality is external because children conform to rules imposed by authority figures. Culturally oriented to the labels of good/bad and right/wrong, children integrate these labels in terms of the physical or pleasurable consequences of their actions. The two stages of this level are: Stage: 1. The punishment-and-obedience orientation . Children determine the goodness or badness of an action in terms of its consequences. They avoid punishment and obey unquestioningly those who have the power to determine and enforce the rules and labels. They have no concepts of the underlying moral order that supports these consequences. Cont’d..

Stage: 2.The instrumental-relativist orientation . The right behavior consists of that which satisfies the child’s own needs (and sometimes the needs of others). Elements of fairness, reciprocity, and equal sharing are evident; they are interpreted in a very practical, concrete manner without the element of loyalty, gratitude, or justice. Cont’d..

At the conventional level children are concerned with conformity and loyalty; actively maintaining, supporting, and justifying the social order; and personal expectations of those significant in their lives. They value the maintenance family, group, or national expectations regardless of consequences. This level correlates with the concrete operational stage in cognitive development and consists of two stages: Stage: 3. The interpersonal concordance or “good boy-nice girl” orientation. Behavior that meets with approval and pleases or helps others is viewed as good. Conformity to the norm is the “natural” behavior, and one earns approval by being “nice”. Cont’d..

Stage: 4. The “law and order” orientation . Obeying the rules, doing one’s duty, showing respect for authority, and maintaining the social order is the correct behavior. The rules and authority can be social or religious, depending on which is most valued. At the postconventional, autonomous, or principled level children have reached the cognitive formal operational stage, and they endeavor to define moral values and principles that are valid and applicable beyond the authority of the groups and persons holding these principles. This level is not associated with the individual’s identification with these groups. Cont’d..

Stage: 5. The social-contract, legalistic orientation . Correct behavior tends to be defined in terms of general individual rights and standards that have been examined and agreed on by the entire society. Procedural rules for reaching consensus become important, with emphasis on the legal point of view; there is also emphasis on the possibility of changing law in terms of societal needs and rational considerations. Agreement and contract outside the legal realm are binding elements of obligation. The most advanced level of moral development is one in which self-chosen ethical principles guide decisions of conscience. These are abstract, ethical, and universal principles of justice and human rights with respect for the dignity of persons as individuals. It is believed that few persons reach this stage of moral reasoning. Cont’d..

Reflexes of the Normal Neonate; 1. Rooting reflex ; By touching or stroking the cheek near the corner of the mouth and the Infant turns his head in direction of the stimulation to find food. It disappears at 3-4 months,of age. 2. Sucking Reflex ; By touching the lips with the finger or nipple or bottle or other object and the infant tries to suck. 3. Swallowing Reflex ; Accompanies the sucking reflex and food reaching the posterior of the mouth is swallowed. It does not disappear.

4. Moro Reflex; Startling the infant with a loud voice or apparent loss of support due to a change in equilibrium. The neonate is held in a supine position above the table or bed. Infants' head is suddenly allowed to drop backwach an inch or so and there is generalized muscular activity with symmetric abduction and extension of the arms and legs with fanning of the fingers. Disappears by 3-4 months. 5. Palmar Grasp ; Any object or finger placed in newborn'sarm and the infant grasp the object by closing fingers around it. Cont’d..

6. Planter Grasp ; By touching the sole of the foot at the base of the toes and the infant grasp the object ground the object by toes. Disappears at 8-9 months of age. 7. Tonic Neck Reflex ; When the infant is placed on supine position turns the head to one side and the arm and leg on the side on the side the head is turned extend. Arm and leg on the opposite side flex. Both hand may make fists. Disappears at 4-5 months. Cont’d..

GROWTH & DEVELOPMENT OF INFANT 1 MONTH A.Physical or Biologic Weight 4.4 ± 0.8 kg (10 ± 1.5 Ib); gains above 680 gm (1.5 Ib) a month during first 6 months, or 1 50 to 210 gm (5 to 7 oz) a week Length Approximately 53 ± 2.5 cm (21 ± 1 in); increases about 2.5 cm (I in) a month during first 6 months

Head circumference Increases about 1.5 cm (0.5 in) a month during first 6 months Pulse 130 ± 20 Respirations 35 ± 10 Blood pressure 80/50 ± 20/10 Cont’d..

Reflexes Primitive reflexes govern movements. Has well-developed sucking, rooting, swallowing , and extrusion (tongue thrust) reflexes, Moro reflex (startle reflex), and asymmetric tonic neck reflex (head turned to one side, one arm extended on the same side, the other arm flexed to shoulder) . Dance and doll's eye reflexes fading Cont’d..

B. Motor GROSS MOTOR Lies in flexed position . When prone, pelvis is elevated but knees are not beneath abdomen as they were after birth Head lags when baby pulled from a supine to a sitting position Head sags forward when baby is held in sitting position May lift head periodically when held over adult's shoulder or placed in prone position Cont’d..

Cervical curve begins to develop as infant learns to hold head erect Turns head to the side when prone Makes crawling movements when prone on flat surface Pushes with the feet against a hard surface to move forward FINE MOTOR Holds hands in tight fists Can grasp an object placed in the hand Cont’d..

Cont’d… C. Sensory Startled by sounds ( Moro reflex ) Attentive to speech of others Indefinite stare at surroundings Fixates on objects brought in front of eyes Notices faces especially and bright objects,but only if they are in the line of vision Protective blinking in response to bright light Follows a bright object to the midline of vision if 6 to 8 inches from eyes

D. Psychosocial, Psychosexual, Spiritual Development PSYCHOSOCIAL Beginning development of sense of trust . Negative counterpart: mistrust Totally egocentric Complete dependence on ,caregivers, usually mother Bonding progresses Shows regard for human face. Activity diminishes when a human face can be seen Establishes eye contact , Smiles briefly Quiets, cuddles, and moldswhen held Perceives self and parents as one. Cont’d..

E. Language, Speech Development RECEPTIVE LANGUAGE Responds to human voices EXPRESSIVE LANGUAGE Opens and closes mouth as adult speaks Utters small throaty sounds Utters sounds of comfort when feeding Cry patterns developing. Cont’d..

