When studying these milestones you want to be familiar with ➢ Pincer grasp:uses the thumb and index finger

d index finger to pick

certain categories, and to helps us remember these up small objects
categories let’s remember the word “BABIES”. ➢ Easily moves objects from one hand to the other
Body changes ➢ Object permanence: this means they now know that
Achieving developmental milestones once an object disappears it still exists.
Baby Safety o Play: looking for hidden toys or playing peek-a-boo
Interventions (considerations when providing nursing care)
Eating Plan 10-12 Months:
Social Stimulation (play) ➢ Begins walking
Body Changes ➢ Follows very simple commands
-Fontanelles close: ➢ Puts objects in a container and bangs them together
• Anterior closed by 18 months ➢ Says simple words like “mama” or “dada”
• Posterior closed by 2 months ➢ Separation anxiety starts
Weight: Baby Safety
• 6 months doubles -SIDS (sudden infant death syndrome): an infant under the
• 1 year triples age of 12 months dies for unknown reasons and this tends to
• Example: 8 lbs. at birth……16 lbs. at 6 months….24 occur during sleep.
lbs. at 1 year Education Pieces for the parent:
Length: ➢ Best sleep position: back
• Grows ½-1 inch every month until 6 months ➢ Dress infant appropriately….don’t over dress
➢ Example: 21 inches at birth……24-27 inches at 6 ➢ Avoid exposing baby to tobacco smoke
months ➢ Remove extra items from sleep areas
• Eruption of teeth: lower central incisors by 10 ➢ Infant can sleep in the same room but not the same
months…fall out by 6-7 years bed
Achieving Developmental Milestones -Shaken baby syndrome (never shake a baby): can cause
➢ The nurse will assess if the infant is meeting the brain injury and death
following milestones at specific ages. It is important ➢ Teach the parent about this and importance of being
to note if baby is reaching these milestones because calm and laying infant down in a safe place and
it tells us if the infant is developing properly. taking a break when things get intense
2 months: Choking: there is a risk of choking starting after birth (babies
➢ Moves head to each side and moves it in response to can choke on milk or mucus in the respiratory tract)…teach
sound parent how to remove with bulb suction and suggest they
➢ Tracts faces with eyes take a CPR class….also when foods are being introduced
➢ Makes noises (early language) cooing (usually around 6 months) AVOID small, hard round food
➢ Smiles items like grapes, uncooked vegetables etc. because these
➢ Hold head up when on stomach (educate: tummy are a major choking hazard
time is important daily) Never leave unattended on surface and stop swaddling once
4 Months: the baby can start rolling over (by 6 months)
➢ Starts to enjoy play and interaction
➢ Cooing turns into babbling and copies other sounds ➢ -Car sear safety: back seat and rear-facing device
➢ Holds and reaches for toys ➢ Burns: infants will start grabbing at items around 4-6
➢ Remembers faces and objects months, adjust water temperatures for the water
➢ Rolls over heater, block off electrical outlets
6 Months: Interventions (considerations when providing nursing care)
➢ Can sit up with support Erikson Stage: Trust vs Mistrust
➢ Stranger anxiety begins ➢ Meet needs promptly…..respond to crying
➢ Babbles with early vowel sounds ➢ Young infants: swaddling, rocking, sucking, holding
➢ Recognizes and responds to name ➢ Older infants: Keeping parent near if possible
➢ Has fun looking at self in mirror (decreases separation anxiety), same caregivers
8-9 Months: (decreases stranger anxiety), calm environment,
➢ Sits without support play: crib mobiles, objects from home older infant
➢ Crawling would be familiar with, etc.
➢ Stands with pulling and holds on to object
Eating Plan “TODDLER”
➢ Breast feeding is considered gold standard in feeding Temper tantrums:
an infant for the first 6 months of life (no other foods Why they have them? It goes along with the common saying
or liquids needed)…..alternative iron-fortified “terrible twos”. At this time in life, the toddler is developing a
formula. sense of autonomy and they want to be independent but
➢ American Academy of Pediatrics (AAP) recommends struggle with this new found development. They easily
exclusively breast feeding for the first 6 months with become stressed or agitated when they can’t accomplish
the exception of vitamin D supplementation (400 IU) something. For example, opening a container to access toys
for breast fed infants. Then can add solids over time or being told “no” can cause a tantrum. Toddlers are
while continuing breast feeding or formula after 6 immature in how they process their emotions.
months. How they response? Scream, cry loudly, throw items on the
➢ None of the following during first 12 months: cow’s ground, hit etc.
milk or honey Education for parents?
