PAEDIATRIC GROWTH AND

DEVELOPMENT (PN:112)
(6 Credits=60hrs)

Infancy – Physical development

 Introduction
• A knowledge of growth and development is
essential for nurses if they are to identify
developmental needs and problems.

• Each developmental stage includes physical,

psychosocial, cognitive, moral, and spiritual
aspects.

• Health assessment and promotion of health

and wellness are emphasized.
 Introduction
Growth
• Growth refers to an increase in physical size of
the whole body or any of its parts.

• It is simply a quantitative change in the child’s

body.

• It can be measured in Kg, pounds, meters,

inches, ….. etc
Child Growth (Image: WHO)
Changes in bodily proportions with age.
 Introduction
Development
• Development refers to a progressive increase
in skill and capacity of function.

• It is a qualitative change in the child’s

functioning.

• It can be measured through observation.

By understanding what to expect during each stage of development, parents
can easily capture the teachable moments in everyday life to enhance their
child's language development, intellectual growth, social development and

motor skills.
 Introduction
Maturation
• Increase in child’s competence and
adaptability.

• It is describing the qualitative change in a

structure.

• The level of maturation depends on child’s

heredity.
 Introduction
Importance of Growth and Development
Knowing what to expect of a particular child at any
given age.

• Gaining better understanding of the reasons

behind illnesses.

• Helping in formulating the plan of care.

• Helping in parents’ education in order to achieve

optimal growth & development at each stage.
 Introduction
Types of growth and development
• Types of growth:
- Physical growth (Ht, Wt, head & chest
circumference)
- Physiological growth (vital signs …)
• Types of development:
- Motor development
- Cognitive development
- Emotional development
- Social development
 NEONATES AND INFANTS (BIRTH TO 1 YEAR)

• Babies are considered neonates from birth to

the first month.

• Infants are babies from 1 month to 1year of

age.
 NEONATES AND INFANTS

Physical Development

• A neonate’s basic task is adjustment to the

environment outside the uterus, which

• requires breathing, sleeping, sucking, eating,

swallowing, digesting and eliminating.
 NEONATES AND INFANTS

• Because newborns are so vulnerable, the first

3 months of life have been called by some as
the “fourth trimester”.

• Infants continue to grow and develop rapidly

during the first year,

• learning more skills as they interact with their

world.
 NEONATES AND INFANTS

• Infants undergo significant physiologic change

in weight, length, head growth, vision and
motor development.

• Some of these changes can be assessed using

standardized growth charts.
 NEONATES AND INFANTS

• The world Health Organizations global child

Growth standards are available to assess

• optimal growth given adequate nutrition,

feeding practices, environment and

• health care for children around the world.

 NEONATES AND INFANTS

1. Weight
• At birth most babies weigh from 2.7 to 3.8
kg. Just after birth most infants lose 5% to
10% of their birth weight
• because :-
 Withdrawal of hormones from mother.
 Loss of excessive extra cellular fluid.
 Passage of meconium (feces) and urine.
 Limited food intake.
 NEONATES AND INFANTS

• This weight loss is normal and infants usually

regain that weight in about I week

• After several days babies usually gain weight at

the rate of 150 to 200 g weekly for 6 months.

• By 5 months of age infants usually reach twice

their birth weight and by age 12 months three
times their birth weight.
 NEONATES AND INFANTS

2. Length
• The average length of a newborn is about 50
cm (20in).

• Female babies on the average are smaller

than male babies.

• Babies from different ethnic groups may vary

height, weight, and head circumference, so
 NEONATES AND INFANTS

• ethnicity must be considered when

determining what is “normal” for any
particular infant.

• Two recumbent lengths are the crown -to-

rump length (the sitting length) and the head -
to-heel length (from the top of the head to
the base of the heels).
 NEONATES AND INFANTS

• Normally the crown-to-rump length is

approximately the same as the head
circumference

• By 6months infants gain another 13.75cm

(5.5in) of height.
• Length measurement
 NEONATES AND INFANTS

• By 12 months they add another 7.5 cm (3in).

• The rate of increase in height is largely

influenced by:-

the baby’s size at birth and

by nutrition.
 NEONATES AND INFANTS

3. Head and Chest Circumference

• Assessment of head circumference is of

particular importance in infants and

• children to determine the growth rate of the

skull and the brain.
 NEONATES AND INFANTS

• An infant’s head should be measured at every

visit to the primary care provider or nurse
until the child is 2 years old.

• Normal head circumference (normocephaly) is

often related to chest circumference.

• Headcircumference
 NEONATES AND INFANTS

• At birth the average infant’s head

circumference is 35cm (14 in) and

• generally varies only 1 or 2 cm (0.5in). The

chest circumference of the newborn is

• usually less than the head circumference by

about 2.5cm (1 in).
 NEONATES AND INFANTS

• As the infant grows the chest circumference

becomes large than the head circumference.

• At about 9 or 10 months the head and chest

circumferences are about the same and

• after 1 year of age the chest circumference is

large.
 NEONATES AND INFANTS
4. Head molding
• The heads of many newborn babies are
misshapen because of the molding of the
head that occurs during vaginal deliveries.

• Molding of the head occurs due to fontanels

and sutures in the skull.
 NEONATES AND INFANTS

• Fontanels are unossified membranous gaps in

the bone structure of the skull.

• Sutures are junction lines of the skull bones

that override to provide flexibility for molding
of the head.

