NSG 217: Weeks 1-3 (Development & Developmental Theorists)

Sigmund Freud

• Psychosexual Theorist

• Id, Ego, Superego 

• Psychosocial development (Freud)

  • Oral stage (birth to 1 year)

  • Anal stage (1 to 3 years)

  • Phallic stage (3 to 6 years)

  • Latency period (6 to 12 years)

  • Genital stage (≥ 12 years)

Oral Stage

• birth to 1 year

• everything as far as pleasure is centered around the oral fixation

  • sucking, biting, chewing and vocalizing 

  • children up to 1 year are putting everything in their mouths

Anal Stage

• 1 to 3 years

• sphincter muscle begins to develop and potty training can occur

  • a negative or positive experience with potty training can really affect personality development 

  • Hold off on potty training until the child can actively participate in potty training & don’t force or shame child into potty training

Phallic Stage

• 3 to 6 years

• Phallic stage: Phallic means genitalia

  • when they start to realize that there's a difference in genders 

  • when child starts to experience the oedipus complex

    • typically around the age of 4

    • unconscious sexual desire for the parent of the opposite sex, and a wish to exclude the parent of the same sex

      • children may want to marry their mom or dad and get upset if the other parent shows any affection towards them 

      • typically doesn’t last for a long period of time

Latency Period

• 6 to 12 years

• Latency period: Stable period 

  • all earlier issues have been resolved or repressed 

  • not a whole lot of changes are going on

Genital Stage

• ≥ 12 years

• Genital Stage: 

  • Starts with puberty; when the sex hormones are being produced

  • Genital organs are now a source of tension and pleasures

  • masturbation usually occurs during this stage 

  • they start forming friendships and preparing for marriage 

Erickson

• Psychosocial Theorist

  • Ego, personal identity, socio cultural identity

• Psychosocial development (Erikson)

  • Trust vs. mistrust (birth to 1 year)

  • Autonomy vs. shame and doubt (1 to 3 years)

  • Initiative vs. guilt (3 to 6 years)

  • Industry vs. inferiority (6 to 12 years)

  • Identity vs. role confusion (12 to 18 years)

Trust vs. Mistrust

• birth to 1 year

• Virtue of hope 

• develops trust when they’re taking in all of their senses 

• Caregivers respond to the infant’s basic needs by feeding, changing diapers, cleaning, touching, holding, and talking to the infant.

• Trust: their needs are consistently met by a caring, loving, motherly figure 

  • “mother” is just whoever provides their mothering care

• Mistrust: when that consistent loving care is inconsistent or lacking 

• Example: when a baby is crying, if their motherly figure consoles the baby & takes care of them and tries to figure out why they’re crying then the baby will develop trust, but if that consoling does not occur mistrust will develop

Autonomy vs Shame & Doubt

• 1 to 3 years

• Virtue of will

• Autonomy: the child is discovering that they can do things on their own, the parent then allows them to do so 

• Shame & doubt develop when the parents don’t allow the child to do things on their own or scolds them when they attempt & they fail. 

• Example: when a child is trying to put their shoes on, if the mother encourages them, helps them, & praises them when they get it right autonomy develops, but if the mother yells because they’re taking too long or because the put the shoes on the wrong feet, or if they still can’t tie their shoes then shame & doubt develops.

• Achieves autonomy and self-control, 

  
  

• Separates from parent/caregiver,

  
  

• Withstands delayed gratification, imitates adults and children.

  
  

• Negativism abounds, show affection

  
  

• Cannot take turns in games until age 3 years

Initiative vs Guilt

• 3 to 6 years

• Virtue of purpose

• Initiative: they have a strong imagination, they start to make up games & initiate activities with others. Often mixed up with autonomy, but in initiative they are developing or making up things. Not just realizing that they can do things on their own but now they’re making things up on their own

• Guilt: when the mother criticizes or controls their imagination & those games that theyre making up & that child feels like a nuisance. 

• Example: When the child makes up a game on their own and it may not make any sense to us as adults but if the mother plays along & tries to learn more about the game initiative will develop, if the mother ignores the child, refuses to play with them tells them their game is stupid or that it doesn’t make sense then guilt will develop.