➢ Normal part of childhood development
Social stimulation (play) (unfortunately)….it will pass as the child becomes
Independent play: starts with observing to older
interacting/grasping for objects and caregiver ➢ Stay calm and don’t give in to the child (teaches
➢ Observing: faces, high contrast objects, being talked them tantrums work) or try to reason with them
or sung to….birth to 4 months ➢ Ignore the behavior but stay close so they know
➢ Interacting: toys to grasp like rattles, peek-a-boo, you’re there
hiding objects, big toys to hold on to and push or ➢ Be consistent with your approach
stand
Toddlers: age 1 year to 3 years Prevention:
Toddlers are changing physically but their growth rate slows ➢ Divert their attention to something else
down a bit compared to the infant. However, they’re making ➢ Be aware of the triggers: hunger, sick, tired etc.
huge leaps and bounds in their mental development and ➢ Let them have some autonomy with choices (give
fine/gross motor development. simple options…..It’s time for bed….we can read this
They are becoming very aware of their environment and want book or that book?”)
to explore and test it out, which helps them understand their ➢ Praise their good behavior
environment. Furthermore, they start developing autonomy. ➢ Prepare them for a change in event:
This is where they realize they’re individuals (separate from ➢ Example: leaving the park…..say “you can go down
the caregiver) and they are able to exert their own will. Also, the slide 3 more times and then we are going home”
they realize their reactions influence others around them. rather than suddenly telling them it’s time to leave.
They will start to look less like a baby and more like a little On the move (SAFETY): toddlers are at a major risk for hurting
child (as you can see in the example below). So, it is amazing themselves due to increased mobility, curiosity, not able to
the changes a child undergoes within the first 3 years of life. perceive the danger or consequences. Therefore, it’s a
Some fine and gross motor skills a toddler can perform: dangerous age for death.
Throw and kick a ball, run, climb, hold a pencil and scribble, Educate parent about: “DANGERS”
build with blocks, say their name, use 100s of words, talk in ➢ Drowning
up to 3 word sentences etc. ➢ Automobile accident (stay in rear-facing until 2 years
Toddler Body Changes in the back and then switches to forward-facing in
Weight (by 24 months): the back after 2 years)
➢ Gains about 4-6 lbs. per year (this is decreased ➢ Nose-dives (falls)
compared to the infant’s rate) ➢ Getting burned
➢ At 24 months, weight should be 4 x the birth weight: ➢ Eating toxic substances
➢ Example: 7 lbs. at birth…what would the weight be ➢ Revolvers/rifles…unsecured firearms
at 2 years? Around 28 lbs. ➢ Suffocate/chokes
➢ Average weight of 24 month old is 26.5 lbs (girls) - Diaper to potty transition “potty training”: child must be
27.5 lbs (boys) ready physically and mentally or it won’t be successful
Height (by 24 months): ➢ The anal and urethral sphincter can be voluntarily
➢ Increases by 2-3 inches per year controlled around 18-24 months. Bowel control
➢ Height at 24 months is ½ their adult height comes before bladder (reason: bowel movement is
➢ Average height for 24 month old is: 33 34 inches easier to detect).
➢ Most children potty trained by 3 years (day-time) .
 ➢ Night-time potty training takes more time….still • Interventions for separation anxiety: remind child
needs a diaper at night (4-5 years). parent is coming back (if this is true), maintain
➢ Know the signs that a child is ready to potty train: routines, encourage child to talk about parent
“TOILET” • Loves to say “NO”:
➢ Two or more hours with dry diaper Negativism: doing the opposite of what is being asked
➢ On and off (potty by self and their pants) • Why? The toddler wants to be independent so when
➢ Interested in potty you ask them to do something they don’t desire or
➢ Likes sitting on toilet (5-10 minutes) weren’t going to do they will say no….it’s all about
➢ Experiencing regular BM (same time) their autonomy.
➢ Tells you they have to go • Education on how to deal: avoid getting a no
Know the signs that a child is ready to potty train: “TOILET” response….give options and let them pick (helps with
• Two or more hours with dry diaper autonomy) example: “You can take your medicine in
• On and off (potty by self and their pants) a blue cup or green cup.” rather than “Are you ready
• Interested in potty to take your medicine?”