• Within a week a newborn’s head usually

regains its symmetry which is reassuring to
the parents.
 NEONATES AND INFANTS

• The larger anterior fontanel (4 to 6 cm in

diameter and diamond shaped) can

• increase in size for several months after birth.

• After 6 months the size gradually decreases

until closure occurs between 9 and 18 months.
 NEONATES AND INFANTS

• The posterior fontanel between the parietal

bones and

• the occipital bone closes between 2 and 3

months after birth

• Fontanels and Sutures

 NEONATES AND INFANTS

5. Vision
• The newborn can follow large moving objects
and blinks in response to bright light and
sound.

• The pupils of the newborn respond slowly and

• the eyes cannot focus on close objects and

follow moving ones
 NEONATES AND INFANTS

• At 4 months the infant recognizes a parent’s

smile although social smiles may appear as
early as 2 months.

• The 4-month-old has almost complete color

vision and follows object through a 180-
degree arc.

• A 5- month -old infant reaches for objects.

 NEONATES AND INFANTS
• Between 6 and 10 months the infant fix on an
object and follow it in all directions.

• By 12 months depth perception has fully

developed and

• the infant will consistently be able to

recognize where a change in level occurs such
as at the edge of the bed.
 NEONATES AND INFANTS

6.Hearing
• Newborns with intact hearing will react with a
startle (surprise) to a loud noise,

• a reaction called the moro reflex.

• Within a few days, they are able to distinguish

different sound.
 NEONATES AND INFANTS

• For example they can tell the difference

between their mother’s voice and that of
another woman.

• By 2 to 3 months they will actively coo

(shake), smile, or gurgle to sounds and voices.
 NEONATES AND INFANTS

• Between 3 and 6 months the infant will look

for sounds, pausing an activity to listen and

• responding with distress or pleasure to angry

or happy voices.

• Between 6 and 9 months individual words

begin to take on meaning and
 NEONATES AND INFANTS

• the infant may look at named objects or

people.

• The 9-to 12 month-old infant understands

many words (e.g. “no” “hot” “dog”)

• uses gestures (e.g. waves “bye-bye”),.

 NEONATES AND INFANTS

• may articulate one or two words with a

specific reference (e.g. “mama,” “dada”), and,

• by 1 year of age, responds to simple

commands
 NEONATES AND INFANTS

7. Smell and Taste

• The senses of smell and taste are functional
shortly after birth.

• Newborns prefer sweet tastes and tend to

decrease their sucking in response to liquids
with a salty content.
 NEONATES AND INFANTS

• They are able to recognize the smell of their

mother’s milk and

• respond to this smell by turning toward the

mother.
 NEONATES AND INFANTS

8. Touch
• The sense of touch is well developed at birth.

• Skin-to-skin touching is important for an

infant’s development.

• The infant responds positively to the warmth,

love, and security it perceives when touched,
held and cuddled.
 NEONATES AND INFANTS

• The newborn is sensitive to temperature

extremes and has poor self-regulation of body
temperature.

• In response to pain, young babies react

diffusely and cannot isolate the discomfort.

• The pain of an open safety pin in the buttock

for example is not isolated in the buttock.
 NEONATES AND INFANTS

9. Reflexes
• Reflexes of the newborn are unconscious,
involuntary responses of the nervous system
to external and internal stimuli

• Reflexes normally present at birth are the

rooting, sucking, Moro, palmar grasp, plantar,
tonic neck, stepping and Babinsk reflexes.
 NEONATES AND INFANTS

• Infant reflexes disappear during first year of

life in an ordered sequence, a process that
allows infant to develop voluntary movement.

• In addition the abilities to yawn, stretch,

sneeze, burp and hiccup are all present at
birth.
 NEONATES AND INFANTS

Sucking reflex

• A feeding reflex that occurs when the infant’s

lips are touched.

• The reflex persists throughout infancy.

 NEONATES AND INFANTS

Rooting reflex
• A feeding reflex elicited by touching the
baby’s cheek,

• causing the baby’s head to turn to the side

that was touched.

• The reflex usually disappears after 4 months.

 NEONATES AND INFANTS

Moro reflex

• Often assessed to estimate the maturity of the

central nervous system.

• A loud noise, a sudden change in position or

an abrupt jarring of the crib elicits this reflex.
 NEONATES AND INFANTS

• The infant reacts by extending both arms and

legs outward with the fingers spread,

• then suddenly retracting the limbs. Often the

infant cries at the same time.

• This reflex disappears after 4 months.

 NEONATES AND INFANTS

• Palmar grasp reflex

• Occurs when a small object is placed against

the palm of the hand causing the fingers to
curl around it.

• This reflex disappears after 3 to 6 months.

 NEONATES AND INFANTS

Plantal reflex Similar to the palmar grasp reflex

• an object placed just beneath the toes cause

them to curl around it.

• This reflex disappears after 8 to 10 months.

 NEONATES AND INFANTS
Tonic neck reflex (TNR) or fencing reflex

• A postural reflex. When a baby who is lying on

its back turns its head to the right side,

• for example, the left side of the body shows a

flexing of the left arm and the left leg.

• This reflex disappears after 4 to 6 months.

 NEONATES AND INFANTS
Stepping reflex (walking or dancing reflex)
• can be elicited by holding the baby upright so
that the feet touch a flat surface.

