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PEDIATRIC NURSING
I. Growth & Development
*Growth - Increase in physical size of a structure or whole.
- Quantitative change.
Two parameters of Growth
1. Weight- Most sensitive measure of growth, especially low birth rate.
6 months-----BW doubles
12 months----BW triples
2-2 ½ yrs-----BW quadrupled
2. Height - Increase by 1”/mo during 1st 6 months, 7-12 months by 1 ½ inch.
- Average increase in height - 1st year = 50%
Stoppage of ht coincide with eruption of wisdom tooth.
*Development - Increase skills or capability to function
- Qualitative
How to measure development:
1. Observe child doing specific task.
2. Role description of child’s progress
3. DDST- Denver development screening test except mental, its I.Q. Test
MMDST (Phil) Metro Manila Developmental Screening Test.
4 Main Rated Categories of DDST
1. Language communication
2. Personal social-interaction
3. Fine motor adapting- prehensile ability to use hand movement
4. Gross motor skills- large body movement
*Maturation- same with development “readiness”
*Cognitive Development –ability to learn and understand from experience, to acquire and retain knowledge, to
respond to a new situation and to solve problems. *Learning---change of behavior
IQ Test- test to determine cognitive development * Average IQ – 90-100
Formula: Mental age x 100 = IQ * Gifted child- > 130 IQ
Chronological age
II. Basic Divisions of Life
1. Prenatal stage from conception- birth
2. Period of Infancy
a. Neonate- 1st 28 days or 1st 4 weeks of life
b. Formal infancy- 29 day – 1 year
3. Early Childhood
a. Toddler – 1-3 yrs
b. Pre school 4-6 years
4. Middle Childhood
a. School age- 7 – 12 yrs
5. Late Childhood
a. Pre adolescent 11 – 13 yrs
b. Adolescent 12 - 18 – 21
Created by Niňa E. Tubio 1
,III. Principles of G & D
1. G&D is a continuous process that begins from conception- ends in death--“ Womb to Tomb principle”
2. Not all parts of the body grow at the same time or at same rate.-------------“Asynchronous Growth principle”
Patterns of G&D:
a. Renal, GIT, musculoskeletal, circulatory----grows rapidly during childhood
b. Neuromuscular tissue (CNS, brain, S. cord)---grow rapidly 1-2 years of life
• Brain achieved its adult proportion by 5 years.
• 1-2 y/o- very important yrs---if with severe malnutrition--mild mental
retardation
c. Lymphatic system- lymph nodes, spleen, tonsils---grows rapidly- infancy and childhood
-protection against infection
• tonsil adult proportion by 5 years
d. Reproductive system- grows rapidly at puberty
Rates of G&D:
a. Fetal and Infancy – period of most rapid G&D -----*prone to develop anemia
b. Adolescent- period of rapid G&D Toddler- slow growth period
c. Toddler and preschool- alternating rapid and slow
d. School age- slower growth
3. Each child is unique
2 Primary Factors Affecting G&D :
A. Heredity: R – race F- born less in length than M by 1 inch.
I – intelligence F- born less in wt. than M by 1 lb.
S – sex
N - nationality
B. Environment: Q – quality of nutrition
S – socio eco. status
H – health
O – ordinal position in family Eldest- ability in comm. & social skills
P – parent child relationship youngest- more toilet trained
4. G&D occurs in a regular direction reflecting a definitive & predictable patterns or trends.
A. Directional Trends- occur in a regular direction reflecting the development of neuromuscular
function. These apply to physical, mental, social and emotional development and includes.
1. Cephalo-caudal--- “head to toe”
• Occurs along body’s long axis in w/c control over head, mouth & eye
movements & precedes control over upper body torso and legs.
2. Proximo- distal---- “Centro distal”
• From center of body to extremities.
3. Symmetrical----side of body develop on same direction at same time at same rate.
4. Mass Specific “Differentiation”
- Learns simple operations before complex function, from broad general pattern of behavior to a refined pattern.