• Likes sitting on toilet (5-10 minutes) Eating Plan
• Experiencing regular BM (same time) • Well balanced diet (tend to be grazers
• Tells you they have to go • toddlers like to have small easy to grab nutritious
Development stage theory: snacks rather than sit down and eat 3 meals a day
Type of Play by Toddlers: parallel play (fruits, veggies, meats, milk, water…limit juices,
This means they observe others play and play beside them processed, sweets, and fatty foods)
but don’t actually play with others. • Don’t let toddler fall asleep with bottle in
Toys Toddlers like: blocks and ones with containers (love mouth…dental caries
putting objects inside things), push and pull toys (wagon, cars, • When should they go to a dentist? When the first set
strollers etc.)…remember they’re walking, stuffed toys, of teeth have broken through….lower central
pretend sets (cooking, shopping, building), coloring, painting, incisors…around 8-10 months so by 12 months
balls (like throwing objects), books that are interactive with (assist w/ brushing teeth and ask if water has
sounds or hidden doors….like to mimic parents activities fluoride in it at home….if not may need fluoride
application)
Erikson’s Stages of Development: Autonomy vs Shame and • Becomes picky about food (eats based on how it
Doubt looks…avoid foods that are mixed together like a
➢ Developing independence….able to reach this stage stir-fry with rice, mixed meats and veggies…separate
because they’ve developed trust with caregiver them…use fun plates)
(needs being met in previous stage)…discovered • Ritualistic (more about this later) about how their
they’re individuals separate from others…their meals are presented….certain foods at for certain
actions affect others and objects in their mealtimes, particular plate, or cup
environment • Doesn’t like trying new foods at this time…will have
➢ Result of stage: develop confidence to develop skills a limited diet of what they like
(toilet training, feeding self, dressing self) • Choking risk….avoid foods that are hard to chew: big
➢ Interventions to help with this stage: provide chunky meats, foods with strings like celery, seeds,
opportunities for independence and give positive hard candy, popcorn etc. )….still fine-tuning their
feedback, don’t punish for doing skills wrong chewing abilities (large pieces can become lodged in
➢ Choices with food, drinks, books to read, activities the throat)…educate about how to relieve from
Separation Anxiety: know the stages choking.
• Protest: crying and doesn’t want parent to leave Rrr (rituals, rivalry, regression)
• Despair: depressed no longer crying but Ritualism: the child wants things done the same way each
withdrawn/quite….but will cry once parent comes time….has certain routines and items they use for specific
back tasks (ex: needs a specific plate to eat, needs a bed time story
• Detachment: rare to get to this stage….to cope they before going to bed etc.)
detach themselves from parent…seems happy and • Why? It’s comfortable and predictable for them. It
that they have coped but they haven’t…affects the actually creates an environment where they can
child parent relationship…won’t cry when parent start learning new skills
returns Rivalry (sibling): this is the age where many toddlers become
a brother or sister
 • Why it causes problems? It breaks the routine, shapes like triangle, circles…all of these skills are getting the
attention is diverted suddenly and they will start to child ready for school.
act out (tantrums or regression). Reduced Separation Anxiety (but still there until around 4 to 5
• Interventions: include them so the focus of attention years): the young preschooler (age 3) does not like being
is not too hard to cope with like with feeding and away from the parent, especially during a stressful situation,
care, consider their comfort for routines and try to sickness, etc.
maintain important ones, watch out for jealously • The young preschooler tolerates it better than the
because toddler may physically harm the new sibling toddler during the protest stage in that he or she will
Regression: toddlers can start to revert back to infancy skills not scream and cry loudly, but instead they will cry
or temporarily lose developmental skills they have quietly and may act out.
obtained…like they can start using the bathroom on self if • The despair and detachment stage of separation
previously potty trained, refusing to eat and want a bottle, anxiety is the same as the toddler.
lose speaking abilities, not sleeping at night etc. • Magically thinker: may think the parent may be hurt
• Why? Toddlers learn and grow differently in the or never coming back when separated from the
development of skills and if overwhelmed or parent….they don’t understand time (so don’t give a
stressed they can regress. Toddlers have specific time for when coming back….just reassure them
bursts of learning based on age (milestones ages) frequently the parent is coming back)
compared to adults who build upon their skills and Erickson Theory
can easier deal with failures and stress than the Initiative vs. guilt: third stage and it’s from ages 3 to 5
toddler. • The child gained the sense of trust and developed
• Causes: Stress (feel like they can’t cope or be autonomy in the previous two stages. Now they
successful at new skill or situation), disruption to need independence to try new things, learn how to
their routine (new sibling, new caregiver, being in accomplish tasks, make decisions, and how to deal
the hospital) with situations that challenge them ex: failure,
• Result: Regresses back in their stage of development making right choices (conscience is
because they’re more comfortable and it’s more developed…choosing right or wrong…will they
predictable. choose to obey?).