Cries when hungry or uncomfortable Begins to coo Play Stimulation (Visual. Auditory, Tactile, And Kinetic) Hold, touch, and rock infant gently Talk and sing softly to infant at close range Encourage mutual eye contact Provide pacifier for sucking Cont’d..

pleasure Place cradle gym or crib mobile within infant's reach Place large bright pictures on crib or wall Repeat noises made by infant Coo to infant Respond to crying signals Have ticking clock, wind chimes, radio, television, or music box nearby Provide soft, cuddly toys and clutch toys too large to swallow Cont’d..

Use soothing lotion when massaging infant's body Swaddle to soothe infant Place infant when awake where household activities are in progress Take infant for rides in carriage or car Provide regular periods of affectionate play when infant is alert and responsive Cont’d..

2 MONTHS A. Physical or Biologic Posterior fontanel closed at 6 to 8 weeks of age B. Motor GROSS MOTOR Less fixed prone position : arms flexed, hips flat, legsextended, head in mid position or side No head droop when suspended in prone position Less head lag when pulled from a supine to a sitting position Lifts head almost 45 degrees above a flat surface when lying prone Holds head erect in midposition Holds head erect when held upright Turns from side to back

2 MONTHS FINE MOTOR Hands may be open Holds a rattle briefly when placed in the hand

Cont’d… C. Sensory Turns head to side when a sound occurs at ear level When on back, follows a dangling object or a moving light beyond the midline of vision Beginning binocular fixation and convergence to objects nearby Eyes follow moving person nearby

Cont’d… D.Psychosocial, Psychosexual Sense of Trust Distinguishes "mother" or primary caregiver from others and is more responsive to that person eye-to-eye contact, & face orientation, smiling, and vocalization are the evidences of attachment between infant and parents, especially the mother

Cont’d… Smiles back in response to another's smile . This is the beginning of social behavior. The true social smile may not appear until the 3rd month Has learned that crying brings attention

Cont’d… E.RECEPTIVE LANGUAGE Alert expression when listening Direct definite regard Soothed by caregiver's, mother's, voice EXPRESSIVE LANGUAGE Cry patterns develop Crying becomes differentiated, varying with the reason for crying, e.g., hunger, sleepiness, or pain. Pitch and intensity vary Responds vocally to caregiver's voice: "ah," "eh," "uh" Coos

Cont’d… Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Same as at 1 month Offer a rattle , pull from supine to sitting position Hold or dangle toy in front of infant to encourage eye Movement Change patterns of objects from bright and shiny to dull and dark for further stimulation Place in vertical infant seat so that environment can be viewed from a different angle

3 MONTHS A.Physical or Biologic Weight 5.7 ± 0.8 kg (12.3 ± 2 Ib) Length 60 ± 2 cm (23.5 ± I in) Pulse 130 ± 20 Respirations 35 ± 10 Blood pressure 80/50 ± 20/10 Reflexes Grasping (palmar) reflex absent Landau reflex appears: an infant suspended in a horizontal prone position with the head flexed against the chest reflexly draws the legs up against the abdomen

B.GROSS MOTOR Symmetric posture of head and body Very slight head lag when pulled from supine to sitting position Sits, back rounded, knees flexed when supported in sitting position Raises chest, usually supported on forearms, when in prone position Holds head erect and steady FINE. MOTOR Hands open or closed loosely Holds hands in front of face and stares at them Holds object put in hand with active grasp Carries hand or object to mouth at will . Reaches for bright objects but misses them

Cont’d… C. Sensory Turns head and looks in same direction to locate sound When on back, turns eyes to a dangling object or a moving light to marginal field of vision (180 degrees) Binocular coordination (vertical and horizontal vision) when an object is moved from right to left and up and down in front of face Regards toy dangled in midline of chest promptly Loses interest in objects that are suddenly removed from the perceptual field Blinks at objects that threaten the eyes

Cont’d… E.psychosodal, Psychosexual, Spiritual Development PSYCHOSOCIAL sense of Trust Recognizes and smile s in response to (usually the mother's) face Stop cying when familiar person approaches interested in surroundings

Cont’d… F. Language, Speech Development RECEPTIVE LANGUAGE Looks in direction of speaker EXPRESSIVE LANGUAGE Cries less Shows pleasure in making many sounds Vocalizes in response to others: coos and chuckles May laugh aloud Babbles from 3rd to 8th month, but it is not linked with specific objects or persons

Play Stimulation ( Visual, Auditory, Tactile, and Kinetic ) Same as at 1and 2 months Encourage infant to raise head when in prone position Pull baby to sitting position, thus encouraging head control Hold bright toys in front of infant to encourage reaching Provide greater variety of toys as baby shows interest in playthings

4 MONTHS A.Physical or Biologic Drools between 3 and 4 months of age, indicating increased production of saliva. Unable to swallow it, therefore, it runs from mouth Reflexes Tonic neck, Moro, sucking, and rooting (when awake) reflexes absent ; extrusion reflex fading

Cont’d… B.Motor GROSS MOTOR Symmetric body postures predominate Sits with adequate support . Enjoys being propped up Holds head erect and steady when placed in sitting position Lifts head and shoulders at a 90 degree angle when on abdomen and looks around Attempts to roll or actually rolls over from front to back Sustains small portion of own weight when held in standing position Activates arms at sight of proffered toy

Cont’d… FINE MOTOR Holds hand predominately open Brings hands together in midline . Plays with fingers Grasps object held near hand. Cannot pick it up when dropped Grasps objects with both hands Attempts to reach objects with hands but overshoots them Objects are carried to mouth Thumb apposition in grasping occurs between

Cont’d… C . Sensory Follows moving objects well with eyes. Even the most difficult types of eye movements are present Fairly good binocular vision Looks briefly for toy that disappears Accommodation begins to develop. Can accommodate to nearby objects Can focus on small objects . Stares at rattle placed in hand and takes it to the mouth Recognizes familiar objects, such as feeding bottle and toys Beginning hand-eye coordination Comforts self by sucking thumb or pacifier.