• Likes to please parents, plans and initiates activities, make up games, explores new things,

  
  

• Acts out the roles of other people (real and imaginary), explores new things

  
  

• Develops sexual identity & conscience

  
  

• May take frustrations out on siblings

  
  

• Enjoys sports, shopping, cooking, working

  
  

• Feels remorse for wrong choice or behaving badly

  
  

• Cooperates with other children

  
  

• Negotiates solutions to conflicts

  
  

Industry vs. Inferiority

• 6 to 12 years

• Virtue of competency

• Industry: means their peer group is very important to them, it helps them develop their self esteem. They need to win approval from their peers. their able to complete specific competencies like reading, writing, or they’re encouraged and reinforced if they are unable to meet those competencies

• Inferiority develops when they are unable to complete those competencies & then their peers don’t accept them because of it

• Example: Child is trying to read a book in front of the class, but is having difficulty, if the teacher encourages the child to read and helps them they will develop industry,if the teacher criticizes the child & skips them & embarasses them in front of their peers, then moves on to another child who can read better, the child develops inferiority. As a child start attending school teachers & school workers become much more important in the development of their psychosocial skills.

• Interested in how things are made and run

  
  

• Success in personal and social tasks

  
  

• Increased activities outside home—clubs, sports

  
  

• Increased interactions with peers, interest in knowledge

  
  

• Needs support and encouragement from important people in child’s life

  
  

• Needs support when child is not successful

  
  

• Inferiority occurs with repeated failures with little support or trust from those who are important to the child

Identity vs. Role Confusion

• 12 to 18 years

• Virtue of fidelity 

• Identity: a major stage in development where the child is learning the roles they will occupy as an adult. 

• Role confusion is failure to establish a sense of identity within a society. 

• Example: “I don’t know what I want to be when I grow up”. It’s okay for them to be unsure of what they want to do, but it’s the parent’s job to help encourage the child and help them find their interests & things that they think that they might want to do, that will help them develop their identity. They will develop role confusion if the parent is trying to pressure them without offering help. now they feel like what they identify with & what their parents want them to be is not meshing.

• Adjusts to changed body image, frequent mood changes

  
  

• Importance placed on conformity to peer norms and peer acceptance, tries out different roles in peer groups-need for peer acceptance at highest level.

  
  

• Defining boundaries with parents and authority figures

  
  

• Identifies with same-sex peers, interested in attracting opposite gender.

  
  

• Takes more responsibility for own behaviors

  
  

• Time of greatest conflict with parents/authority figures

  
  

• By the end: Able to understand implications of behavior and decisions

  
  

• Roles within peer groups established

  
  

• Has matured sexual identity and idealistic career goals

Erickson’s Other Stages

• Erickson also has 3 other stages:

  • Intimacy vs Isolation (20 - 39 yrs)

  • Generativity vs stagnation (40 - 64 yrs)

  • Integrity vs Despair (65 - Death)

Piaget

• Cognitive development Theorist

• Sensorimotor (birth to 2 years)

• Preoperational (2 to 7 years)

• Concrete operations (7 to 11 years)

• Formal operations (11 to 15 years)

Sensorimotor

• birth to 2 years

• this is essentially their sense of cause. They direct their behavior towards objects & they problem solve by trial & error. They are very curious

  • approximately 4-7 months they develop object permanence.

    • Prior to 4 months of age if you take a block and put it behind your back the child will think that the block has disappeared, and not that it still exists but it’s just now out of her sight. at roughly 4-7 months of age the child then begins to realize now that when they block is put behind your back it still exists, and now the child will start to try to look behind your back to find the block. 

• Infant uses senses and motor skills to learn about the world.

  
  

• Infant begins to gain control over reflexes and recognizes familiar objects, odors, and sounds.

  
  

• Thumb sucking may occur by chance; then the infant repeats it on purpose to bring pleasure. Imitation begins.

  
  

• Infant repeats actions to achieve wanted results (e.g., shakes rattle to hear the noise it makes).