B. Sequential- involves a predictable sequence of G&D to w/c the child normally passes.
1. Locomotion- creep, crawls, sit then stand.
2. Socio & Language skills- solitary games, parallel games
C. Secular- worldwide trend of maturing earlier & growing larger as compared to succeeding generations.
5.Behavior--most compressive indicator of developmental status. *1st cry--oha
6. Universal language of child- play 2nd sound-cooing
7. Great deal of skill and behavior is learned by practice. Practice makes perfect. 3rd sound-ahh(bowel)
9. Neonatal reflexes must be lost 1st before dev’t can proceed. *1st play-solitary
-Plantar reflex shld. disappear before baby can walk
Created by Niňa E. Tubio 2
, -Moro reflex shld. disappear before baby can roll
*Persistent primitive infantile reflexes- case of cerebral palsy
IV. Theories of G&D
Developmental Tasks- different from chronological age
skill or growth responsibility arising at a particular time in the individual’s life.
The successful achievement of w/c will provide a foundation for the accomplishments of future tasks.
Theorists
1. SIGMUND FREUD: (1856-1939) Austrian neurologists----- Founder of Psychoanalysis
- offered personality development, Psychosexual theory
*Phases of Psychosexual Theory*
a.) Oral Phase------------- 0-18 months
- Mouth: site of gratification
-Activity of infant- biting, sucking crying.
-Why do babies suck?- enjoyment & release of tension.
-Provide oral stimulation even if baby on NPO.
-Pacifier.
-Never discourage thumb sucking.
b.) Anal Phase------------- 18 months-3 years
-Anus: site of gratification
-Activity- elimination, retention or defecation of feces must take place
- Principle of holding on or letting go.
-Mother wins or child wins
-Child wins- stubborn, hardheaded anti social. (anak pupu na, child holds pupu, child wins)
-Mother wins- obedient, kind, perfectionist, meticulous--------- OC-anal phase
-Help child achieve bowel & bladder control even if child is hospitalized.
c.) Phallic Phase----------- 3-6 years
- Genitals: site of gratification
- Activity- may show exhibitionism
- Increase knowledge of a sexes
- Accept child fondling his/her own genitalia as normal exploration
- Answer Childs question directly.
- Right age to introduce sexuality – preschool
d.) Latent Phase---------- 7-12 years
-Period of suppression- no obvious development.
-Childs libido or energy is diverted to more concrete type of thinking
-Helps child achieve (+) experience, ready to face conflict of adolescence
e.) Genital Phase--------- 12-18 years
-Genitals: site of gratification
-Achieve sexual maturity
-Learns to establish relationships with opposite sex.
-Give an opportunity to relate to opposite sex.
2. ERIC ERICKSON- Psychoanalysis theory
-stresses important of culture & society to the development of ones personality
-environment , culture
*Stages of Psychosocial Theory*
a.) Trust vs. Mistrust – 0-18 months.
-foundations of all psychosocial task
-to give & receive is the psychosocial theme
-know to develop trust baby
1. Satisfy needs on time
- breastfeed
2. Care must be consistent & adequate
Created by Niňa E. Tubio 3
, -both parents- 1st 1 year of life
3. Give an experience that will add to security- touch, eye to eye contact, soft music.
b.) Autonomy vs. Shame & Doubt---- 18-3 years
- Independence /self gov’t
- Develop autonomy on toddler ---1. Give an opportunity of decision making, offer choices.