Cont’d… D.Psychosocial, Psychosexual, Spiritual Development PSYCHOSOCIAL Sense of Trust Smiles in response to smiles of others or when they appear nearby Initiates social play by smiling or vocalizing Shows evidence of wanting social attention and of increasing interest in other family members Shows interest in new stimuli Fusses if left alone or bored, thereby demanding attention from others Shows eagerness when feeding bottle appears Breathes heavily when excited PSYCHOSEXUAL Oral Stage (0 to I year) SPIRITUAL Undifferentiated (0 to 1 year)

Cont’d… E. Language, Speech Development RECEPTIVE LANGUAGE Responds differently to pleasant or angry voice Does not cry when scolded EXPRESSIVE LANGUAGE Laughs aloud Vocalizes socially: coos and gurgles when spoken to Very "talkative" to self, people, or toys "Talking" and crying follow each other quickly Can vocalize consonants: b, g, h, k, n, p

Cont’d… Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Hold, touch, and rock infant gently Smile when talking and singing to infant Encourage mutual eye contact Laugh when infant laughs Echo sounds that infant makes

Cont’d… Observe subtle clues from infant's body language and respond to them Light tickling stimulates laughter Provide variety of small multitextured (fuzzy, smooth) and colored objects that infant can hold but not swallow Shake rattle placed in infant's hand Offer toys for grasping Move rattle around the infant so that it can be followed visually and grasped. This helps develop hand-eye coordination and improve head control

5 MONTHS A. Physical or Biologic Weight At least twice the birth weight. Mean age for doubling birth weight is 3.8 months Physical growth slowing down Can breathe

Cont’d… B. Motor GROSS MOTOR Sits with slight support Balances head well when sitting Holds back straight when pulled to a sitting position Rolls from back to front

Cont’d… FINE MOTOR Tries to obtain object beyond reach. Grasp object with whole hand Holds object while looking at another C. Sensory position Pulls feet up to mouth when supine Can localize the sound made below the ear. Can fixate object 3 feet away. D. Psychosoclal, Psychosexual, Spiritual Development PSYCHOSOCIAL Sense of Trust Smiles at self in mirror Begins to discriminate family members from strangers Accepts an object from another person Plays enthusiastically . Shows displeasure when toy is lost Pays with own feet

Cont’d… E. Language, Speech Development RECEPTIVE LANGUAGE Responds when own name is spoken EXPRESSIVE LANGUAGE Squeals when happy or excited Vocalizes displeasure when a desired object is taken away Consonant sounds increase Sounds like vowels appear with consonants, such as "goo" Begins to mimic sounds

Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Same as 4 months Provide sufficient different objects for play (small objects that are too large to swallow) Make various sounds near ear Hold infant in standing position and bounce to exercise legs and to develop balance Cont’d…

6 MONTHS A. Physical or Biologic Weight 7.4 ± 1 kg (16.5 ± 2.5 lb); gains about 340 gm (0.75 Ib) a month, or 90 to 150 gm (3 to 5 oz) a week during second 6 months Length 65.5 ± 3 cm (26 ± 1 in); gains about 1.25 cm (0.5 in) a month during second 6 months Head circumference 43 cm (17 in). Increases about 0.5 cm (0.25 in) per month during second 6 months Pulse 120 ± 20 Respirations 31 ± 9 Blood pressure 90/60 ± 28/10 Teething Two lower central incisors erupt (6 ± 2 months) Begins to bite and chew

Cont’d… B. Motor GROSS MOTOR Sits alone briefly if placed in a favorable leaning positionon hard surface. Holds arms out Back is straight when sitting in high chair Pulls to a sitting position Springs up and down when sitting Lifts chest and upper abdomen when prone, putting the weight on the arms and hands Turns completely over, with rest periods during the turn. Infant must be protected from falling

Cont’d… Sustains most all of own weight when held in standing position Hitches—moves backward when in a sitting position by using the arms and hands FINE MOTOR Grasps with simultaneous flexion of fingers: begins to use fingers to feed self. Retains transient hold on two objects , one in each hand. Drops one object when another is offered Begins to transfer object from one hand to the other Manipulates small objects Begins to bang objects that are held (rattles, spoon, toy) Holds own bottle but may prefer for it to be held

C. Sensory Localizes sounds made above the ear Retrieves a dropped object that can be seen and reached Enjoys more complex visual stimuli Moves in order to see an object Cont’d…

Psychosocial/Psychosexual/spiritual development: Sense of Trust Recognizes parents Cont’d…

Cont’d… Recognizes strangers (5th and 6th month) as different fromfamily members Begins to extend arms to be picked up Excites on hearing foot steps.

Cont’d… Laughs when head is hidden in a towel. Thrashes arms and legs when frustrated Imitation of others is beginning: sticking tongue out Knows what is liked and disliked Intellectual development Biggining of object permanence when infant briefly searches for dropped object

Cont’d… E. Language, Speech Development RECEPTIVE LANGUAGE Recognizes familiar words EXPRESSIVE LANGUAGE Actively vocalizes pleasure with cooing or crowing Cries easily on slight or no provocation (withdrawal of a toy) Vocalizes several well-defined syllables Imperfect imitation begins (6 to 9 months) Shows enjoyment in hearing own vocalization "Talks" to image in mirror. May pat image of self if close to mirror

Cont’d… Play Stimulation (Visual, Auditory, Tactile and Kinetic) Same as 4 and 5 months Encourage infant to look in a mirror; repeat names of parts of face, such as mouth, nose, and eyes Make funny faces for infant to imitate Point out people, food, objects and repeat their names Talk to infant about own and surrounding activities Repeat infant's name Encourage response to simple commands Use the word "no" only when necessary Provide more complex soft cuddly toys Provide harder large toys,

7 MONTHS A. Physical or Biologic Reflexes Sucking and rooting reflexes disappear at 7 to 8 months when asleep Parachute reflex appears between 7 to 9 months. An infant suspended in a horizontal prone position and towered suddenly will extend the hands forward to provide protection from failing. This reflex continues indefinitely Teething Upper central incisors erupt (7.5 ± 2 months) Lower lateral incisors erupt (7 ± 2 months) Ultimate color of iris is established

Cont’d… B. Moto r GROSS MOTOR Sits alone on hard surface, leaning forward on hands Lifts head as if trying to sit up when supine Control of trunk is more advanced Rolls more easily from back to abdomen

Sustains all of weight on feet when held in standing position Bounces actively when held in standing position FINE MOTOR Holds 2 toys at once Cont’d…

Cont’d… Approaches a toy and grasps it with one hand (uni dextrous) Transfers a toy from one hand to the other, usually successfully Imitates simple acts of others Bangs objects that are held Uses a raking motion to try to obtain small objects. Holds cup.