  
  

• Infants coordinate previously learned schemes with previously learned behaviors.

• They may grasp and shake a rattle intentionally or crawl across the room to reach a desired toy.

• Infant can anticipate events.

• Object permanence is fully present at about 8 months of age. The infant begins to associate symbols with events (e.g., waving goodbye means someone is leaving).

  
  

Preoperational

• 2 to 7 years

• children are very egocentric, they can’t put themselves in someone else’s shoes.

  • Example: If they push another child and you ask them how would you feel if I did that to you, they are unable to rationalize that in their head. 

  • They also interpret objects in terms of their use or relationships to them. 

    • Example: a child has a little toy handgun and makes it make the sound as pew pew, and they call the gun a “pewmer”, because to them that’s the noise it made. The child has no idea that it’s a gun and that it could harm people because to them, their relationship was that it was a “pewmer”.

• Places items in and out of containers, completes puzzles with 4 pieces

  
  

• Imitates chores, begins to represent the world symbolically.

• Starting to think before acting. 

• Sense of ownership (me/mine)

  
  

• Understands requests and can follow simple directions

  
  

• Time, space, and causality understanding is increasing

  
  

• Uses mental trial and error rather than physical

  
  

• Plays make-believe with dolls, animals, and people

  
  

• Increased use of language for mental representation

  
  

• Starting to make connections between an experience in the past and a new one that is currently occurring

  
  

• Classifies and sorts objects by shape and color

  
  

• Play becomes more complex

  
  
  

Concrete operations

• 7 to 11 years

• Kids start to become logical and coherent.

• They can classify, sort, & organize facts.

• They are able to problem solve in their head without actually acting out. 

  • Examples: in sensorimotor phase a child might keep jumping and falling off of a couch because they learn by trial and error, but in the concrete operations phase they might realize that if they jump they might not make it and fall so they’re not going to try it, they don’t have to do trial & error any longer to try & figure those things out. 

• Child learns rules such as conservation. 

Formal Operations

• 11 to 15 years

• when they become flexible and adaptable.

• They can think abstractly and draw logical conclusions.

• Can transcend the concrete situation and start to think about the future.

Kohlberg

• Moral Development Theorist

• Preconventional level

• Conventional level

• Postconventional, autonomous, or principled level

Preconventional level

• 9yrs of age and younger

• they determine goodness & badness of an action in term of the consequences. 

  • if they’re punished its a bad action & if they were rewarded it’s a good action

  • they want to avoid punishment & they want to obey those with power

Conventional Level

• mostly adolescents & adults

• This consists of Conformity, loyalty, family, they generally want to be nice & obey the rules

Postconventional

• also known as autonomous, or principle level phase

• mostly adults

• they try to correct their behavior to conform to that which is agreed upon by society as being acceptable 

Fowler

• Spiritual Development

  • Stage 0: undifferentiated

  • Stage 1: intuitive-projective

  • Stage 2: mythical-literal

  • Stage 3: synthetic-convention

  • Stage 4: individuating-reflexive

What is the most important part of pediatrics?

• Development

Kids & Respiratory Depression

• kids tend to respiratory arrest compared to an adult who cardiac arrests

  • unless they have an underlying cardiac condition of some sort 

Growth & Development

• Growth: 

  • an increase in number and size of cells as they divide and synthesize new proteins; results in increased size and weight of whole or any of its parts

• Development:  

  • a gradual change and expansion; advancement from lower to more advanced stage of complexity; increased capacity through growth, maturation, and learning

• Development is always compared to growth

  • most of the time the two go together, but you can develop without growth (ex: dwarfism) & you can grow without development (ex: cerebral palsy)

• you need to know the childs given age and their developmental age, sometimes they can’t be drastically different 

Directional Trends of Growth

• Cephalocaudal: (Head to Tail)

  • Head develops first

    • Is large and complex

    • A baby’s head is really big compared to the rest of their body 

    • usually when they’re about 4 months old they have a decent amount of head control, prior to that not so much 

  • Lower develops later

• Proximodistal: (Near to Far)

  • Midline to Peripheral

  • Proximodistal

    • develops their core first before the fine muscles (ex. fingers)

    • example: palmer vs pincer grasp

      • The palmar grasp uses the whole hand and palm to clutch an object in a fist, typically developing around 4 to 6 months. In contrast, the pincer grasp is a refined movement using just the tips of the thumb and index finger to pick up small items, emerging around 8 to 12 months.