• The legs then move up and down as if the

baby were walking.

• This reflex usually disappears at about 2

months.
 NEONATES AND INFANTS
Babinski reflex;
• when the sole of the foot is stroked, the big toe
rises and the other toes fan out.

• A newborn baby has a positive Babinski. After age

1, the infant exhibits a negative Babinski, that is
the toes curl downward.

• A positive Babinski after age 1 can indicate possible

upper motor neuron damage
One month-Reflexes
NEONATES AND INFANTS

Infancy –Motor Development

 NEONATES AND INFANTS
• Motor development is the development of the
baby’s abilities to move and to control the
body.

• Initially body movement is uncoordinated.

 NEONATES AND INFANTS

• At I month of age the infant lifts the head

momentarily when prone,

• turns the head when prone, and has a head

lag (hold up) when pulled to a sitting position.

• Head lag should be minim by 4 months of age.

 NEONATES AND INFANTS

• After 6 months infants may sit without

support

• At 9 months they can reach, grasp an object

and transfer it from hand to hand.

• At 12 months they can turn the pages of a

book, put objects into a container, walk with
some assistance and help to dress themselves.
 Head Control

Newborn Age 6 months

 Sitting Up

Age 2 months
Age 8 months
 Ambulation

13 month old
Nine to 12-months
 Fine Motor Development
in infancy

6-month-old
12-month-old
NEONATES AND INFANTS

Infancy –Psychosocial Development

 NEONATES AND INFANTS

• According to Erikson (1963) the central crisis at

this stage is trust versus mistrust.

• Resolution of this stage determines how the

person approaches subsequent developmental
stages.
 NEONATES AND INFANTS

• During the first years of life infants depend on

the parents for all their physiologic and
psychologic needs.

• Fulfillment of these needs is required for the

infant to develop a basic sense of trust.

• Parents can enhance this sense of trust by (a)

being sensitive to the infant’s needs and
 NEONATES AND INFANTS

• meeting these needs promptly and skillfully;

• (b) responding consistently to an infant’s

needs, and

• (c) providing a predictable environment in

which routines are established.
 NEONATES AND INFANTS

• Mothering or nurturing behavior, such as

consistent care, handling, stroking and

• cuddling is essential for healthy psychosocial

development.

• By 8 month most infant exhibit attachment to

their parents and may show displeasure when
left with strangers.
 NEONATES AND INFANTS

• The newborn reacts socially to caregivers by

paying attention to the face or voice and by
cuddling when held.

• The baby is able to interact with the

environment by responding to various stimuli
such as touch and sound
 NEONATES AND INFANTS

• Infants have no understanding of waiting and

no time frame by which to measure waiting.

• Crying is their initial reaction to stress, and the

major way they communicate stress. Infants
learn gradually to tolerate stress.

• According to Freud, infants have an oral focus

many of their activities and pleasures are
 NEONATES AND INFANTS

• mouth centered, and they reduce tension by

sucking and chewing on objects.

• Nurses and parent can reduce the stress of an

infant by maintaining the infant’s routine as

• much as possible and providing a consistent,

predictable environment.
NEONATES AND INFANTS

Infancy- Cognitive (intellectual)

Development
 NEONATES AND INFANTS

• According to piaget (1966) cognitive

development is a result of interaction
between an individual and the environment.

• Piaget referred to the initial period of

cognitive development as the sensorimotor
phase.
 NEONATES AND INFANTS

• This phase has six stages three of which take

place during the first year.

• From 4 to 8 months infants begin to have

perceptual recognition.

• By 6 months they respond to new stimuli, and

they remember certain objects and look for
them for a short time.
 NEONATES AND INFANTS
• By 12 months infants have a concept of both
space and time.

• They experiment to reach a goal such as a toy

on a chair. An infant’s cognitive development
also proceeds from

• reflexive ability of the newborn to using one

or two actions to attain a goal by the age of 1
year.
 NEONATES AND INFANTS

Moral Development
• Infants associate right and wrong with
pleasure and pain.

• What gives them pleasure is right, since they

area too young to reason otherwise.

• When infants receive abundant positive

responses from the parent such as smiles,
 NEONATES AND INFANTS

• caresses (touch/hug), and voice tones of

approval in these early months they learn that

• certain behaviors are wrong or goods and pain

or pleasure is the consequence.
 NEONATES AND INFANTS

• In later months and years, children can tell

easily and quickly by changes in

• parental facial expressions and voice tones

that their behavior is either approved or
disapproved.
 NEONATES AND INFANTS

Health Risks
• A number of health problems of neonates and
infants require interventions from health care
personnel.

• Safely concerns are of particular importance.

1. Failure to Thrive
• Failure to thrive is a unique syndrome in
which an infant falls below the fifth
percentile for

• weight and height on a standard growth

chart or is falling in percentiles on a growth
chart
 NEONATES AND INFANTS

• The two categories for this syndrome are

organic causes (e.g. cardiac disease) and

• inorganic causes which usually involve the

parent-child relationship.
 NEONATES AND INFANTS

• Infants deprived of mothering especially from

months 3 to 15 will not learn to form
significant relationships or to trust others.

• Touch, cuddling and visual and auditory

stimulation are all critical for the infant.

• It is through these mechanisms that the baby

comes to know self and the environment.
 NEONATES AND INFANTS
• Infants who fail to establish a loving
responsive relationship with a caregiver often
fail to develop normally.