Cont’d… C. Sensory Head turns in a curving arch to localize sounds Depth perception beginning to develop

Cont’d… Fixates on very small objects and details Discrimination between simple geometric forms begins to develop Has preferences in taste for foods

Cont’d… PSYCHOSOCIAL Sense of Trust Shows increasing fear of strangers (7 to 8 months) Actively clings to a familiar person when distressed Unhappy when caregiver, usually mother, disappears Responds socially to own name Emotional instability—rapidly changes from crying to laughter Closes lips tightly when disliked food is offered

Intellectual development: Demonstrate expectation in response to repetition of stimuli. Cont’d…

Cont’d… E. Language, Speech Development RECEPTIVE LANGUAGE Recognizes own name Responds with gestures to words such as "come" EXPRESSIVE LANGUAGE Vocalizes eagerness Vocalizes "m-m-m" when crying Imitates simple noises and speech sounds Makes polysyllabic vowel sounds Vocalizes "da," "ma," "ba " Babbling decreasing Some jargon (own language) Vocalizes with adult like inflections when others are speaking

Play Stimulation (Visual, Auditory, Tactile and Kinetic) Same as 4, 5, and 6 months Place toy under blanket and encourage infant to find it Repeat simple sounds: "dada," "mama" Provide objects or food that can be bitten and chewed safely Continue to encourage playing in water and perhaps "swimming" in shallow tub or pool Encourage banging of toys and clapping hands on objects Continue to help infant learn balance

8 MONTHS A. Physical or Biologic Beginning of a pattern in bowel and bladder elimination

B. Motor GROSS MOTOR Sits alone steadily Pulls self into standing position with help Hand-eye coordination is perfected so that random reaching and grasping no longer occur Cont’d…

FINE MOTOR Holds 2 objects while looking at a third Persistently reaches for objects beyond range of grasp Releases objects from hands voluntarily Cont’d…

Complete thumb apposition Pincer grasp beginning to develop, using the fingers against the lower portion of the thumb Eats finger foods , such as crackers, that can be held in one hand Drinks from cup with assistance (7 to 9 months) Cont’d…

Cont’d… C. Sensory Recognizes familiar words and sounds

Cont’d… C. PSYCHOSOCIAL Sense of Trust Greets strangers with joy or bashful behavior, turning away, crying or even screaming Refuses to play with strangers Separation or stranger anxiety, to be distinguished from anaclitic depression, occurs between the 6th and 8th months; caused by the infant's increased capacity to discriminate between family members, close friends, and strangers

Cont’d… Affection for or love of family members appears stretches arms to loved family members increased anxiety over loss of parent, especially mother motional instability still evident Just likes changing clothing and diapers

Cont’d… SYCHOSEXUAL Oral Stage (0 to 1 year) SPIRITUAL Undifferentiated (0 to 1 year)

Cont’d… E. INTELLECTUAL Sensorimotor Stage Substage III: Secondary Circular Reaction (4 to 8 months) Knows that objects are separate from self Searches briefly for objects seen being placed elsewhere.

Cont’d… The search is confined to only one modality Actions to produce a result have been memorized Substage IV: Coordination of Secondary Schemas (8 to 12 months) Perception of space becomes refined between 8 – 12 months

Cont’d… Abilities learned earlier are combined and extended to deal with new situations: behavioral and perceptual patterns are coordinated and applied to new situations Object permanence progresses and is related to the increasing ability to deal with matters of time and space.

Cont’d… Perceptions of space become refined between 8 to 12 months Beginning perception of cause and effect relationship Early beginning of anticipatory and intentional behavior Problem solving beginning to develop

Cont’d… E. LANGUAGE : RECEPTIVE LANGUAGE Stops activity when own name is spoken Beginning to understand meaning of "no" EXPRESSIVE. LANGUAGE Shouts for attention Imitates sound sequences combines syllables: "da-da,“ "ma-ma" (nonspecific meaning) Can vocalize consonants d, i, and w

Cont’d… Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Hold, touch, and rock infant gently Talk and sing to infant Place infant in a sitting position against a wall and encourage leaning away from the wall to improve balance Gently push infant from a sitting position to improve balance

9 MONTHS A. Physical or Biologic Reflexes Plantar grasp absent , Teething Upper lateral incisors erupt (9 -2 months)

Cont’d… B. Motor GROSS MOTOR Raises to a sitting position alone with good coordination Sits steadily for longer period of time

Cont’d… Recovers balance when leaning forward, but not sideways Crawls instead of hitching. Crawling may be done as early as the 4th month; the average age is 8 to 9 months. Creeping . This is a more advanced type of locomotion than crawling. The trunk is carried above the floor, but parallel to it. The infant uses both hands and knees in moving forward. Beginning to pull self to standing position alone while holding on to furniture

Cont’d… FINE MOTOR Bangs two objects together Pokes objectives with fingers Uses thumb and index finger in early pincer grasp Has preference for the use of one dominant hand Holds own bottle with good hand-mouth coordination. Puts nipple in and withdraws it from mouth at will Drinks from cup with some spilling (9—12 months) Attempts to use a spoon but spills contents

Cont’d… C. Sensory Head turns directly to source of sound Increased depth perception Recognizes by looking or moving toward familiar object when named Able to follow objects through transition from one place to another

Cont’d… Psychosocial, Psychosexual, Spiritual Development PSYCHOSOCIAL Sense of Trust Knows what "no" means Beginning to play simple games with adult such as "so big," "bye-bye" Caregiver, usually mother, becoming more important as a person Wants to please caregiver,usually mother Beginning fears about being left alone, as when put into the crib Dislikes having face washed so covers face with arms and hands