Sequential Trends & Developmental Pace

• Sequential Trends

  • Definite, predictable sequence

  • Some variance

• Developmental Pace

  • Although development has a precise order

    • Does not progress at same pace

• Although development has a precise order

  • Does not progress at same pace

Physiological Changes Through the Years

• Metabolism

  • BMR (Basal Metabolic Rate) highest in newborns

    • Kids have a higher BMR

• Temperature

  • Reflective of BMR

  • as body surface area increases, BMR decreases so temperatures and HRs are decreased as we get older. (a newborn would have a higher temp compared to an adolescent). Things tend to be faster the younger that you are. a higher respiratory rate in newborns doesn’t really correlate with their BMR.

• Sleep & Rest 

  • newborns sleep between 16-20 hours in a day. they need to be fed every 3 hours so we need to wake them up if they're sleeping 

• Nutrition 

  • Single most important influence on growth 

  • nutrition also impacts development as well. 

    • socioeconomic status & accessibility to good nutrition is also something you need to consider 

    • we can give older kids a food diary to ask what they ate prior to coming in so we can see if diet is the issue. We then try to see what resources we could offer 

When does the normalization of adult vitals occur

• The normalization of adult vitals would occur between the ages of 10-12. 

How long do newborns sleep?

• Newborns sleep between 16-20 hours in a day.

• they need to be fed every 3 hours so we need to wake them up if they're sleeping 

What is the single most important influence on growth?

Nutrition

• nutrition also impacts development as well. 

Role of Play in Development

• Universal medium of play—children learn!

• Play is their Work

• Content of Play

  • Social-affective

    • Learn relationships

  • Skill 

    • Acquire skills & further develop them

  • Dramatic/Pretend 

  • Games

• you may not understand everything that they learn for or exhibit from play

  • initiation vs Guilt

Types of play by age

• Unoccupied

• Solitary

• Onlooker

• Parallel

• Associative

• Cooperative

• 
  

Unoccupied Play

• 0-3 Months

• Baby makes random movements with arms, legs, hands, and feet—exploring their body and surroundings.

Solitary Play

• 0-2 Years

• Baby is happy to play alone, focusing on their toys and learning independence.

Onlooker Play

• Around 2 Years

• Baby watches others play, learning by observing.

Parallel Play

• 2+ Years

• Baby plays next to other children with similar toys but without direct interaction

Associative Play

• 3-4 Years

• Baby begins to interact with others while playing, though play isn’t fully coordinated yet.

Cooperative Play

• 4+ Years

• Baby plays together with others, sharing and collaborating in group activities. 

Function of Play

• Sensorimotor Development

• Intellectual Development

• Socialization

• Creativity

• Self Awareness

• Therapeutic Play

Infants

• Birth - 12 months

• Erickson: trust vs mistrust

• No concept of danger (crawler)

  • usually kids are crawling about 9 months of age 

    • when they start to become problematic 

    
    

  • Children don’t know whats dangerous and what isn’t; they don’t know any better

    • Ex. baby doesn’t know that they might drown in water or that they might fall down stairs 

      • make sure bathroom, door is closed 

• Falls

  • falls are a big thing within this age group

    • usually due to adults leaving kids where they shouldn’t be left like couch or changing table

• oral phase

  • you need to be careful of poison ingestion

  • Inhalation of foreign objects

    • Everything goes in the mouth

• Suffocation leading cause of death

• Ingestion injuries

• Burns

What Erickson Stage are Infants in?

• trust vs mistrust

Which Freud Stage are infants in?

• oral phase

What is the leading cause of death in Infants?

• Suffocation is the leading cause of death

Newborns

• newborn: 0 - 28 days 

  • we need to understand that there is a difference, because depending on whether or not you’d get a diagnosis, the child may end up on the nicu, picu, on the floor. 