2. Encourage to make decision rather than judge.
3. Set limits
c. Initiative vs. Guilt------------------------ 4-6 years
-Learns how to do basic things
-Let explore new places & events
-activity recommended- modeling clay, finger painting--enhance imagination & creativity
& facilitate fine motor dev’t
d. Industry vs. Inferiority------------------- 7-12 yrs
-Child learns how to do things well
-Give short assignments & projects
e. Identity vs. Role Confusion or Diffusion 12-18 yrs
-Learns who he/she is, what kind of person he/ she will become
by adjusting to new body image and seeking emancipation from parents
-Freedom from parents.
f. Intimacy vs. Isolation-----------------------18-25 yrs. Up to 30 y/o
-looking for a lifetime partner and career focus
g. Generatively vs. Stagnation------------ 30-45 y/o
h. Ego Integrity vs. Despair---------------45-65 & above
3. JEAN PIAGET- Swiss psychologists , pioneer work on dev.t of intelligence in children
-develop reasoning power
*Stages Of Cognitive Development*
A. Sensory Motor------ 0-2 y/o
-“Practical Intelligence”- words & symbols not yet available baby communicates thru senses & reflexes.
Schema (Subdivision) Age Behavior
1. Neonate Reflex 1 month All reflexes
2. Primary Circular Reaction 1-4 months -Activity related to body
-Repetition of behavior (ex. thumb sucking)
3. Secondary Circular Reaction 4-8 months -Activity not related to body
-Discover object & person’s permanence
-Memory traces present
-Anticipate familiar events.
4. Coordination of Secondary Reaction 8-12 months -Exhibit goal directed behavior
- of permanence & separateness (search of
lost toy, knows mom, throw & retrieve)
5. Tertiary Circular Reaction 12-18 -Use trial & error to discover places & events
months -“ invention of new means”
(1-1 1/2yrs.) -capable of space & time perception
(hits fork, spoon on table or drops fork)
6. Invention of new means thu mental 18-24 -Transitional phase to the pre operational
combination---“Symbolic Representation” months thought process.
B. Preoperational Thought---- 2-7 y/o
Schema Age Behavior
1. Preconceptual 2-4 yrs -Thinking basically complete literal & static
-Egocentric- unable to view others viewpoint
-Concept of dying is only now
-Concept of distance is only as far as they can see.
-Concept of Animism: inanimate object is alive
(-) reversibility concept- in every action there’s an opposite reaction or cause & effect
2. Initiative 4-7 yrs Beginning of Causation
Created by Niňa E. Tubio 4
PEDIATRIC NURSING
I. Growth & Development
*Growth - Increase in physical size of a structure or whole.
- Quantitative change.
Two parameters of Growth
1. Weight- Most sensitive measure of growth, especially low birth rate.
6 months-----BW doubles
12 months----BW triples
2-2 ½ yrs-----BW quadrupled
2. Height - Increase by 1”/mo during 1st 6 months, 7-12 months by 1 ½ inch.
- Average increase in height - 1st year = 50%
Stoppage of ht coincide with eruption of wisdom tooth.
*Development - Increase skills or capability to function
- Qualitative
How to measure development:
1. Observe child doing specific task.
2. Role description of child’s progress
3. DDST- Denver development screening test except mental, its I.Q. Test
MMDST (Phil) Metro Manila Developmental Screening Test.
4 Main Rated Categories of DDST
1. Language communication
2. Personal social-interaction
3. Fine motor adapting- prehensile ability to use hand movement
4. Gross motor skills- large body movement
*Maturation- same with development “readiness”
*Cognitive Development –ability to learn and understand from experience, to acquire and retain knowledge, to
respond to a new situation and to solve problems. *Learning---change of behavior
IQ Test- test to determine cognitive development * Average IQ – 90-100
Formula: Mental age x 100 = IQ * Gifted child- > 130 IQ
Chronological age
II. Basic Divisions of Life
1. Prenatal stage from conception- birth
2. Period of Infancy
a. Neonate- 1st 28 days or 1st 4 weeks of life
b. Formal infancy- 29 day – 1 year
3. Early Childhood
a. Toddler – 1-3 yrs
b. Pre school 4-6 years
4. Middle Childhood
a. School age- 7 – 12 yrs
5. Late Childhood
a. Pre adolescent 11 – 13 yrs
b. Adolescent 12 - 18 – 21
Created by Niňa E. Tubio 1
,III. Principles of G & D
1. G&D is a continuous process that begins from conception- ends in death--“ Womb to Tomb principle”
2. Not all parts of the body grow at the same time or at same rate.-------------“Asynchronous Growth principle”
Patterns of G&D:
a. Renal, GIT, musculoskeletal, circulatory----grows rapidly during childhood
b. Neuromuscular tissue (CNS, brain, S. cord)---grow rapidly 1-2 years of life
• Brain achieved its adult proportion by 5 years.