E. Intellectual development: Able to follow through transition from 1 place to another Cont’d…

E. Language : RECEPTIVE LANGUAGE Stops activity in response to "no" Beginning to respond to simple commands given verbally Responds to adult anger Cont’d…

EXPRESSIVE. LANGUAGE Cries when scolded Echolalia or correct imitative expression of sounds made by others (9 to 10 months) Association of words with persons or objects. Says "ma-ma," "da-da" as names of persons Intonation beginning to become patterned through imitation Cont’d…

Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Same as 8 months Encourage exploration of toys with eyes and fingers (examine and poke) Show infant large pictures in book Encourage to bang two toys together Continue to vocalize with infant Play infant games such as "so big" and "bye-bye," with appropriate motions Cont’d…

Cont’d… Begin to play " peek-a-boo" (covering the infant's face with a towel) and "pat-a-cake," with appropriate motions Encourage crawling by moving a toy away from the prone infant Encourage creeping by playing "wheelbarrow" (infant walks on hands while adult holds the body up at the hips or legs) Help infant learn to stand by encouraging reaching for an object held overhead Provide a larger environment in which the infant can move safely: crawling, creeping, cruising

10 MONTHS A.Motor GROSS MOTOR Moves from prone to sitting position May sit by falling down from standing position

Sits steadily for indefinite period of time. Does not want to lie down unless sleepy Creeps well Pulls to standing position well, holding to the crib rail o other support Cruises well (walks sideways while holding on to a supporting object with both hands) Cont’d…

Makes stepping movements forward when two hands are held FINE MOTOR Picks small objects up with index finger and thumb (pincer grasp) Releases an object after holding it brings the hands together Cont’d…

Cont’d.. C. Sensory Marked interest in very small objects Searches for a lost toy with greater persistenc

Cont’d… E. Psychosoclal, Psychosexual, Spiritual Development PSYCHOSOCIAL Sense of Trust Expresses several beginning recognizable emotions such as anger, sadness, jealousy, anxiety, pleasure, excitement, and affection

Cont’d… Plays social games with adults, such as "pat-a-cake" and "peek-a-boo" May object to being away from parent Improves in the ability to imitate others: imitates facial expressions Shows preference for one toy over another Offers toy to another but will not release or give it up Looks at pictures in a book with another person Attracts the attention of others by pulling on their clothes or fussing Whatever action that attracts attention is repeated Intellectual development: Demonstrate independence in dressing. Develops objects permanence.

Cont’d… E. Language : RECEPTIVE LANGUAGE Understand simple commands : gives a toy on a request that is accompanied by gestures EXPRESSIVE LANGUAGE

Cont’d… May speak one word besides "ma-ma" and "da-da," such as "no," "hi" Understands meaning of "bye-bye" and waves Imitates adult's inflection, pitch variations Imitates sounds of animals.

Cont’d… Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Same as 8 and 9 months Obtain infant's attention when requests are made and use gestures to indicate meaning Make facial expressions and sounds that infant can imitate Show infant a cardboard or cloth picture book Continue infant games, including " pat-a-cake" and "peek-a-boo," with appropriate motions Provide opportunities for holding and releasing objects Encourage cruising by placing furniture in a circle Encourage infant to bounce in a standing position by holding the hands for support Place infant in a jumper seat to encourage standing and jumping

11 MONTHS B. Motor GROSS MOTOR Stands erect with minimal support and lifts one foot to take a step Cruises: walks holding on to furniture FINE MOTOR Explores toys and other objects more carefully Removes covers from boxes Takes toy out of box or cup Puts toy inside box or cup but may not let go yet Beginning to hold a crayon and make a mark on paper C. Sensory Tilts head backward to see upward

Cont’d… D. PSYCHOSOCIAL Sense of Trust Shows pleasure when a desired act is accomplished Becomes frustrated when activities are restricted Asserts self among family members Seeks approval, avoids disapproval

E. Intellectual : Anticipates body gestures when a familiar nursery rhymes or stories being told. Cont’d…

F. Language, Speech Development RECEPTIVE LANGUAGE Responds to simple questions: for example, "Where is the kitty?" by pointing and looking toward object EXPRESSIVE LANGUAGE Imitates specific speech sounds of others Cont’d…

Cont’d… Play Stimulation (Visual, Auditory, Tactile, and Kinetic) Same as 8, 9, and 10 months Provide opportunities for placing small objects into larger objects and for taking them out again Play simple games such as rolling a ball to infant. Show infant how to "throw" it back Encourage play with other persons Encourage infant to stand alone by gradually decreasing support (furniture or adult's hands) Place infant in a walker and encourage letting go by offering a toy to grasp

12 MONTHS A. Physical Growth and Development Physical or Biologic Weight 10 ± 1.5 kg (22 ± 3 pounds); has tripled birth weight Length 74.5 ± 3 cm (29 ± 1.5 inches); length has increased by almost 50 per cent from birth Head circumference 46 cm (18 inches); head circumference has increased by one third since birth Brain weight has increased rapidly since birth, resulting in significant developmental achievements Head and chest are equal in circumference Anterior fontanel closes between 12 and 18 months

Pulse 115 ± 20 Respirations 30 ± 10 Blood pressure 96/66 ± 30/24 Reflexes Babinski reflex disappears Teething Has 6 to 8 deciduous teeth Lumbar curve and the compensating dorsal curve develop as walking continues Physiologic stability achieved and maintained during first year Cont’d…

B. Motor : GROSS MOTOR Stands alone for variable length of time Sits down from standing position alone Walks in few steps with help or alone (hands held at shoulder height for balance Improves competence in motor skills through practice FINE MOTOR Good pincer grasp Picks up small bits of food and transfers them to mouth. Cont’d…

Enjoys eating with fingers Attempts to put a small pellet into a narrow-necked bottle but does not succeed Releases one or more objects inside another object or container Attempts to put one block on top of another but does not succeed Turns pages in a book but usually not one at a time Drinks from a cup and eats from a spoon but still requires some held Holds crayon adaptively to make a stroke or a mark on a piece of paper Cont’d…