  
  

• it overlaps with infants 

• The fastest period of growth is that first month of life

How much weight does an infant gain per week?

• 5-7 ounces weight gain per week 

When does an infant double their weight?

• Double birth weight by age 4-5 months

When does an infant triple their weight?

• Triple birth weight by age 1 year

  • the most important thing to look for is has the baby tripled their birth weight by age 1 year because that’s going to tell you that they have been getting good nutrition for at least a year & if they’re still able to maintain their weight, height, head circumference within the percentile that we’re looking for. 

How much taller does an infant get per month?

• Height increases by 1 inch per month 

Proportional Changes in an Infant

• Expanding head size

  • Reflects the growth & differentiation of nervous system

• Growth in “spurts” rather than gradual pattern 

Fine Motor Development Infant

• baby’s shouldn’t be holding their bottle on their own when being fed because they don’t know how to take the bottle out of their mouths so they’re at risk for aspiration 

Which fine motor skill develops at 2 months?

• Briefly opens hands

Which fine motor skills develops at 4 months?

• Bats at objects

  
  

• Holds toy when put in hand

  
  

• Brings hands to mouth

Which fine motor skill develops at 6 months?

• Reaches for desired items

Which fine motor skills develops at 9 months?

• Gross pincer grasp (rakes)

  
  

• Transfers objects from one hand to another

Which fine motor skill develops at 12 months?

• Fine pincer grasp

Gross Motor Development Infants

• Gross motor = bigger muscles

Which gross motor skills develop at 2 months?

• Holds head up when prone

• Moves all four extremities

Which gross motor skills develop at 4 months?

• Holds head steady without support

  
  

• When prone, pushes up on forearms/elbows

Which gross motor skills develop at 6 months?

• Rolls from prone to supine

  
  

• Tripod sits

  
  

• When prone, uses arms to push up straight

Which gross motor skills develop at 9 months?

• Sits unsupported

  
  

• Gets to sitting on own

Which gross motor skills develop at 12 months?

• Pulls to stand

  
  

• Cruises (walks holding onto furniture)

When do children begin to crawl?

• usually kids are crawling about 9 months of age 

• Abdomen off floor

When do children begin to walk with assistance?

• 10 months

• may also be called ‘cruising’

• (can occur as late as 12 months)

When do children begin to walk alone?

• 12 months

• Maybe later or earlier

  • if a baby doesn’t show any desire to walk by 14-15 months we have to figure out why that may be, maybe due to leg muscle or nerve issues

Infants Social Development

• Attachment

  • usually form an attachment to their mom; could be due to 

    • breastfeeding  (source of food)

    • skin to skin with the mother within the first hour of birth can decrease the likelihood of hypoglycemic events

• Separation anxiety 

  • 10-12 months – distress when parent leaves

• Language development

  • First language is crying, then its cooing (first 2 months), then smiling (could be gas), blowing raspberries

• Play

  • Squealing, they can just hold on to toys. 

    • the more that you encourage a child to play as they grow older, the more quickly developed their gross or motor skills would be. 

When does an infant develop separation anxiety?

• 10-12 months – distress when parent leaves

Promoting Development-Play-Infant

• Infant

  • Multisensory stimulation

    • they use their five senses

  • Hearing spoken language

  • Fine/gross motor activities

  • Remember what type of play the infant uses from the video.

    • Unoccupied Play (0-3 months) & Solitary Play (0-2 years)

Injury in Infants

• Injuries are a major cause of death during infancy (especially 6-12 months)

  • 6-12 months

    • babies start to become mobile, so things that weren’t initially a risk, are now becoming a risk. 

• Aspiration of foreign objects

  • Foods

• Suffocation (balloons & gloves)

  • balloons & gloves when blown up can be popped if infant puts them into their mouth, which now makes it an aspiration risk 

• Motor vehicle injuries

  • Are the kids in a proper facing car seat?