• Interventions: don’t punish due to the regression, • If not given opportunities to try new things or make
identify the cause of stress (try to remove or choices by self the child will develop guilt and
alleviate it if possible) or when a regression episode struggle with trying new things and struggle with
is likely to occur (going to a new daycare…not the being independent….will have issues with developing
best time to be learning a new skill that requires a sense of purpose.
independence until comfortable with new daycare • If this stage is failed, they will experience guilt.
situation), concentrate on what the toddler is doing • If this stage is accomplished, the child will have a
well sense of purpose.
PRESHOOLERS Interventions to help the child in this stage:
• The preschooler includes the ages 3-5 years, and to • Encouraging play, especially imaginary play,
help us remember the main concepts about the giving the child within reason freedom to try
preschooler, let’s remember the word “preschool”. new things and encouraging them when they
Physical changes fail, avoid criticizing or trying to control all
• The preschooler is going through the process of aspects of choices and try to accept their
stretching and filling out. Their face is becoming choices
more defined (less round) and they’re losing the Piaget’s Theory:
protruding belly. In addition, their limbs are • Preoperational: 2-7 years and overlaps with the
elongating. By the end of preschoolerhood, at the toddler in the previous lecture
age of 5, the child will be social, talkative, and very • The preschooler is egocentric still like the
active with a blossoming personality. toddler but are changing to eventually be able
Fine and gross motor skill development is rapidly becoming to see things for other people’s point of view
fine-tuned from the age of 3 to 5. (currently they see things from their point of
Gross motor skill examples: ride a tricycle, catch and bounce view only).
a ball, run, hop, skip, climb etc. and all of these skills are • They’re magical thinkers and love pretend play
becoming very well established as he or she approaches 5. (having imaginary playmates etc.)
Fine motor skill examples (by the age of 5): copy and write • Animism: the preschooler thinks inanimate
first name, zip-up jacket, button-up shirt, use scissors, copy objects (ex: toys) are living things and have
 feelings like they do….example: my son had a want to play with others…starts out with associative
stuffed monkey and when he would eat, he play…then cooperative play
would have to feed the monkey because it was • Play style: associate play (starting around 3
hungry too. years…progressed from parallel play by the toddler)
• Literal thinkers to cooperative play (around 4-5 years).
Scared of things “FEAR” o Associative play: children are playing/talking
Preschoolers fear many things due to their inability to together in the sense they are doing the same
distinguish fact from fiction and their creative imaginations activity together like using the same toys (where
fuel this fear. they begin to understand sharing or borrowing) or
using the same equipment
• Animism (discussed above) can cause fear. Toys that o example: playing in a sand box by using shoves and
are scary looking or make loud noises can cause this. sand molds but they aren’t working together to
The YouTube lecture contains a real life example of a accomplish something but rather focusing on their
preschooler experiencing fear due to animism. own activity…..this type of play is building the
• Hospitalizations: feel like they are sick because of framework for social interaction and how to get
something they did and the hospitalization/sickness along with others…hence cooperate
is punishment…reassure them this is not the case o Cooperative play: children play together doing the
but they have a sickness and be honest with them same activity by cooperating and collaborating
about it…explain in very simple terms. together and have the same focus and goals doing
• Procedures: the preschooler fears mutilation of their so…..ex: working together to build a sand
body and that they may lose something on their castle…they must communicate with peers, follow
body. This is especially true since they are very the rules, be kind, share, leader
creative thinkers and make the procedure worst Outline behavior expectations for the parent during this age
than it really is. They most definitely fear invasive range:
procedures like shots, IVs, etc. • Can experience loss of control due to being
• Interventions and education to help them cope: hospitalized or sick. This occurs because they can’t
• simple explanations, medical play: dolls do the things they normally did like dress, eat, play.
(demonstrate how to give a shot and let them do it, • Due to this loss of control, the child can regress.
read a book about it), listen to the child and answer • Aggression in behavior: can be influenced by parents
their questions, keep parent with them if possible, “modeling” or other aggressive people in the child’s
give choices, allow to be independent (regression life, media
can still happen when stressed or experience loss of • Negativism and ritualism like during the toddler
control), avoid giving a specific time but in relation years is decreasing
to an event or in stages as it’s about to • Can experience nightmares (reassure them that
happen….example: “Your friend will visit after your you’re there, listen, help go back to own bed)
afternoon nap.”….don’t say “At 1 o’clock your friend Language explosion: major development in language during
will be here.” this time….vocabulary exploding by age of 5 in that they know
Child Safety: not as rambunctious and unaware of danger about 2400 words and speak in 5 word sentences that are
compared to the toddler because the preschooler has now complex with descriptive words and use conjunctions like and
developed more intellect and can follow the rules, but still or but to join words together.
have to watch with other things like: unsecured guns, • May experience stuttering during this time but
swimming, bike safety, stranger danger etc. should resolve after the age of 5.