• Infants with inorganic failure to thrive show

delayed development without any physical
cause.

• They are often malnourished and fail to gain

weight and grow normally.
 NEONATES AND INFANTS

2. Infant Colic
• Colic is acute abdominal pain caused by
periodic contractions of the intestines.

• It occurs in infants as young as 2 weeks of age

and for most infants disappears by 3 months
of age.
 NEONATES AND INFANTS

• Although the direct cause is not known, colic

tends to occur in babies with sensitive
temperaments.

• Factors such as swallowing air, feeding too

rapidly, allergies, taking excessive amounts of
carbohydrates, infant emotional distress, and
anxiety of the caregiver may be associated with
colic.
 NEONATES AND INFANTS
• To help relieve the colic, the nurse can assess the
infant during feeding and suggest possible
changes.

• Suggestions may include cuddling (holding) the

infant, swaddling, rocking and finding position
that provides the infant with the most comfort

• (e.g. wearing the baby in a front pack, placing

the infant in a swing or vibrating chair).
 TODDLERS (1 to 3YEARS)
• Toddlers develop from having no voluntary
control to being able to walk and speak.

• They also learn to control their bladder and

bowels and they acquire a wide variety of

• information about their environment

 TODDLERS (1 to 3YEARS)
Physical Development
• Two-year-old children lose the baby look.

• Toddlers are usually chubby, with relatively

short legs and a large head.

• The face appears small when compared to

the skull, but
 TODDLERS (1 to 3YEARS)
• as the toddler grows the face seems to grow
from under the skull and appears better
proportioned.

• Toddlers have a pronounced lumbar lordosis

and a protruding abdomen.

• The abdominal muscles develop gradually

with growth and the abdomen flattens.
 TODDLERS (1 to 3YEARS)
1. Weight
• Two year-old can be expected to weigh
approximately four time their birth weight.

• The weight gain is about 2 kg between ages

1 and 2 years and about 1 to 2 kg between 2
and 3 years. The 3 year old weights 13.6 kg
 TODDLERS (1 to 3YEARS)
2. Height
• A toddler’s height can be measured as height
or length.

• Height is measured while the toddler stands

and length is measured while the toddler is in
a recumbent position.
 TODDLERS (1 to 3YEARS)
• Although the measurements differ slightly,
nurses must specify which measurement is
used to avoid confusion.

• Between ages 1 and 2 years the average

growth in height is 10 to 12 cm (4 to 5 in ) and

• between 2 and 3 years it slows to 6 to 8 cm

(2 ½ to 3 ½ in )
 TODDLERS (1 to 3YEARS)
3. Head Circumference

• The head circumference of the toddler increases

about 2.5 cm (1 in) on average each year.

• By 24 months the head is 80% of the average

adult size and the brain is 70% of its adult size.
 TODDLERS (1 to 3YEARS)
4. Sensory Abilities
• Visual acuity is fairly well established at 1 year.
Accommodation to near and far object fairly well
developed by 18 months and continues to mature with
age.

• At 3 years of age, the toddler can look away from a toy

prior to reaching out and picking it up.

• This ability required integration of visual and

neuromuscular mechanisms
 TODDLERS (1 to 3YEARS)
• The senses of hearing, taste, smell, and touch
became increasingly developed and

• associated with each other. Hearing in the 3 –

year old is at adult levels.

• The taste buds of the toddler are sensitive to

the natural flavors of food, and
 TODDLERS (1 to 3YEARS)
• the 3 year old prefers familiar odors and
tastes.

• Touch is a very important sense, and a

distressed toddler is often soothed by

• tactile (tangible/palpable) sensations.

 TODDLERS (1 to 3YEARS)
5. Motor Abilities

• Fine muscle coordination and gross motor

skills improve during toddlerhood.

• At the age of 18 months babies can pick up

cereal pieces and place them in a receptacle.
 TODDLERS (1 to 3YEARS)
• They can also hold spoon and a cup and can
walk upstairs with assistance.

• At 2 years, toddlers can hold a spoon and put

it into the mouth correctly.

• They are able to run, their gait is steady and

they can balance on one foot and ride a
tricycle.
 TODDLERS (1 to 3YEARS)
• By 3 years most children are toilet trained,

• although they still may have the occasional

accident when playing or during the night.
 TODDLERS (1 to 3YEARS)
Psychosocial Development

• According to Freud the ages of 2 and 3 years

represent the anal phase of development,

• when the rectum and anus are the especially

significant areas of the body.
 TODDLERS (1 to 3YEARS)
• Eriksson viewed the period from 18 months to
3 years as the time when

• the central developmental task is autonomy

versus shame and doubt.

• Toddlers begin to develop their sense of

autonomy by asserting themselves with the
frequent use of the word “no.”
 TODDLERS (1 to 3YEARS)
• They are often frustrated by restraints to their
behavior and between ages 1 and 3 may have temper
tantrums (anger/irritability).

• However, with the guidance of their caregivers they

slowly gain control over their emotions.

• Parents need to have a great deal of patience coupled

with an understanding of the importance of this
development milestone.
 TODDLERS (1 to 3YEARS)
• To be effective, caregivers need to give the
child some measure of control and at the

• same time be consistent in setting limit so

that the child learns the results of
misbehavior.
 TODDLERS (1 to 3YEARS)
• The nurse can also assist the parents and
caregivers in promoting toddlers
development by suggesting the following
activities :-

 Provide toys suitable for the toddler, including

some toys challenging enough to motivate but
not so difficult that the toddler will fail.
 TODDLERS (1 to 3YEARS)
• Failure will intensify feelings of self – doubt
and shame.