C. Sensory Listens for recurring sounds Full binocular vision well established. Follows fast-moving object with eyes Discriminates simple geometric forms: squares, circles Visual acuity: 20/100 to 20/50 Psychosocial, Psychosexual, Spiritual Development Cont’d…

D. PSYCHOSOCIAL Sense of Trust theoretically achieved. If not, a sense of mistrust predominates Infant's emotion, such as fear, jealousy, anger, can be more clearly interpreted Attachment developed to primary caregiver(s) Clings to caregiver, usually mother, when fearful explores away from caregiver if secure Responds to requests for affection such as a kiss or a hug Has established beginning view of self as a separate person "Security blanket" or favorite toy beginning to provide comfort Cooperates in dressing: puts arms through sleeves, feet into shoes. Takes off socks Drops objects on purpose so someone can pick them up Cont’d…

E. INTELLECTUAL: Object permanence Early beginning of anticipatory & intentional behaviour. Problem solving beginning to develop although the infant has not leart to think. Cont’d…

F. Language, Speech Development RECEPTIVE LANGUAGE Responds with gestures or actions to more complex verbal requests, such as "Please give it to me" EXPRESSIVE LANGUAGE May speak two or more words besides "ma-ma" and "da-da" Cont’d…

Understands meaning of many more words than can be spoken Knows names of increasing number of objects Imitates sounds animals make Intonation becoming more like adult speech Continues using jargon Indicates "no" by shaking head Beginning voluntary control over responses to sound: may or may not respond or may delay response to another's voice Vocalization decreases as walking increases Cont’d…

F. Play Stimulation (Visual, Auditory, Tactile, and Kinetic ) Same as 8, 9, 10, and II months Provide large crayons for drawing Provide stacking discs or blocks Provide objects to place inside larger containers Place infant in walker several times a day to encourage walking movements Encourage infant to push a chair or stroller around Provide push-and-puil toys toencourage walking Give infant " piggyback " rides to improve balance Encourage infant to walk, eventually holding only one hand Provide roughhouse activity Provide increasing visual, auditory, tactile, and kinetic stimulation. Cont’d…

AGE 15 MONTHS A. Motor Gross. Motor; - Assumes standing position without support. - Walks without support from 13 months of age - Looses balance when walking around corners or stopping suddenly. - Kneek without support - creeps up staires - Throws small objects repeatedly & picks them up again but may fall. - Cannot throw ball without falling. Fine Motor: - Builds a tower 2-3 cubes - Opens boxes, pokes finger in hole - Scribbes spontaneously, makes line with crayon.

- Pats pictures in books & begins to turn pages. - Inserts pellet in a narrow packed bottles. - May give up bottle. - Holds a cup with all fingers grasped about it. - Cannot fill the spoon well. Spoon is likely to be turned upside down before reaching mouth. - Enjoys finger feeding. Sticks out arm & leg to help in dressing. Removes socks. - Indicates when diaper is wet or soiled Cont’d…

C. Sensory; - Sound localization indicated by head movement in all planes. - Binocular vision fully developed. - Displays an intense and prolonged interest in pictures. - Can identify geometric forms & place bound object into its approximate place or hole. Cont’d…

D. Psychosocial, Psychosexual, Spiritual Development Ego centric - Tolerates some separation from parent - Less fearful of strangers - Coping decreased in unfamiliar environment. - Paternal person increasingly significant - Hugs & kisses parents - Kisses pictures in book - Begins to imitate parents doing housekeeping chores - Very early temper tantrums.

D. Intellectual Development - Experiences only the present. Lanquage development: - Comprehends more than can communicate - Recognizes names of various parts of body. - Responds to familiar, simple commands. - Says 4-6 words including names - Asks for objects by pointing. - May use head shaking gesture to denote "no" - Communicates "No" even when following a request. Cont’d…

AGE 18 MONTHS A. Gross Motor; - Walks sideways & backwards - Walks upstairs with one hand held - Runs clumsily, falls often - Moves quickly from place to place. Jumping attempted both feet.

Seats self in small chair - Climbs on furniture - Gets into everything: explores drawers etc. - Pulls & pushes toys - Pushes light furniture around room. - Throws ball overhand without falling. Fine Motor; - Builds Tower of 3-4 Cubes - Scribber vigorously and imitates a vertical stroke with crayon. Cont’d…

- Turn pages in a book 2-3 at a time. - Puts block into hole - Transfer objects hand to hand at will. - Holds cup with both hands. Hands it to caregiver, put sit down or drops it on floor. - Eats with spoon, may play with food - Negativism and high activity level may interfere with eating. - Removes simple garments - May complain when wet or soiled - increased readiness for bladder & bowel control. - May swear faces.

C. Sensory; - Cans see pictures thus has intense interest in pictures. - Identifies various shapes - Convergence well established. - Some depth perception Cont’d…

- Temper tantrums may be more evident - Less fear to strangers - Seeks helps from others when in trouble - May resist sleep for sometime after being put to bed. - Calls for primary caregiver - Thumb sucking may peak, especially before or dursing sleep for comfort - kisses parents - imitates, parents behaviour & domestic activities. Begining awareness of ownership: possessiveness begins, Awareness of gender identity begins D. Psychosocial, Psychosexual, Spiritual Development

E. Intellectual development - Concept of object permanence is fully developed is comforted when nearing parent's voice even if parent cannot be seen. - Can differentiate self from object. - short attention span. - Beginning sense of time & anticipation of events. - Begins to think - Beginning traces of memory - Experiments actively to achieve goals. Cont’d…

F. Language _Development: - Identified pictures of familiar objects when named - Identified one or more parts of body when named - Speaks 10 real words - uses words more than gestures to express desires - Points to a common object, e.g. shoe or ball - About 25% of vocalizations are intelligible - One word used to communicate Cont’d…

AGE 24 MONTHS A. Gross Motor; - More grown up, steady gait. - Can walk with heel-toe gait - Walks backward well in imitation - Runs more quickly in more controlled way; has fewer falls.