Healthy eating: not as picky as the toddler, especially by • If child does this: take time to listen, don’t rush them
five…more willing to try new foods and be better at sitting or finish their words or sentence or scold or make
down to eat as they approach 5 (younger children will still not fun of the child for this issue or make a big deal
be able to sit for long periods) about it…. referral for speech therapy may be
• “baby teeth” completely in by 3 (dental care very needed to prevent problems as he or she becomes
important)…start losing them around 5 to 6 (varies older and still stutters.
from child to child)….avoid fatty, sugary foods SCHOOL AGE
• always watch for choking risk….don’t run with Skills:
suckers in mouth or talk with food in mouth etc. The school-age child has learned many things up to this point
• Others are starting to become important for and it all started when they were an infant. So, now the child
playtime…finally starting to transition where they is building upon those skills and mastering them with
independence. This helps them discover their role within the Onset of puberty varies…girls tend to enter puberty earlier
family and among friends. than boys. The onset of puberty for girls is between the ages
As the child advances from 6 to 12, parent to child, and child of 8-13 years, while boys enter puberty around 9-14 years.
to peer interaction along with schooling will be the main Therefore, the child should be educated about puberty and
drivers for learning and growth (why called it’s called the body changes that will occur.
school-age child). The school setting varies and can be via a Harmful Risks:
public, private, online, or home setting. The school-age child is very active with other peers (some
Fine motor skills: these are skills that use small muscles: school-age children may want to show off or compete).
Writing (not only writes their name with ease but will Therefore, they need education about taking steps to stay
advance with writing sentences and complex stories), safe during play. Educational topics include:
drawing with details (no longer just stick people), typing,
helping with advanced cooking and cleaning tasks • Safe usage of bikes/scooters/skates (helmets and
Gross motor skills: these are skills that use large muscles: ride other protective gear)
bike without training wheels, swim, use scooters or skates, • Swimming safety: avoid diving or deep water
compete in sports etc. dangers like undercurrents…always wearing a life
Cognitive skills: (the child now has an increased ability to jacket (consider swimming lessons)
focus and pay attention) : reading, writing stories, solving • Strangers: kidnapping tactics, not trusting a stranger,
math problems (concrete operations), developing hobbies inappropriate touch (teach child what is okay vs.
(classifies objects), understands conservation, increased what is not)
ability with memorizing and learning complex material as • Avoid dangerous objects: fire and guns (keep out of
they progress through school grades reach and locked up)
Language Skills: Advancing and fine tuning, understandable • Car and Traffic safety: wear seat belt while riding in a
and adult like in many ways, any language problems should vehicle
be consulted with a speech pathologists, turning spoken • Most school-age children will be riding in a booster
words into written words, starts creative writing, learning seat (state laws vary)
grammar rules and can follow them, definitions and spelling • Example: some states say if the child is older than 8
words years and at least 4’9 they no longer need a booster
Social skills: less egocentric and more concerned about seat
others and their perspective (cares about what others think Obstacles at this Age:
and how they can help out), loves peer activities and forms • The school-age child is forming self-concept during
special friendships with the same gender (changes when they this time. They are asking themselves, “Who am I?”
become teens), parents influence still a big part but they start and “How do I fit in?” The parents play a role with
to question it toward the end of this stage, competitive play this developing as well as the school setting, which is
(teams) and joining clubs where rules are important to follow majorly influenced with peer approval (accepted by
Play style with others includes cooperative, competitive, others) and teachers (grades and feedback they
physical, constructive play with challenges. Also, like doing get….smart enough etc.). A poor self-concept leads
things by self like reading, video games, collecting items, and to self-doubt, depression, and low self-worth.
board games. • Tips for helping a child develop a good self-concept:
Games you may see a school-age child playing: Simon Says, be positive and highlight child’s strengths, guide with
Charades, Hide and Seek, Tag, Basketball, board games, setting obtainable goals (and praise when
Hopscotch, jump rope, kick the can etc. completed), care about their interests and help them
Changes (body): grow in them, let them grow and when they mess up
Teeth: started losing baby teeth usually around 5 to 6 year help them reflect back on what happened and how
(central incisors) and now permanent teeth start coming in to improve next time
(usually the central incisors) . Teething technically doesn’t
• Bullying: harming or intimidating a person
end until adulthood with wisdom teeth coming in around age
Most common setting in at school but can be outside of
21 (makes for 32 permanent teeth), but most of the 28
school or via social media “cyberbullying”.
permanent teeth are done erupting by 12 to 13 years
• Boys tend to be more physical while girls will tease,
(therefore, at the end of this stage to beginning of the next).
mock, or spread rumors.