 Make positive suggestions rather than

commands. Avoid an emotional climate of
negativism, blame and punishment.
 TODDLERS (1 to 3YEARS)
 Give the toddler choice, all of which are safe,
Howe ever, limit number to two or three.

 When toddler has a temper tantrum make

sure the child is safe and then leave.

 Help the toddler to develop inner control by

setting and enforcing consistent reasonable
limits.
 TODDLERS (1 to 3YEARS)
 Praise the toddler’s accomplishments give
random and spontaneous feedback for
positive behavior.

Self- concept
• is made up of body image development,
feelings about self, adaptive and defensive
mechanisms, reactions from others,
 TODDLERS (1 to 3YEARS)
• and one’s perceptions of these reactions
attitudes, value, and many of life’s experiences

• Children learn to develop a sense of self-

concept through their immediate social

• environment in which their parents plays a

significant role.
 TODDLERS (1 to 3YEARS)
• If the children’s social interactions with their
parents are negative

• (e.g. constant disapproval regarding eating,

toilet training, or other behavior)

• the children may begin to see themselves as

bad.
 TODDLERS (1 to 3YEARS)
• This perception is the basis of a negative self-
concept.

• Parents need to give toddler positive input so

that they can develop a positive and health
self-concept.

• With a healthy sense of self-esteem and

security, the toddler is able to deal with
 TODDLERS (1 to 3YEARS)
• periodic failures later in life without damage
to self-esteem.

• Although toddlers like to explore the

environment they always need to

• have a significant person nearby.

 TODDLERS (1 to 3YEARS)
• Parents needs to know that young children
experience acute separation anxiety,

• the fear and frustration that come with

parental absences.

• Abandonment is their greatest fear.

 TODDLERS (1 to 3YEARS)
• At this age, the child may have difficulty
accepting a baby – sitter or strongly resist

• being left by the parents at a day – care

center. For example, toddlers may become

• highly anxious when separated from their

parents and admitted to a hospital.
 TODDLERS (1 to 3YEARS)
• Regression or reverting to an earlier
development stage may be indicated by bed
wetting or using baby talk.

• Nurses can assist parents by helping them

understand that this behavior is normal and

• indicates that these toddlers are trying to

establish their position in the family.
 TODDLERS (1 to 3YEARS)
• Experience with separation helps the child
cope with parental absences.

• Children need room for exploration and

interaction with other children and adults.

• At the same time, they need to know that the

parental bond of a loving and close
relationship remains secure.
 TODDLERS (1 to 3YEARS)
• Toddlers assert their independence by saying
“no” or by dawdling (precise).

• During the toddler stage, receptive and

expressive language skills are developing
quickly.

• Children can understand words and follow

directions long before they can actually form
them into sentences.
 TODDLERS (1 to 3YEARS)
Cognitive Development

• According to Piaget, the toddler completes

the fifth and sixth stages of the sensor motor
phase and

• starts the preconception phase at about 2

years of age.
 TODDLERS (1 to 3YEARS)
• In the fifth stage the toddler solves problems
by a trial – and – error process.

• By stage 6 toddlers can solve problems

mentally.

• For example when given a new toy the toddler

will not immediately handle the toy to see
how it works,
 TODDLERS (1 to 3YEARS)
• but will instead look at it carefully to think
about how it works.

• During Piaget’s preconceptual phase, toddlers

develop considerable cognitive and
intellectual skills.

• They learn about the sequence of time.

 TODDLERS (1 to 3YEARS)
• They have some symbolic thought: for
example, a chair may represent a place of
safety,

• and a blanket may symbolize comfort.

• Concepts start to form in late toddler hood.

 TODDLERS (1 to 3YEARS)
• A concept develops when child learns words
to represent classes of objectives or thoughts.

• An example of a concrete concept is table,

• representing a number of articles of furniture

that are all different but all tables.
 TODDLERS (1 to 3YEARS)
Moral Development

• According to Kohlberg, the first level of moral

development is the reconvention when

• children respond to punishment and reward.

 TODDLERS (1 to 3YEARS)
• During the second year of life children begin
to know that some activities elicit affection
and approval.

• They also recognize that certain rituals, such

as repeating phrases from prayers, also elicit
approval.
 TODDLERS (1 to 3YEARS)
• This provides children with feelings of
security.

• By 2 years of age, toddlers are learning what

attitudes their parents hold about moral
matters.
 TODDLERS (1 to 3YEARS)
Spiritual Development

• According to Fowler (1981) the toddler’s stage

of spiritual development is undifferentiated.

• Toddlers may be aware of some regions

practices, but they are primary involved in
learning knowledge and emotional reactions
rather than establishing spiritual beliefs.
 TODDLERS (1 to 3YEARS)

• A toddler may repeat short prayers at

bedtime, conforming to a ritual, because
praise and affection result.

• This parental or caregiver response enhances

the toddler’s sense of security.
 TODDLERS (1 to 3YEARS)
Health Risks

• Toddler experience significant health

problems due to injuries, visual problems,

• dental caries and respiratory and ear

infections.
 TODDLERS (1 to 3YEARS)
1. Injuries
• Injuries are the leading cause of mortality of
toddlers.

