Pediatric Growth and Development
In nursing, developmental theories can be useful in guiding assessment, explaining
behaviors, and providing a direction for nursing interventions.
List the central task as identified in Erikson’s stages of development.
Stage Age Central Positive Negative
Task Resolution Resolution
Infancy Birth - Learning to trust others. Mistrust, withdrawal,
18 months estrangement. Can develop
when basic needs are not met.
Early 18 months - Self-control without loss of Compulsive self-restraint or
Childhood 3years self-esteem. Ability to compliance. Willfulness and
cooperate and to express defiance. Shame can develop
oneself. Learns to control own when child is scolded for failed
body. attempts.
Late 3- Lack of self-confidence.
Childhood Learning the degree to which Pessimism, fear of wrong-
5 years
assertiveness and purpose
doing, Over control and over
influence the environment.
restriction of own activity. If
Beginning ability to evaluate
actions are in conflict with
one’s own behavior. Develops
parents’ ideas, guilt may
a conscience.
develop.
School 6- Beginning to create, develop, Loss of hope, sense of being
Age 12 years and manipulate. Developing mediocre. Withdrawal from
sense of competence and school and peers.
preservation. Learns to
compete, cooperate, and
follow rules.
Adolescence 12 - Feeling of confusion,
Coherent sense of self. Plans
20 years indecisiveness, and possible
to actualize one’s abilities.
antisocial behavior.
Fill in the blanks.
Three ways trust can be enhanced in an infant are by:
1. _______________________________________________________________
Because toddlers are curious about their environment and are becoming independent,
______________is a primary concern when caring for them.
Imagination peaks during the preschool years. Heightened fears and anxiety also occur.
Most preschoolers fear shots and injections. What simple action by the nurse can “make
it better” after giving the child an injection? ____________________________________
Although school-age children work hard to succeed, they are always faced with the
possibility of failure. When teaching a school-age child, the child should receive
______________for their efforts to help them feel competent and in control of
themselves and of the environment.
Adolescents are usually self-conscious and sense an imaginary audience in which they
are onstage, and everyone is watching them. They are focused on their appearance and
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, have a preoccupation with peer acceptance. Knowing this, list at least 4 things the nurse
can do to address an adolescent clients’ developmental needs?
Developmental Screening
Developmental screening is designed to identify problems or delays during normal
childhood development. When properly applied, screening tests for developmental or
behavioral problems in preschool children allow improved outcomes due to early
implementation of treatment.
Developmental screening of infants and toddlers along with the provision of treatments
and services for those with developmental delays is required by U.S. law. The
Individuals with Disabilities Education Act (IDEA) Amendments of 1990 to 1997 require
that individual states establish programs to identify and assist children at risk for
developmental delays. One example of a commonly used screening tool for children
aged 0-6 is the Denver Developmental Screening Test (DDST).
The DDST compares a child's performance to the percentage of children in the same
age group who can perform certain tasks. These tasks are grouped into four categories:
social contact, fine motor skill, language, and gross motor skill.
The main purpose of a developmental assessment depends on the age of the child:
Tests may detect neurological problems such as cerebral palsy in the neonate.
Tests may reassure parents or detect problems in early infancy.
Testing in late childhood can help detect academic and social problems early
enough to minimize possible negative consequences.
Physical Assessment Tips
Birth to 6 months If baby is comfortable and stress free, exam can be conducted on
table. Sensory methods, such as voice, noise makers, toys to see or
touch, or skin touch attract babies. They like a smiling human face.
Do quiet things first, and then head to toe.
6 to 12 months Consider exam in parent’s lap due to separation or stranger anxiety
(up to 4 years). “Warm up” more slowly with play techniques. Object
permanence and ability to anticipate develops, so provide comfort
measures after unpleasant procedures. Increased mobility leads to
additional safety measures and limit-setting concepts, which continue
with each age group.
Toddlers Exam in parent’s lap, due to need for parent security. Play games.
Do least intrusive things first. Save ears, nose, and throat for last.
Avoid “no” responses or choices they cannot make. Offer simple
acceptable choices. Let them touch equipment.
Pre-Schoolers Keep parent close. Some will cooperate with exam on table. Protect
modesty. Use dolls, animals, or parents to “examine” first. Magical
thinking may cause fearfulness or thinking equipment is alive. Let
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