- Walks up & down stairs, both feet on one step at a time, holding onto a railing or the wall. - Jumps crudely with both feet in place - Kicks large ball without falling. - Picks up object from floor without losing balance, Fine Motors - Builds a tower of 6-7 cubes - Scribbles in more controlled way. - Imitates a circular and horizontal stroke.

- Turn one page of a book at one time. - Opens door by turning door knob; may run away - Unscrews lid of jar. - Folds paper once imitatively. Cont’d…

Is proud of accomplishment of motor skill, Self Care; - Drinks well from a small glass held in one hand Plays with food, can use straw Cont’d…

- Removes most of own clothing - Verbalizes toilet needs - Toilet-trained in daytime generally - May brush teeth with help - Attempts to wash self in tub or shower C. Sensory; - Accommodation well developed - inserts square objects into its appropriate place or hole.

- Separation anxiety from primary caregiver is at height - Has great sense of possessiveness - Behaves as though other children were physical objects - Pulls other persons to show them something - Does not readily ask for help. - Sleep resisted overtly; has many demands before bedtime, D. Psychosocial, Psychosexual, Spiritual Development

- Thumb sucking decreases - Temper tantrums decreasing E. Intellectual Development: - preoccupation with symbols in language, dreams and fantasy. - Attention span longer - Memory increases - Very early understanding of past, present and future.

- increased sense of time. - Symbolic thought begins, can "pretend". - Imitation becoming more symbolic - Moral If punished for doing it/ it's wrong; if not punished, it must be right. F. Language Development - Understands more complex sentences

- Enjoys stories with pictures - Has vocabulary of about 300 words - Refers to self by first name - Uses pronouns - 'I'/ 'me', 'you', - Verbalizes need for toileting, food or drink. - Talks incessantly - About 66% vocalization are intelligible.

AGE 30 MONTHS A. Gross Motor; - Stands on one foot alone momentarily - Walks on tiptoe for few steps on request - Walks up & down stairs, one foot on a step - jumps from step or loss chair. - Jumps with both feet. - Can throw a large ball overhand Rides a walker or pedal car. FINE MOTOR - Builds tower of 8 cubes - Makes vertical & horizontal strokes but may or may not join them to make across. - Holds cray on with Fingers instead of entire hand. - Good hand finder coordination; moves ringers.

Self care: - Self feeding with occasional spilling - Gets a drink without assistance - Chews with mouth closed - puts arm through large armhole - Buttons & unbuttons large front buttons Cont’d…

- Help puts thing away - Has mastered daytime bladder control - Beginning night time bladder control - May go to toilet byself . - Adequate attempt to wash hands C. Sensory: Visual acuity: 20/30 Recall visual images. Cont’d…

- Sense of shame & doubt predominates - Egocentrism still present - Separates more easily from parent - Ritualistic behaviour speaks - Reluctant to go to bed - Temper tantrums may or may not decrease D. Psychosocial, Psychosexual, Spiritual Development

- in play, helps put things away, can carry breakable objects, pushes with good steering. - Begins to notice sex differences; knows own sex. - May attend to toilet needs without help except for wiping. E. Intellectual Development: - Concept of time improved but still limited. - Begins casual thinking - Problem-solving through trial & error

F. Language Development; - Identifies five body parts when named - Gives full name if asked - Refers to self by appropriate pronoun - Uses pleurals & past tense of verbs. - Talks constantly - Asks why? - Uses 4-5 words sentences. - About 75% of vocalizations are intelligible, Cont’d…

AGE 3 YEARS, A. Gross Motor: - Walks a straight line - Walks backward & on tiptoes

- Runs without looking at feet - Jumps of bottom step - Rides tricycles - Goes upstairs using alternate feet. Fine Motor - Builds a tower of 9-10 blocks. - Copies a circle - Uses blunt scissors with one hand to cut. - Puts beads on strings. - Can help with simple household work. Cont’d…

Self care, - Can put on coat without assistance - Can undress self in most instances. - Can pull pant up & down - Can go to toilet alone - Brushes teeth with help. Cont’d…

C. Sensory: Visual acuity 20/20

- Egocentic in thought & behaviour - Alternative between reality & imagination. - Dresses self almost completely if helped with back buttons and told which shoe is right or left. - Pulls on shoes - Fears the dark - May have dreams and nightmares. D. Psychosocial, Psychosexual, Spiritual Development

- Knows own sex & sex of others - Less dependant on parents but needs reassurance and help. - Can help to set table; Can dry dishes without breaking any. F. Intellectual - Language acquisition - Tries to please & conforms to requests. Able to follow directional command Has a beginning understanding of time.

G. Language Development - Has vocabulary of about 900 words - uses 4 word sentences - Talks incessantly. - Repeats sentences of six syllables. - Asks many questions - Names figures in a picture Cont’d…

AGE 4 YEARS- 1 . Gross Motor ; - Skips and hops on one foot - Jumps from greater heights - Pedals a tricycle quickly; turn sharp corners. - Catches ball with extended arms and with hands - Climbs, ladder, trees, playground equipment - Walks down stairs using alternate footing. Fine Motor:: - Cuts around picture with scissors

- Draws a simple face - Copies a square Self Care; - Manages spoon with little spilling - Buttons side buttons, small buttons - Can put on shocks with help. - Can lace shoes, but may not be able to tie bow. - May bathe self, with assistance, - Vsadhes and dries hands without supervision. Cont’d…

C. sensory - Visual acuity 20/20 Cont’d…

- Tends to be impatient and selfish. - Usually separates easily from parents - Physically &verbally aggressive - Still has fears - Dreams & nightmares continue. - Sexually curious D. Psychosocial, Psychosexual, Spiritual Development

- Demonstrates strong attachment for parent of opposite sex - Jealousy of sibling may be evident - More cooperative in play E. Intellectual Development; - Classified objects according to one characteristic, - Not able to conserve matter. - Obeys because parents set limits. - Highly imaginative. - Uses alibis to excuse behaviour

F. Language Development - understands directives (On, under, in back, in front) - Names one or more colours correctly - uses I - Uses 3-7 wors sentences. - Has a vocabulary of 1500 words Cont’d…

