Growth and development

the child gains control of the head and neck before the trunk and limbs

the child controls arm movements before hand movements.

For example, the child reaches for objects before being able to grasp them

Frued

Erikson

Piaget

Kohlberg

birth to 1 y

1 yr to 3 yrs

3-6 yrs

6-12 yrs

12-18 yrs

Freud - Infants

the baby obtains pleasure and comfort through mouth.

When a baby is NPO, offer a pacifier if not contraindicated. Alter painful procedures, offer a baby a bottle or pacifier or have the mother breast feed

Piaget - Infant

The baby learns from movement and sensory input

Use crib mobiles, manipulative toys, wall murals, and bright colors to provide interesting stimuli and comfort.Use  toys to distract the baby during procedures and assessments

Erikson - Infant

The baby establishes a sense of trust when when basic needs are met

Hold the hospitalized baby often.Offer comfort after painful procedures. meet the baby's needs for food and hygiene.Encourage parents to room in .Manage pain effectively with use of pain medications and other measures.

• not much knowledge of body !
• reaction to illness: separation anxiety- protest, despair, detachment (denial)

anal learns control over body functions

• Ask about toilet training and the child's rituals and words for elimination during the admission history
• continue the child's normal patterns of elimination in the hospital
• do not begin toilet training during illness or hospitalization
• accept regression in toileting during illness or hospitalization
• have potty chairs available in the hospital and childcare centers

• pre-operational – egocentrism,
• transductive reasoning, magical thinking

• Sensorimotor stage (end); preoperational stage ( beggining) 
• The child shows increasing curiosity and explorative behavior
• language skills improve
•  name objects and give explanations to the child

autonomy vs. shame and doubt

Knowledge of body: maybe body parts

Reaction to illness: separation anxiety ( same as infant)

•  Nursing implications:
• allow self feeding opportunities
• encourage the child to remove and put on own clothes, brush teeth, or assist with hygiene
• if restraint for  a procedure is necessary, proceed quickly providing explanations and comfort
• ensure safe surroundings to allow opportunities to manipulate objects
• name objects and give explations

phallic – focus  on genitalia and differences between girls and boys

The child initially identifies with the parent of the opposite sex but by the end of this stage has identified with the same sex parent.

• Nursing implications:
• Be alert for children who appear more comfortable with male or female nurses, and attempt to accommodate them. Encourage parental involvement in care

pre-conceptual  - egocentrism, transductive reasoning, magical thinking

Preoperational stage: the child is increasingly verbal but has some limitations in thought process. causality is often confused, so the child may feel responsible for causing an illness

• Nursing implications:
• assess children's concerns as expressed through their drawings.
• accept the child's choices and expressions of feelings.
• offer explanations about all procedures and treatments
• clearly explain that the child is not responsible for causing illness

initiative vs. guilt: child likes to initiate play activities

• Knowledge of body: very primitive ideas
• Reaction to illness: fear of mutilation

• NI:
• plan for playtime and offer variety of materials from which to choose
• offer medical equipment for play to lessen anxiety about strange objects

• latency - quieter sexual stage
• child places importance on privacy and understanding the body

NI:

• Provide gowns. covers, and underwear
• knock on door before entering
• explain treatments and procedures

concrete operations - accurate understanding of cause and effect; can follow rules, can see another’s point to view

Child is capable of mature thought when allowed to manipulate and see objects

• NI:
• Give clear instructions about details of treatment
• show equipment that will be used in treatment

Industry VS inferiority: the child gains a sense of self-worth from involvement of activities.

• NI
• encourage the child to continue with school work while hospitalized
• encourage the child to bring fav pastimes to the hospital
• help the child adjust to the limitations on fav activities

• Knowledge of body: may know a lot
• Reaction to illness: punishment for previous bad behavior

genital – growth to sexual maturity, relationships

• NI:
• Ensure access to gynecologic care for adolescent girls
• provide information on sexuality
• ensure privacy during health care
• have brochures and videos available for teaching about sexuality

• formal operations – ability to think abstractly, can reason and consider outcomes
• capable of mature abstract thought
• NI:
• give clear and complete information about health care and treatments
• offer both written and verbal instructions
• continue to provide education about disease to the adolescent with a chronic illness, as mature thought now leads to greater understanding

identity vs. role confusion: the adolescent's search for self-identity leads to independence from parents and reliance on peers

• N/I:
• take the health history and perform examinations w/o parents present
• introduce the adolescent to other teens with the same health condition

Knowledge of body: may know more than you!

Reaction to illness: concern about body image