• Falls

• Poisoning

  • the more mobile the child gets, the more susceptible they are to poisoning 

• Burns

  • Hot water (<120), sunburns, etc

• Drowning

Foods that should be avoided in infants

• Foods that should be avoided infants 

  • grapes

  • honey

  • nuts

    • peanuts

  • hot dogs (biggest risk)

New laws regarding car seats

• now the child needs to be in a rear facing car seat until they’re two or until the manufacturer of the car seat says so, the longer you can rear face the better. 

• they need to be in a car seat with a booster until they’re 5-8 years or 4’9 inches, whatever comes first

• if they’re less than 13 years they need to be in the back seat.

Prevention of Injury Infants

• Accident prevention is up to the adults

• Children learn from your behavior

• Bath water 100-105 degrees

  • Hot water heater set at 120° F (49° C)

• Clothing should not have ties or buttons and should be fired retardant

• Proper car seat use 

• Guard rails at top of the stairs

• Car seats

  • Rear facing

• Side rails up on cribs

• Do not use baby powder

• Never leave in high chair alone

• Cover all electrical outlets

• Avoid toys with small objects

Toddlers

• Age 12-36 months (1-3yrs)

• The biggest thing about toddlers is that they are developing autonomy 

• Erickson Stage: autonomy vs shame & doubt 

  • Ex: if the child wants to pour their own milk into cereal

    • if the mom says no that they're going to make a ness they will doubt their own skills; sometimes you have to come up with a compromise 

      • this may seem little compared to their childhood, but they carry on this doubt throughout their life 

      • Compromise: mom can pour small amount of milk in a cup and give that to the child

• “Negativism”

  • Stage of negativism 

    • everything is “no” 

      • they even say no to things that they like 

• “Ritualization” provides sense of comfort

  • Need to maintain sameness

    • Very stuck on routines and sameness

      • if they get admitted to the hospital we want to ask parents abt routine so that we can mimic that in the hospital as close as possible, so that it can decrease their anxiety and increase their compliance 

  • Regression

    • You will also see a lot of regression 

      • reverting back to previous things that you had moved beyond

        • Ex: a kid who is potty trained may wet the bed in the hospital 

        • Regressions occurs because the child is in an unfamiliar environment & a high stress situation

          • we need to reassure parents that the regression is temporary 

          • when they go home and aren’t under as much stress, then the regression will go away and they’ll be potty trained again. 

• Not aware of dangers

  • Just like infants toddlers aren’t aware of dangers

    • they will fall down stairs, touch a hot oven, may get burned around campfires, drowning (may not realize that water is as deep). 

• World is expanding because of biological growth, seeking autonomy

  • Because they are seeking autonomy and their growing biologically, they are expanding bc theyre learning so many new things and exploring the environment around them 

• Sibling rivalry

  • They will also have a sibling rivalry both ways (older or younger)

    • Older: they might be jealous bc they get to do more things, they have more autonomy, they get to go outside by themselves, etc

    • Younger: If the child is used to always being the baby, when they get a new younger sibling they will begin to envy the baby and seek out attention.

Toddlers Language Development

• At this Stage language development is rapid, they go to knowing about 50 words when they’re two to 1000 words at 3. 

  • their speech isn’t always the clearest

    • parents may understand them because they’re around them all of the time 

Promoting Optimum Growth & Development Toddler

• “The TERRIBLE Two’ 

• Intense period of exploration

• Temper tantrums/stubbornness occur frequently

  • The best way to deal with temper tantrums is to ignore them as long as the child is safe 

    • children know what they're doing, they want to see how you’re going to react to what their doing

      • depending on how you react would tell them whether they will keep doing this over and over again, or if they realize that its not getting them anywhere so they just won't do it anymore 

How much does weight gain slow down to in toddlers?

• Weight gain slows to 3-5 lbs/year

When should birth weight be quadrupled?

• Birth weight should be quadrupled by 2 ½ yrs old

How much does height increase per year in toddlers?