AGE 5 YEARS 1. Gross Motor : - Skips & hops one alternate feet - Throws and catches ball well. - Jumps rope and jumps over object - Skates with good balance - Walks backward with heel to toe - Balances on alternate feet with eyes closed. Fine Motor; - Copies a triangle & diamond - Copies letters, may be able to write own name. - Adds 7-9 parts to stick figure. - uses scissors, pencils very well. Self Care; - Select form over spoon when appropriate

- May be able to lace shoes. - Bathes Self - Combs hair wipes self independently. B. Sensory ; Visual acuity 20/20

D.Psychosocial, Psychosexual, Spiritual Development - Separates easily from parents - Less rebellious & quarrelsome - Independent it trustworthy - Has fantacies & daydreams - Looks for parental support & encouragement - Engages in co-operative play - Strongly identifies with parent of same Sex, specially boys with their fathers. - Enjoys activities e.g. sports, cooking, shopping with parent of same sex.

E. Intellectual _Development; - Classifies objects according to relationships that are similar. - accurately describes events. - Aware of cultural differences - Very curious - Use time-oriented words with increased understanding.

_F. Language Development: - Has vocabulary of 2100 words - Uses sentences of 6-8 words - Names primary colours - Knows names of days of week, months & other time associated words - Can follow three commands in succession. Cont’d…

AGE 6-8 YEARS, A. Gross Motor: - Rides bicycle without training wheels. - Runs, jumps, climbs, hops - Constantly in motion - Coordination improving Fine Motors - Knows right from left hand - Draws a person with 12-16 parts - prints words - learns cursive writing - Has improved eye-hand coordination

Self Caret 6 Years - like to eat with fingers - Talkative while eating 7 Years - Improved table manners - less talking. - Has a tendency to dawdle in bathtub - Needs to be reminded to wash hands - Weaves whatever is selected by parents - Leaves clothes where they are removed Can brush and comb hair sensory ; Cont’d…

- is becoming real member of the family group - Take parts in group play - Boys prefer playing witn boys; girls prefer playing with girls. - spends a lot of time alone. - Jealous of Siblings - Fears injury to body - Insists on being first is everything - Has a "know it all" attitude. - Does what are adults seen doing - Has own way of doing things - May steal or may cheat to win D.Psychosocial, Psychosexual, Spiritual Development

F. Intellectual Development ; - Attention span increasing - Can describe objects in picture, knows their use - Can see differences more than similarities - Can tell time - Knows date, month & season Is learning to read follows rules to avoid punishment Cont’d…

F. Language Development; - Follows series of 3 commands, response dependent on mood. - Responds to praise & recognition - Can repeat sentences of 10-12 words - uses all forms of sentence structure - Develops a sense of humor, enjoys telling jokes. Cont’d…

A. Gross Motor - perform tricks on bicycles; races - Begins to participate in organized sports. - Throws a ball skillfully - over hand or under hand Fine Motor; - Uses both hands independently. - Draws a person with 18-20 parts - Has increased smoothness and speed in fine motor control. - Cursive writing improved. 8-10 Years

Self Care: - Handles eating utensils skillfully - Dresses self completely, enjoys selecting own clothes. - Unaware of dirty clothes - Needs to be reminded to brash teeth. C. Sensory Visual acuity of adult value. .

D. Psychosocial, Psychosexual, Spiritual Development - Becoming piece oriented Is easy to get along with at home - Is more sociable and better behaved. - Compare self with others - Enjoys scouts, group work etc. - Relationship with siblings a improved

- Begins hero worship - Curious about everything - Interested in boy-girl relationship but will not admit it. F Intellectual Development ; - Give similarities and differences between two things from memory. - Counts backward - Interested in school work

- Time -usually punctual. - Repeat days of the week, and months in order; knows the date. - Describes common objects in detail. - Attend 3rd or 4th grades. - Reads more. Reads classic books/ but also enjoys comics. - Can grasp concepts of parts and whole. G. Language Development: - Follows suggestions better than command - Begins to use shorter and more compact sentences

10-12 YEARS A. Gross Motor ; Enjoys all physical activities. Fine Motor Co-ordination continues to improve Self care - Criticizes table manners of parents. - May wear some clothes continually. - Leave clo tries where they fall. - Enjoys wearing current style of clothes - Needs constant reminding of personal hygiene. - Bathes frequently - prefers showers. C. Sensory;

D. Psychosocial, Psychosexual, Spiritual Development - Has greater self control - Respects parents & their role - Chooses friends more selectively; may have a "best friend" - Develops beginning interest in opposite sex. - Likes mother and wants to please her in many ways. - Likes dad, top; he is adored & idolized. - Loves friends; talks about them constantly.

D. Psychosocial, Psychosexual, Spiritual Development - Has out bursts of anger (10 yrs.) - Able to control anger (12 yrs.) Hero worship of adult continues. Still fears the dark. F. I ntellectual Development: - Develops abstract and deductive reasoning - Uses problem solving methods

- Can define abstract terms - Collect facts for future use. - produces simple paintings & drawings - Writes brief stories - Attends 5th - 7th grades - Uses telephone for practical purposes. Writes occasional short letters to friends and relatives.

G. Language Development : - Follows suggestions better than requests; is obedient. - Oral vocabulary of 7200 words, reading vocabulary of 50,000 words. - User parts of speech correctly. - Able to give precise dictionary definition of words. - Enjoys riddles. Cont’d…

REFERENCES: 1. Marlow R. Borothy & Redding A. Barbara, "Text book of ' Paediatric Nursing" 6th edn. London, W.B. Saunders Company, 1988, pp-163-1011. 2. Achar, S.T. "Text book of Paediatrics" 2nd ed., Madras, Orient Longman, 1982, pp.31-74. 3. Waechter et al, "Nursing Care of Children" 10th ed. St. Louis, J.B. Lippincott Company, 1985, 4. Wong & Whaley, "Nursing Care of Infant & children" 5th ed., St. Louis, C.V. Mosby, 1995. pp.282-435

THANKS

Unit 2 healthy child

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Unit 2 healthy child

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