Peds and Family

Family and Normal Growth and Development, know stages and what it applies to

-       Erikson’s Stage of Psychosocial Development

§  CHART PIAGET AND ERIKSON (EXAM)

o   Trust vs Mistrust (0–1-year-old)

§  Developing trust and attachment

o   Autonomy vs shame and doubt (Toddlers)

§  Exploring a sense of control, gaining independence

o   Initiative vs guilt (preschooler)

§  Facing challenges and overcoming them, exploration

o   Industry and inferiority (school age)

§  More freedom and social development

o   Identity vs role confusion (adolescent)

§  Sense of self and identity

-       Piaget’s Cognitive Development Stages

o   Sensorimotor (birth to 24 months)

§  Progression from reflexes  repetitive movements  imitation

§  Object permanence develops (starting of memory)

§  Use of symbols/mental representation (think of things they cannot see)

o   Preoperational (2-7 years months)

§  Shifting from ego-centric to social awareness

§  Consider other’s viewpoints

§  Pretending’s

o   Concrete Operations: (older school-age 7+), 7-11 years old

§  See chart on page 961 for examples of concrete operations/thoughts

§  Learns that people think differently

§  Thinks more deeply

§  Likes to group things

o   Formal Operations (adolescent)

§  Capacity for abstract thinking

§  Think about thinking

§  Concerned about how others think

-       Infant (0-2 months)

o   Physical Growth:

§  Gains 150-200 g weekly

§  Posterior fontanelle closes at 2 months

o   Motor Development:

§  0-1 month – Reflexes (rooting, etc)

o   Language development

§  Initial – crying

§  Sounds by 4-6 weeks

o   Social cognitive

§  Social smile at 2 months

-       Infant (3-5 months)

o   Physical Growth:

§  Gains 150-200g weekly

§  Doubles birth weight by 4 months

§  Teething at 5 months

o   Motor Development:

§  Starts by holding an object but by 6 months can reach for it

§  Head lag disappears

§  Rolls over at 6 months

§  Can be held in standing position

o   Language Development:

§  “talks” when spoken to (coos, babbles),

§  squeals and laughs

o   Social/Cognitive:

§  Interested in surroundings

§  Recognizes familiar faces

-       Infant (9-11 months)

o   Motor Development:

§  Starts to crawl (9 months)

§  Starts to balance

§  Pull to stand (11 months)

§  Has a crude pincer grasp

o   Language Development:

§  Responds to simple commands

§  “no”

§  May say first words at 10 months

§  Has 3-5 words by 12 months

o   Social/Cognitive:

§  Parent is very important

§  Waves bye

§  Develops object permanence at 10 months

§  Repeats actions that are funny

§  Follow pictures in a book

§  Shakes head no (11 months)

-       12 months

o   Physical Growth:       

§  By 12 months- triples BW     

§  Anterior Fontanelle almost closed     

o   Motor Development: 

§  Can walk when hands held

§  “cruises”

§  May start walking

o   Language Development:

§  Understands meaning of words by 10-11 months

o   Social:

§  Shows emotion

§  Starts to explore

§  May have security blanket/toy

§  Searches for objects where last seen

-       Toddler 13-17 months

o   Physical Growth

§  Steady weight and height gain

o   Motor Development

§  Able to walk (usually by 13 months)

§  Throws object to floor

§  Tower of 2 blocks (15 months)

§  Begin to dress, feed, play

§  EXPLORE!

o   Language Development

§  4-6 words

§  Asks by pointing

§  Understands simple commands

§  Says “no” for everything

o   Social/Cognitive

§  Tolerates some separation from parents

§  Less fear of strangers

§  Imitates parents

-       2 years old

o   Physical growth:

§  Birth weight x 4 by 2.5 years

§  May be ready for potty training

o   Motor Development:

§  Can go up and down stairs

§  Runs

§  Kicks ball

o   Language Development

§  2–3-word sentences

§  Up to 300 words

§  Says name, I, me, you

§  Verbalizes needs

o   Social/Cognitive:

§  Longer attention span

§  More independence from caregiver (dresses self, recognizes self)

-       Preschooler (3-4 years)

o   Physical growth:

§  Slows, stabilizes

§  Bone and muscle not mature

o   Motor Development:

§  Improves fine motor

§  Writing, drawing, dressing

§  Can use scissors (4 yrs)

§  Hops, stands on one foot for a few seconds

§  Catches ball

o   Language Development

§  Major mode of communication

§  Lots of questions

o   Social/Cognitive:

§  Gaining independence

§  Begins to understand time

§  Remains egocentric

§  Mood swings

§  Obeys limits but no understanding of right and wrong

-       School age (5-7)

o   Physical Growth:

§  Begins losing teeth

§  Height 5-7 cm/yr

§  Weight 2-3 kg/yr

o   Motor Development:

§  Coordination improves

§  Steadier on feet

§  Understands time (7 years)

§  Repetition to master skills

o   Language Development:

§  Nothing significant (continues to learn more words)

o   Social/Cognitive:

§  Tolerates differences (by 5) but may not understand until later

§  Becoming cooperative and more social

§  Enjoys choices

-       School (8-12 years)

o   Physical Growth:

§  Girl – may enter puberty (10-12)

§  Boys – growth slows

o   Motor Development:

§  Very active

§  May overdo (may not settle after recess

o   Language Development:

§  Enjoys conversation

o   Social/Cognitive:

§  Friends grow in importance

§  Independent in self-care (may need reminders)

§  Becomes critical of self

-       Adolescent (13-17)

o   Physical Growth:

§  Puberty

§  Hormonal changes

§  Sexual maturation

§  Dramatic growth

o   Motor Development:

§  Reaching maturity

o   Language Development

§  Nothing significant

o   Social/Cognitive:

§  Abstract thinking (15-17)

§  Remains self-centered

§  Questioning moral values

§  Understand duty and rights of others

§  Gaining independence from family (struggle between independence and dependence)

§  Peer affirmation very important

-       Family Assessment: the 15-minute interview

o   1. Manners

o   2. Therapeutic Conversations

o   3. Genograms & Ecomaps (especially important for those in hospital for 3+ days)

o   4. Therapeutic Questions

o   5. Commendations (strengths and weaknesses of the family SDOH)

o   6. Evaluate the interview process

o   Other Tools:

§  Duvall’s theory

§  Developmental stages of children

§  Family effect on growth and development

o   Genogram: structure of family

o   Ecomap: support systems