Height increases about 3” per year

Biological Development in Toddlers

• Growth is “step like” rather than “linear”

  • By the time that they are a toddler, growing slows down a little bit

    • their growth is more step like 

      • like they grow then stop for a little then grow then stop etc

• Reach half of their adult height by 2 years old

• Toilet training & Toilet Training Readiness 

Toileting with toddlers

• Toilet training

  • Anal Phase: 1-3

  • a lot of resources talk about not forcing potty training early because it can cause psychological damage long term 

  • by 18-24 months they can develop sphincter control to where they can control their bowel movements. The problem with bowel movements is that children don’t like the way that it feels, especially children with autism, so they will often hold bowel movements, which leads to constipation 

  • at roughly 8 months and older they start to have a dramatic increase in their bladder capacity, so they can hold their bladder for a lot longer 

    • as children get older, bladder capacity increases and they can take bathroom breaks less frequently, and begin to tell their teacher when they need to go to the restroom 

Biologic Development Toddler (Cont.)

• Maturation of Systems

  • Most physiologic systems are relatively mature by the end of toddlerhood

    • usually by the time that they are ending toddlerhood (36 months), most of their physiological systems are pretty mature 

• Upper respiratory infections, otitis media, and tonsillitis are common among toddlers

  • Because by the time that a child is three they are exposed to more people (preschool, daycare, caretaker, etc.), they are more susceptible to getting infections, specifically Upper respiratory infections, otitis media, and tonsillitis (aka strep throat)

    • children are also more susceptible because they don’t tend to wash their hands, cover their coughs, pick & eat/wipe their boogers on things.

    • RSV = respiratory syncytial virus 

      • very common 

• Body temperature is maintained

  • By toddlerhood temperature has leveled off 

• Child is physiologically able to control elimination

• Defense mechanisms of skin are intact

  • up until toddlerhood their skin is very thin, and does not protect them from injury as well as our skin would

    • by the time they are at that end of toddlerhood, their skin is intact, and all of their levels have been developed, and they are now protected from potential injuries 

Sensory Changes in Toddlers

• Visual acuity of 20/40 acceptable

• Hearing, smell, taste, and touch increase in development

• Uses all senses to explore environment

• Taste preferences 

  • picky eaters 

    • most of the time it’s vegetables

• Physiologic Anorexia

  • Physiologic anorexia 

    • theyre not growing as fast as infancy so they dont need as many calories as they needed in infancy 

    • you may think that they have a poor appetite or that youre not feeding them enough, but at this age theyre going to tell you when theyre hungry 

      • if you offer them a snack and they dont want it they either don’t like what youre offering them or theyre just not hungry 

Development of Body Image Toddler

• Development of body image parallels cognitive development

• Child refers to body parts by name

  • they will refer to body parts by name if you refer to body parts by name

    • that's what they will refer to things for life

• Child recognizes words used to describe appearance

  • You have to start avoiding negative labels because now the child begins to pick up on it 

• Child recognizes gender differences by age 2 years

When does a child begin to recognize gender differences?

• Child recognizes gender differences by age 2 years

Development of Gender Identity Toddler

• Exploration of genitalia is common

  • Genital fondling can occur – What Theorist?

    • Freud

  • Parental reaction should be accepting

• Gender roles are understood by toddler

  • Playing “house”

    • Playing house mirrors their own house 

      • they mimic what they are seeing or hearing at home 

• Gender identity is formed by age 3 years

By what age is gender identity formed?

• Gender identity is formed by age 3 years

Play with Toddlers

• Interaction with people more important

• Parallel & Associative Play 

• Imitation

• Fine/gross motor play

• Reading aloud, naming objects

  • theyre continuing to grow and learn, vocab, etc.

Dental Health in Toddlers

• Regular dental examinations

  • recommended to go to a pediatric dentist, not js a regular dentists

  • Our book recommends that they should have a dental exam at one year, but most dentists recommend 2-3 years

• Removal of plaque

• Fluoride

  • they will determine whether or not they need fluoride 

    • they only get fluoride if public water system is lacking in fluoride 

• Dietary factors

• Early childhood cavities

• you can use a soft bristle toothbrush & just water up until the age of two 

  • after two you can start using toothpaste; best to use dentist’s recommendation 

  • at the maximum children should be weaned from bottles by the time they are 15 months of age 

    • when they use bottles the liquid sits in their mouth and coats their teeth which may begin to decay their teeth 