• 1-2 y/o- very important yrs---if with severe malnutrition--mild mental
retardation
c. Lymphatic system- lymph nodes, spleen, tonsils---grows rapidly- infancy and childhood
-protection against infection
• tonsil adult proportion by 5 years
d. Reproductive system- grows rapidly at puberty
Rates of G&D:
a. Fetal and Infancy – period of most rapid G&D -----*prone to develop anemia
b. Adolescent- period of rapid G&D Toddler- slow growth period
c. Toddler and preschool- alternating rapid and slow
d. School age- slower growth
3. Each child is unique
2 Primary Factors Affecting G&D :
A. Heredity: R – race F- born less in length than M by 1 inch.
I – intelligence F- born less in wt. than M by 1 lb.
S – sex
N - nationality
B. Environment: Q – quality of nutrition
S – socio eco. status
H – health
O – ordinal position in family Eldest- ability in comm. & social skills
P – parent child relationship youngest- more toilet trained
4. G&D occurs in a regular direction reflecting a definitive & predictable patterns or trends.
A. Directional Trends- occur in a regular direction reflecting the development of neuromuscular
function. These apply to physical, mental, social and emotional development and includes.
1. Cephalo-caudal--- “head to toe”
• Occurs along body’s long axis in w/c control over head, mouth & eye
movements & precedes control over upper body torso and legs.
2. Proximo- distal---- “Centro distal”
• From center of body to extremities.
3. Symmetrical----side of body develop on same direction at same time at same rate.
4. Mass Specific “Differentiation”
- Learns simple operations before complex function, from broad general pattern of behavior to a refined pattern.
B. Sequential- involves a predictable sequence of G&D to w/c the child normally passes.
1. Locomotion- creep, crawls, sit then stand.
2. Socio & Language skills- solitary games, parallel games
C. Secular- worldwide trend of maturing earlier & growing larger as compared to succeeding generations.
5.Behavior--most compressive indicator of developmental status. *1st cry--oha
6. Universal language of child- play 2nd sound-cooing
7. Great deal of skill and behavior is learned by practice. Practice makes perfect. 3rd sound-ahh(bowel)
9. Neonatal reflexes must be lost 1st before dev’t can proceed. *1st play-solitary
-Plantar reflex shld. disappear before baby can walk
Created by Niňa E. Tubio 2
, -Moro reflex shld. disappear before baby can roll
*Persistent primitive infantile reflexes- case of cerebral palsy
IV. Theories of G&D
Developmental Tasks- different from chronological age
skill or growth responsibility arising at a particular time in the individual’s life.
The successful achievement of w/c will provide a foundation for the accomplishments of future tasks.
Theorists
1. SIGMUND FREUD: (1856-1939) Austrian neurologists----- Founder of Psychoanalysis
- offered personality development, Psychosexual theory
*Phases of Psychosexual Theory*
a.) Oral Phase------------- 0-18 months
- Mouth: site of gratification
-Activity of infant- biting, sucking crying.
-Why do babies suck?- enjoyment & release of tension.
-Provide oral stimulation even if baby on NPO.
-Pacifier.
-Never discourage thumb sucking.
b.) Anal Phase------------- 18 months-3 years
-Anus: site of gratification
-Activity- elimination, retention or defecation of feces must take place
- Principle of holding on or letting go.
-Mother wins or child wins
-Child wins- stubborn, hardheaded anti social. (anak pupu na, child holds pupu, child wins)
-Mother wins- obedient, kind, perfectionist, meticulous--------- OC-anal phase
-Help child achieve bowel & bladder control even if child is hospitalized.
c.) Phallic Phase----------- 3-6 years
- Genitals: site of gratification
- Activity- may show exhibitionism
- Increase knowledge of a sexes
- Accept child fondling his/her own genitalia as normal exploration
- Answer Childs question directly.