• They are curious and like to feel and taste

everything.

• The most common causes of fatal injuries are

automobile crashes.
 TODDLERS (1 to 3YEARS)
• Drawing, burns, Poisoning, and falls, Parents
or other caregivers needs to take the
appropriate preventive measures to guard
against these health threats
 TODDLERS (1 to 3YEARS)
2. Visual Problems

• During this period the toddler should be

screened for Amblyopia.

• Amblyopia (reduced visual acuity in one eye)

is usually the result of strabismus (cross- eye),
 TODDLERS (1 to 3YEARS)
• but can be caused by refractive errors (e.g.,
myopia). or opacities in the lens.

• Initially the child with amblyopia has straight

eyes, but the condition can lead to deviation
of the “lazy” eye and loss vision
 TODDLERS (1 to 3YEARS)
3. Dental Caries

• Dental carries occur frequently during the

toddler period, resulting from the interaction

• between the tooth surface, Streptococcus

mutans bacterium, and carbohydrates,
especially sugar in the diet.
 TODDLERS (1 to 3YEARS)

• Prolonged exposure of teeth to carbohydrates

(use of the bottle during naps and at bedtime)
can cause caries.
 TODDLERS (1 to 3YEARS)
4. Respiratory Tract and Ear Infections

• Respiratory and middle ear infections are

common during toddler hood:

• their incidence increase with exposure to

other children (as in day – care centers or
preschools),
 TODDLERS (1 to 3YEARS)
• with use of bottle during naps or at bedtime,
or if bottles are propped for feedings.

• Respiratory infections contribute significantly

to visits to pediatric primary care provider in
the toddler years.
 TODDLERS (1 to 3YEARS)
Health Assessment and Promotion

• Growth and development in the toddler and

preschool years provide the basis for

• a child’s future health and well-being.

 TODDLERS (1 to 3YEARS)
• It is essential that nurses do accurate and
timely assessments to promote health and

• detect problems early, thus allowing for

interventions

• Providing health education, information about

growth and development, and
 TODDLERS (1 to 3YEARS)
• anticipatory guidance to parents is also an
important nursing role.

• Assessment activities for the toddlers are

similar to those for the infant in terms of

• measuring weight, length (height) and vital

signs
 TODDLERS (1 to 3YEARS)
DEVELOPMENT ASSESSMENT GUIDELLINES FOR
THE TODDLER

• In four development areas, does the toddler

do the following?
 TODDLERS (1 to 3YEARS)
PHYSICAL DEVELOPMENT
• Demonstrate physical growth (weight, height
and head circumference) within normal range.

• Manifest vital signs within normal range for

age.

• Exhibit vision and hearing abilities within

normal range.
 TODDLERS (1 to 3YEARS)
MOTOR DEVELOPMENT

• Perform gross and fine motor milestones

within the normal range for age.

• For example by 3 years of age is the toddler

able to do the following?
 TODDLERS (1 to 3YEARS)
– Walk up steps without assistance.
– Balance on one foot, jump and walk on
toes.
– Copy a circle.
– Build a bridge from blocks
– Ride a tricycle.
 TODDLERS (1 to 3YEARS)
PSYSCHOSOCIAL DEVELOPMENT

• Perform psychosocial development

milestones for age.

• For example by 3 years of age is the toddler

able to do the following?
 TODDLERS (1 to 3YEARS)
• Express likes and dislikes

• Display curiosity and questions.

• Accept separation from mother for short

period of time

• Begin to play and communicate with children

and other outside the immediate family.
 TODDLERS (1 to 3YEARS)
• Understand work such as up, down, cold, and
hungry.

• Speak in sentences of three to four words.

• Imitate religious rituals of the family.

 TODDLERS (1 to 3YEARS)
DEVELOPMENT IN ACTIVITIES OF DAILY LIVING

• Feed self.
• Eat and drink a variety of foods.
• Begin to develop bowel and bladder control.
• Exhibit a sleep pattern appropriate for age.
• Dress self.
 TODDLERS (1 to 3YEARS)
Health Promotion Guidelines for Toddler

• HEALTH EXAMINATION

• At 15 and 18 months and then as

recommended by the primary care provider.

• Dental visit starting at age 3 or earlier.

 TODDLERS (1 to 3YEARS)
TODDLER SAFETY

• Importance of constant supervision and

teaching child to obey commands

• Home environment safety measures (e.g. lock

medicine cabinet)
 TODDLERS (1 to 3YEARS)
• Outdoor safety measures (e.g. close
supervision near water)

• Appropriate Eliminate toxins in environment

(e.g. pesticides,herbicides, mercury, lead,
arsenic in playground materials)
 TODDLERS (1 to 3YEARS)
NUTRITION

• Importance of nutritious meals and snacks

• Teaching simple mealtime manners

• Dental care.
 TODDLERS (1 to 3YEARS)
ELIMINATION

• Toilet training techniques

• REST /SLEEP
• Dealing training sleep disturbances
 TODDLERS (1 to 3YEARS)
PLAY
• Providing adequate Space and a variety of
activities.

• Toys that allow “acting on “ behaviors and

provide motor and sensory stimulation
 PRESCHOOLERS (4 AND 5 YEARS)
• During the preschool period physical growth
slows, but control of the body and
coordination increase greatly.