Educate: Dental care VERY important to prevent cavities,
• Signs child is bullied: see physical injuries that child
learning to develop habits of good oral hygiene (brush twice a
can’t explain very well, school items are missing,
day and floss daily), visiting dentist every 6 months (twice a
doesn’t want to go to school (fakes sickness), grades
year), orthodontics if needed
are poor, behavior changes (withdrawing, agitated,
depressed), suicidal behavior
 • Get your child to open up about it (takes time), • Teach with pictures, outlines, age appropriate
report it, don’t ignore it, but take an active part as a videos, equipment and lay how it will happen
parent in getting it stopped (contact school, report • Tactful with privacy (especially during procedures
to authorities etc.) and let your child know you care that expose privates) (modesty)
Weight: nutrition and exercise very important in helping • Time given for activities that helps keep them
prevent childhood obesity… obesity leads to health problems distracted from sickness or upcoming procedures
like type 2 diabetes, hypertension, joint pain and much more. • Their friends…keeping in communication with school
friends is important
Remember the risk factors for obesity:
Learn Developmental Theories for School Age Child
HEAVY
Erikson’s: Industry vs. Inferiority
• High caloric diet (limit junk food, fast food, sugary The school-age child is very industrious and is yearning to
drinks) accomplish things through developed skills they have
• Exercise lacking (limit electronic activities and acquired and mastered. Accomplishments give them a sense
encourage to get outside and exercise) of satisfaction, and this causes them to feel confident, which
• “US Department of Health and Human Services, makes them feel like a competent person in the world they
recommends that children and adolescents ages 6 live. Therefore, the goal from this stage is competency.
through 17 years do 60 minutes (1 hour) or more of The main drivers in helping them develop this are through
moderate-to-vigorous physical activity competing (play/sports), school work, their parents, and
daily”(“Physical Activity Guidelines for School-Aged peers.
Children and Adolescents”, 2019). However, the child must know that not everyone can
• Accessibility limited to healthy foods accomplish or master every skill or task and this is okay. They
• View food as a way to deal with stress just need to keep trying and focus on their other
• Your genetics and family dynamics (how family accomplishments.
members eat, what’s prepared, exercise habits, and Inferiority develops when the child feels like they aren’t good
genetics affect how a person puts on weight) at something or have limitations that prevent them from
• Education on Managing or Preventing Obesity in a accomplishing. This can lead to the lack of trying to
School-age Child: accomplish and affect self-esteem.
• Make it a family effort (set obtainable goals and start Piaget’s:
slow) Preoperational stage until 7 years and then concrete
• Replace junk food that child likes with creative operations starts at 7 years until 12.
healthy foods The school-age child is starting to think about how others
• Example: instead of candy serve vibrant tangy fruits, view things and egocentric thought is decreasing (they know
or baked sweet potatoes fries instead of French fries, that other people have different thoughts).
pizza with low fat or plant based cheese, turkey They are concrete thinkers. They take a statement for exactly
pepperoni, avoid sugary drinks (set limit), avoid how it was said and doesn’t think beyond it. They can’t think
rewarding with food, make exercise fun (bike trails, abstractly yet.
team sports) They now have the ability to understand conservation. An
Exposure to drugs, violence, and sexual content through example of this would be: there are two plates that are the
media and school: listen to your child and pay attention to same size with the same amount of food on them, but when
what they are exposed to (via online, from friends etc.), have food from one plate is moved to a smaller plate a child
an honest open line of communication with the child and talk without conservation thinking would think that the smaller
about these issues when they come up and how to deal with plate had more food on it than the larger plate. However, a
them. school-age child understands that the smaller plate has the
Will test the limits by telling lies, stealing, cheating same amount of food on it as the larger one and that the
Outcome of Hospitalizations (Nurse’s Role) plate was just switched.
Hospitalized school-age child can experience the following In addition, they develop classification skills (can place items
FEARS: in a group based on similarities or like characteristics….color,
size, what it’s used for etc.)