    • if they’re still sucking on a pacifier or a bottle then their teeth will begin to buck out which may lead to them needing braces later on

    • they say that you should also refrain from using sippy cups that require sucking for the child to use them, because of the same reason as pacifier 

• Don’t send them to bed with their bottles or sippy cups because if they fall asleep with them in their mouths, then whatever is in that bottle will just coat their teeth all night long breaking them down 

Toddlers Characteristics

• Increased initiative and desire to imitate the behaviors of adults

• Doesn’t understand the concept of danger

• Short attention span

• Darts into streets (tricycles)

• Falls-toddler is learning how to walk

  • if a child falls on their head or land on their arm and it looks more distorted that’s more serious so you’d want to seek medical advice

Preschoolers

• Age: 3-6 Years

• Erikson

  • Initiative vs Guilt 

    • Feelings of guilt, anxiety, and fear may result from thoughts that differ from expected behavior

• Believe in the power of words and are very literal

  • they believe in the power of words and take things very literally 

    • Ex: “if i can be a fly on that wall”, they’re going to take that literally and ask why you’d want to be a fly 

• “Magical Thinkers”

  • they think that their thoughts are powerful 

  • Ex: I dont think I’m batman, I am batman

    • kid can really believe it & try to fly 

• Oedipus stage 

  • part of the phallic stage 

  • they tend to wish the same gender parent is dead or goes away because they want the opposite gendered parent to themselves 

  • they don’t act on it, but you may see it in their behavior 

• They begin to develop morals

  • most of the time from parents or adults who influence them (ex. teachers)

  • begin to subscribe to certain religion

  • or if their family are vegans they’d follow that 
    
    

• They’re starting to realize that getting rewards is better than getting punished 

Promoting Optimal Growth and Development Preschooler

• Preparation for most significant lifestyle change: going to school

• Cooperative interaction with other children

  • Not all children have cooperative interactions

    • some kids may have varying diagnoses like autism or adhd oppositional defiant disorder 

      • most of the time they’d have an individualized education plan to increase cooperation 
        
        

• Experience of brief and prolonged separation

  • Sometimes kids may not take separation as well especially if they’ve spent most of their time with their parent

• Increased attention span and memory 

What is the average weight gain for a preschooler?

• Average weight gain remains about 5 lb/year

What is the average increase in height for a preschooler?

• Average height increases 2½-3 inches/year

Biological development of a preschooler

• Physical growth slows and stabilizes

• Body systems mature and stabilize; can adjust to moderate stress and change

  • can adjust to moderate stress and change

    • which is why they can start to handle being dropped off at school 

• Walking, running, climbing, and jumping should be well established.

Play for Toddlers & Preschoolers

• Preschooler

  • Dramatic play, puppets

  • Reading together

  • What type of play?

    • cooperative play 

Toddler and Preschooler Injuries

• Children have no fear of water

  • Drown!

• Poisonings--curious

• Burns scalds/flame

  • handles on pots should always be turned in so that they don’t reach it

  • no candles

• Opens car doors when car is in motion 

• safety & preventing a potential hazard is very important 

  • part of our job is teaching parents how to prevent injury in their children in their various ages

Toddler and Preschooler Injury prevention

• Emphasis is on Teaching safety measures

• Explain why it isn’t safe to do what adults do

  • parents need to teach kids that whatever you do as a parent doesn’t matter & that they need to follow the rules 

• Use car seats & booster seats

• Have child sit in the back seat of the car until 13

• Be a good role model 

• at this age, kids like to please you or make you happy 

  • if you make things into a game they’ll totally do things (Ex: chores)

School-Age Child: Promoting Optimal Growth and Development:

• “School age” generally defined as ages 6 to 12 years

• Physiologically begins with shedding of first “baby” teeth; ends at puberty with acquisition of final permanent teeth

• Gradual growth and development

  • Boys and girls differ little in size

    • you see a bigger difference in height between both genders, once they're in about middle school 

• Progress with physical and emotional maturity

How much do School Age children’s heights increase by each year?

• Height increases by 2.5 inches/year