• Preschoolers’ worlds get larger as they meet

relatives, friends and neighbors.
 PRESCHOOLERS (4 AND 5 YEARS)
Physical Development
• By the time children are 4 or 5 years old, they
appear taller and thinner than toddler

• because children tend to grow more in height

than in weight.

• The preschooler’s brain almost reaches its

adult size by 5 years.
 PRESCHOOLERS (4 AND 5 YEARS)
• The extremities of the body grow more
quickly than the body trunk,

• making the child’s body appear somewhat out

of proportion.

• The posture of preschoolers gradually changes

as the pelvis is straightened and the
abdominal muscles become stronger.
 PRESCHOOLERS (4 AND 5 YEARS)
• Thus the preschooler appears slender with
erect posture.

1.Weight

• Weight gain in preschool children is generally

slow.
 PRESCHOOLERS (4 AND 5 YEARS)
• By 5 years they have added only another 3 to
5 kg to their 3 year old weight,

• increasing it to somewhere between 18 and

20 kg .
 PRESCHOOLERS (4 AND 5 YEARS)
2. Height

• Preschool children grow about 5 to 6.25 cm

(2.0 to 2.5in) each year.

• Thus by 4 years of age they double the birth

length and measure about 102 cm (41 in)
 PRESCHOOLERS (4 AND 5 YEARS)
3. Vision

• Preschool children are generally hyperopic

(farsighted) that is unable to focus on near
objects.

• As the eyes grow it refracts light normally.

 PRESCHOOLERS (4 AND 5 YEARS)
• If the eyes become too long the child becomes
myopic (nearsighted),
• that is unable to focus on objects that are far
away.

• In severe cases of hyperopia or myopia,

glasses may be prescribed.
 PRESCHOOLERS (4 AND 5 YEARS)
• By the end of the preschool years, visual
ability has improved;

• normal vision for the 5- year old is

approximately 20/30.

• The Snellen E chart can be used to asses the

preschooler’s vision.
 PRESCHOOLERS (4 AND 5 YEARS)
4. Hearing and Taste

• The hearing of the preschool child has

reached optimal levels,

• and the ability to listen (attend to and

comprehend what is said) has mature since
the toddler age.
 PRESCHOOLERS (4 AND 5 YEARS)
• As for the sense of taste, preschoolers show
their preferences by asking for something
delicious/appetizing and may refuse
something they consider undelicious

• At about age 3, children may display food

“jags” refusing to eat some foods, only eating
a few particular foods.
 PRESCHOOLERS (4 AND 5 YEARS)
• It is important that parent not engage the
child in a “battle of wills” over food.

• If parents provide healthful foods in an

environment that is pleasant and

• comfortable for eating the child will eat what

is needed.
 PRESCHOOLERS (4 AND 5 YEARS)
5. Motor Abilities
• By 5 years of age, children are able to wash
their hands and face and brush their teeth.

• They are self conscious about exposing their

bodies and go to the bathroom without telling
others.
 PRESCHOOLERS (4 AND 5 YEARS)
• Typically, children run with increasing skill
each year.

• By 5 years of age, they run skillfully and can

jump three steps.

• Preschoolers can balance on their toes and

dress themselves without assistance.
 PRESCHOOLERS (4 AND 5 YEARS)
Psychosocial Development
• Eriksson wrote that major development crisis
of the preschooler is initiative versus guilt.

• Preschooler must solve problems in

accordance with their consciences.

• Their personalities continue to develop.

 PRESCHOOLERS (4 AND 5 YEARS)
• Eriksson viewed the success of this milestone
as determining the individual’s self – concept.

• According to Eriksson, preschoolers must

learn what they can do.

• As a rest preschooler imitates behavior, and

their imaginations and activity become lively.
 PRESCHOOLERS (4 AND 5 YEARS)
• Parents can enhance the self – concept of the
preschooler by providing opportunities for

• new achievements where the child learn,

repeat and masters.

• For example a child obtains a two wheel bike

with safety wheels and
 PRESCHOOLERS (4 AND 5 YEARS)
• They quickly learns coordination, balance use
of the brakes and bicycle safety.

• Mastery of these tasks vides the child with a

sense of accomplishment.

• The child is so ready for the new challenge of

mastering the two – wheeler.
 PRESCHOOLERS (4 AND 5 YEARS)
• The self – concept of the preschooler is also
based on gender identification.

• Preschoolers are aware of the two sexes and

identify with the correct one.

• They often imitate sexual stereotype and

usually begin by identifying with the parent of
the same.
 PRESCHOOLERS (4 AND 5 YEARS)
• They may mimic the parent’s behavior,
attitudes and appearance.

• Parents need to be aware that preschoolers

are curious about their own bodies and

• sexual functions, as well as those of others

and will often ask question.
 PRESCHOOLERS (4 AND 5 YEARS)
• Parents should answer question calmly and
frankly, using words and concepts the child
understands.

• Children do not have the social, emotion, or

moral context that adults do,

• so a simple answer may be more than

adequate.
 PRESCHOOLERS (4 AND 5 YEARS)
• When parents over react to child’s question,
refuse to answer or

• punish or shame the child, the child can

become confused.

• Freud theorized that the preschooler is in the

phallic stage of development.
 PRESCHOOLERS (4 AND 5 YEARS)
• The biologic focus of the child during this
stage is the genital area, and masturbation is
common.