- Right age to introduce sexuality – preschool
d.) Latent Phase---------- 7-12 years
-Period of suppression- no obvious development.
-Childs libido or energy is diverted to more concrete type of thinking
-Helps child achieve (+) experience, ready to face conflict of adolescence
e.) Genital Phase--------- 12-18 years
-Genitals: site of gratification
-Achieve sexual maturity
-Learns to establish relationships with opposite sex.
-Give an opportunity to relate to opposite sex.
2. ERIC ERICKSON- Psychoanalysis theory
-stresses important of culture & society to the development of ones personality
-environment , culture
*Stages of Psychosocial Theory*
a.) Trust vs. Mistrust – 0-18 months.
-foundations of all psychosocial task
-to give & receive is the psychosocial theme
-know to develop trust baby
1. Satisfy needs on time
- breastfeed
2. Care must be consistent & adequate
Created by Niňa E. Tubio 3
, -both parents- 1st 1 year of life
3. Give an experience that will add to security- touch, eye to eye contact, soft music.
b.) Autonomy vs. Shame & Doubt---- 18-3 years
- Independence /self gov’t
- Develop autonomy on toddler ---1. Give an opportunity of decision making, offer choices.
2. Encourage to make decision rather than judge.
3. Set limits
c. Initiative vs. Guilt------------------------ 4-6 years
-Learns how to do basic things
-Let explore new places & events
-activity recommended- modeling clay, finger painting--enhance imagination & creativity
& facilitate fine motor dev’t
d. Industry vs. Inferiority------------------- 7-12 yrs
-Child learns how to do things well
-Give short assignments & projects
e. Identity vs. Role Confusion or Diffusion 12-18 yrs
-Learns who he/she is, what kind of person he/ she will become
by adjusting to new body image and seeking emancipation from parents
-Freedom from parents.
f. Intimacy vs. Isolation-----------------------18-25 yrs. Up to 30 y/o
-looking for a lifetime partner and career focus
g. Generatively vs. Stagnation------------ 30-45 y/o
h. Ego Integrity vs. Despair---------------45-65 & above
3. JEAN PIAGET- Swiss psychologists , pioneer work on dev.t of intelligence in children
-develop reasoning power
*Stages Of Cognitive Development*
A. Sensory Motor------ 0-2 y/o
-“Practical Intelligence”- words & symbols not yet available baby communicates thru senses & reflexes.
Schema (Subdivision) Age Behavior
1. Neonate Reflex 1 month All reflexes
2. Primary Circular Reaction 1-4 months -Activity related to body
-Repetition of behavior (ex. thumb sucking)
3. Secondary Circular Reaction 4-8 months -Activity not related to body
-Discover object & person’s permanence
-Memory traces present
-Anticipate familiar events.
4. Coordination of Secondary Reaction 8-12 months -Exhibit goal directed behavior
- of permanence & separateness (search of
lost toy, knows mom, throw & retrieve)
5. Tertiary Circular Reaction 12-18 -Use trial & error to discover places & events
months -“ invention of new means”
(1-1 1/2yrs.) -capable of space & time perception
(hits fork, spoon on table or drops fork)
6. Invention of new means thu mental 18-24 -Transitional phase to the pre operational
combination---“Symbolic Representation” months thought process.
B. Preoperational Thought---- 2-7 y/o
Schema Age Behavior
1. Preconceptual 2-4 yrs -Thinking basically complete literal & static
-Egocentric- unable to view others viewpoint
-Concept of dying is only now
-Concept of distance is only as far as they can see.
-Concept of Animism: inanimate object is alive
(-) reversibility concept- in every action there’s an opposite reaction or cause & effect
2. Initiative 4-7 yrs Beginning of Causation
Created by Niňa E. Tubio 4