Fear of pain, injury (losing a body part or becoming Moral Development by Kohlberg
deformed), death, losing independence/control (interruption Why do children conform to rules?
to school routine, separation from family and friends), Early until 7 years: the child know there are rules but doesn’t
modesty: doesn’t like showing private parts really understand the purpose or why of the rules….they
behave because of consequences or praises…and conforms
Nurse’s Role with the Hospitalized School-age Child: 7 T’s for rewards or praise
• Take time to let them to express fears Later on until 10 years: “good boy or nice girl
• Talk about those fears and coping techniques to help orientation”…follow rules and conforms because they’re liked
maintain control and this helps maintain a good standing with people…they
• Truthful about procedures and tests want to be liked or seen as “good”.
 • Emotional changes: active hormones in the body like
Older school age children over 10 year: conform due to “law estrogen can lead to crankiness, sensitivity,
and order orientation” and wants to keep social order by outbursts, and agitation
obeying law and rules so they conform. Puberty in Boys:
ADOLOESCENT ➢ Starts around 9-14 years (happens in stages)
TEEN ➢ Enlargement of penis and testes
• The BIG Changes: during this time the child is ➢ Increase growth of hair in pubic area, armpits, chest,
transitioning from a child to adult physically and legs, arms, and face
emotionally. ➢ Changes in voice (Adam’s apple in neck…larynx
• One of those BIG changes is puberty. Puberty is a enlarges)
time of rapid changes for the child’s body along with ➢ Increase in muscle mass (increase weight)
emotional changes. ➢ Average weight for 18 year old male in U.S.: 147.5
• Puberty leads to the reproductive organs become lbs.
active. This is the ovaries for girls and testes for boys. ➢ Can increase to almost a 1 foot in height during this
Once this occurs, it means that person has become time period depending on genetics and other factors
sexually mature (hence capable of making offspring). ➢ Average height for 18 year old male in U.S.: 69.3
• Girls and boys change differently. Girls typically inches…5’9”
enter puberty sooner than boys by about 2 years. ➢ Can keep growing until around 20 years
Puberty tends to last up to 5 years and occurs in ➢ Skin changes: activation of sebaceous glands leading
stages. to zits and apocrine glands leading to body odor
• Therefore, based on development of secondary sex ➢ Emotional changes: active hormones in the body like
characteristics (like the growth of pubic hair) and testosterone can lead to moodiness and agitation
primary sex characteristic (breast or penis Other changes for teens:
development), a 5-point scale can be used to help Teeth: the younger age groups are erupting teething and
determine how far along a person is in the puberty losing teeth. However, the adolescent is almost done with
period. This scale is called Tanner Stages and it goes erupting teeth so that they have around 32 permanent teeth.
from 1 to 5 (with 5 being completely mature). All that is left to erupt are the second molars which erupt by
• This scale grades girls based on breast development 13 years, and then around 17-21 years the wisdom teeth start
and pubic hair growth, and boys by penis and erupting.
scrotum growth and pubic hair growth. Many adolescents have braces to correct crowding issues and
other orthodontic needs. Therefore, educate them about
regular dental visits (twice a year…every 6 months),
Puberty in Girls: importance of brushing twice a day and flossing daily.
• Starts around 8-13 years (happens in stages) Social: Peer influence is now a major part of their life. The
• First sign of puberty is breast changes (with breast activities they do are usually around peers, and they like to
tissue developing). Other changes that occur are communicate constantly via text messaging, social apps, and
increase in hair growth (armpits and pubic area). phone. They also like surfing the internet, working at jobs,
• Increase in weight with the storing of fat on the watching movies, and playing sports.
stomach, butt, and thighs….average 18 year woman
weight in U.S.: 125 lbs. The adolescent is separating from parents (challenging their
• Major growth spurts occurs during puberty with an authority) and yearning for independence. The parent and
increase in height child relationship will be strained at times, but once the child
becomes an adult and matures, the relationship will become
• Depending on the girl’s genetics and other factors,
closer. It’s important the teen is able to branch out and find
they can grow up to 8 inches throughout the teen
their identity.
period
Now, due to all these changes listed above and major peer
• Average 18 year woman in U.S.: 64 inches…5’ 4”
influence, body image can be affected. If the teen has a
• Girls tend to stop increasing in height 2 years after
negative body image it can lead to low self-esteem and self-
the onset of menstruation
concept, which can manifest as depression, eating disorders,
• Girls tend to stop increasing in height 2 years after
and more.
the onset of menstruation
The teenager will compare their physical changes due to
• Hips widen puberty to their peers. And unfortunately teens are faced
• Skin changes with activation of sebaceous (oil with more challenges than previous generations with this
glands) and apocrine glands (sweat glands) which because of media, especially social media. Social media gives
leads to the development of zits and body odor. a false perception of what is real vs. filtered.
• Menstruation happens about 2-3 years after puberty Furthermore, it’s important to note that this isn’t just a girl
has started thing but boys can also struggle too.
It’s important to help the adolescent with developing a “This is who I am”. Once they figure this out, it will drive them
positive body image. Some educational points to help with in their future relationships, pursuits of career, and other
this include: goals.
REAL What helps them figure this out is getting involved in social
Role model for your teen: have a positive body image relationships and other experiences that help them grow and
yourself, make it important to be healthy rather than a explore. This will guide them in their ability to figure out who
certain weight or look, explain how you may have struggled they are and what they want to do in life.
as a teen too Goal of this stage is the formation of the fidelity: Fidelity is a
Eating Disorder Signs: anorexia (won’t eat, losing weight, commitment or faithfulness to obligations. Therefore, once
obsessed about exercise, negative about self) or bulimia they have an identity, they can be a productive, stable person
(consuming a lot of food and then throwing up afterwards, in society who is faithful in their duties.
using laxatives) if this isn’t achieved, role confusion can happen. This is where
Avoid the media trap: have rules for social media, talk to child the teen is unsure on who they are, what they like, how they
about how not everything you see on T.V. or in magazines is fit into the world, and unsure about their future. They will
how people look drift around in educational, relationship, and career pursuits.
Love your child: praise and build up, help them feel confident, Piaget’s Theory on Cognitive Development:
don’t concentrate on their looks or other people’s looks but Formal Operational
their qualities 12 years old to adulthood
Education for the Adolescent The teen has the ability to think abstractly and can see other
Adolescence can be a dangerous time because the teen has possible outcomes. They can look at how things can play out
an adult like body with amazing strength and endurance, but based on decisions or events to a certain point (this ability
they are still maturing. They may engage in risky activities further develops in adulthood).
because of peer pressure, inability to completely understand They can start planning for the future and analyze how
consequences, and the feeling that “it won’t happen to me”. decisions they make can affect them and others around them
Therefore, it’s essential the teen participates in a driving (cause and effect). Solve problems by developing potential
course and is educated about always wearing a seat belt, no ideas or solutions for problems (hypothesizing) and
texting or cell phone usage during driving, never driving manipulate scenarios or ideas in mind to solve something
under the influence, no speeding or drag racing, etc. without having to see it.
Other safety concerns for the teen include: self-harm Kohlberg’s Moral Development
More education: substance abuse, sexual activity (education Social Contract Orientation
on sex is needed), swimming safety (drowning another risk The teen knows others have different ideas on what is right
for death and diving injuries), using protective equipment in or wrong (hence their moral values). They start to
sports and physical activities (like the school-age child), understand, yes, we have law and rules that majority of
firearms (locked up), gangs people agree on (although some groups of people will
Health Education: disagree), but everyone should try to work
Nutrition: increased time for growth especially during puberty together/reciprocate (an understood social contract) so
and needs many minerals and nutrients to help facilitate the society can exist and function.
growing body However, people have rights and basic human freedoms and
Educate on diet high in calcium to support bone growth, iron, moral personal values they follow. And if those laws and rules
protein, folic acid, zinc, fiber, and vitamin d hinder or go against those, there’s an exception for the rules
Reasons for poor nutrition in the teen: or laws.
➢ life becomes busy with activities, friends, and other Nurse’s Role for the Hospitalized Adolescent
commitments Fears:
➢ it’s easier to eat foods that are high calories and no ➢ Separation from peers (not around them so they
nutritional value may be rejected)
➢ parent’s influence on food choices is limited ➢ Loss of control (act out, refuse, anger)
➢ prefers to drink what peers are drinking like soft ➢ Privacy invaded
drinks, energy drinks or coffee type products (less ➢ Death, Deformity (affect body image)
intake of milk and water) Interventions
➢ social eating with peers (typically not healthy but ➢ Open and honest
tasty) ➢ They hide their feelings and questions… try to
➢ body image poor (skips meals thinking this will help answer questions they would have but not ask you
with weight loss, overeats to cope with stress ➢ Give them control in decisions and activities (eat,
leading to obesity) wear, and routines)
Erikson’s Stage of Psychosocial Development: ➢ Encourage social activities in recreation room, if
Identity vs. Role Confusion possible
The independence they now have allows them to figure out ➢ Maintain privacy
their identity. They’re trying to figure out the statement, ➢ Teach with videos, diagrams, photos