• The phase of close emotional relationships

with both parents changes to the phase Freud
referred to as the Electra or Oedipus complex.
 PRESCHOOLERS (4 AND 5 YEARS)
• At this time the child focuses feelings of love
chiefly on the parent of the opposite sex, and

• the parent of the same sex may receive some

hostile feelings.

• The child begins to develop sexual interest

and becomes interested in clothes and hair
styles.
 PRESCHOOLERS (4 AND 5 YEARS)
• During the preschool years four adaptive
mechanisms are learned:

• identification, introjections, imagination, and

repression.

• Identification occurs when the child perceives

the self as similar to another person and
behaves like that person
 PRESCHOOLERS (4 AND 5 YEARS)
• For example a boy may internalize the
attitudes and gender behavior of his father.

• Introjections are similar to identification. It is

the assimilation of the attributes of the
others.
 PRESCHOOLERS (4 AND 5 YEARS)
• When preschoolers observe their parents,
they assimilate many of their values and
attitudes.

• Imagination is an important part of

preschoolers’ lives, helping children make

• sense of the world and giving them a sense of

control and mastery.
 PRESCHOOLERS (4 AND 5 YEARS)
• The preschooler has an active imagination and
fantasizes in play, for example

• a chair becomes a beautiful throne to a girl

and she is the ruler of all she sees.

• Repression is removing experiences,

thoughts, and impulses from awareness.
 PRESCHOOLERS (4 AND 5 YEARS)
• The preschooler generally represses thought
related to the Oedipus or Electra complex.

• Preschool children gradually emerge as social

beings.

• At the age of 3 to 4 they learn to play with a

small number of their peers.
 PRESCHOOLERS (4 AND 5 YEARS)
• They gradually learn to play with more people
as they grow older.

• Preschoolers participate more in the family

than they did previously.

• In associations with neighbors, family, guests,

and baby – sisters, too, they learn about social
relationships.
 PRESCHOOLERS (4 AND 5 YEARS)
• In their speech, children of 4 years are often
dogmatic: they tend to believe that what they
know is right.

• Four – year olds love nonsense words such as

“jump- jump” and

• can string them to gather much to an adult’s

exasperation (anger/frustration).
 PRESCHOOLERS (4 AND 5 YEARS)
• At 4, children are aggressive in their speech
and

• capable of long conversations, often mixing

fact and fiction.

• By 5 years of age speaking skills are well

developed.
 PRESCHOOLERS (4 AND 5 YEARS)
• Children use words purposefully and ask
questions to acquire information.

• They do not merely practice speaking as 3-

and 4- years – olds do, but speak as a means
of social interaction.

• Exaggeration is common among 4- and 5 year

– old.
 PRESCHOOLERS (4 AND 5 YEARS)
• Preschoolers also become increasingly aware
of themselves.

• They play with their bodies largely out of

curiosity.

• They know where the body begins and ends as

well as the correct names for the different
parts.
 PRESCHOOLERS (4 AND 5 YEARS)
• By 5 years of age, they are able to draw a
person including all the features.

• Preschooler also learns about their feeling;

they know the words cry, sad, laugh, and the
feelings related to them.

• They also begin to learn how to control their

feelings and behavior.
 PRESCHOOLERS (4 AND 5 YEARS)
• The preschooler uses the same types of
coping mechanisms in response to stress as
the toddler does,

• although protest behavior (kicking, screaming)

is less likely to occur in the older preschooler.

• Preschoolers usually have greater ability to

verbalize stress.
 PRESCHOOLERS (4 AND 5 YEARS)
• Preschoolers need to feel that they are lovely
and that they are an important part of the
family.

• The child who has to compete with siblings for

parental attention will often display jealousy.

• Parents and caregivers should be aware that

preschooler need time to adjust to a new baby
 PRESCHOOLERS (4 AND 5 YEARS)
• and may need additional attention or special
activities to help then through this adjustment
period.

• Preschoolers with older siblings may also

experiences sibling jealousy.

• Siblings may fight and argue and become

aggressive because of their daily proximity or
competition for parental attention.
 PRESCHOOLERS (4 AND 5 YEARS)
• Parents who can plan some special time or
activity for each child will help that child to
feel lover and may decrease the sibling
jealousy.
 PRESCHOOLERS (4 AND 5 YEARS)
• Guidance and discipline are important parts of
the parental role during the preschool years.

• As children seek independence from adults,

they often test limits by

• refusing to cooperate and by repeatedly

ignoring parental requests.
 PRESCHOOLERS (4 AND 5 YEARS)
• These power struggles can sometimes be
avoided by encouraging children to be
responsible for their own behavior as much as

• possible and by setting reasonable

expectations and consistent limits.

• When conflict does occur, parents can employ

mutual discussion and compromise.
 PRESCHOOLERS (4 AND 5 YEARS)
Cognitive Development
• The preschooler’s cognitive development,
according to Piaget, is the phase of intuitive
thought.

• Children as still egocentric, but egocentrism

gradually subside as they experience their
expanding world
 PRESCHOOLERS (4 AND 5 YEARS)
• Preschoolers learn through trial and error, and
they think of only one idea at a time.

• They do not understand relationships such as

those between mother and

• father or sister and brother.

 PRESCHOOLERS (4 AND 5 YEARS)
• Children start to understand the words are
associated with objects in the toddler hood or
the early preschool years.

• Preschoolers become concerned about death

as some thing inevitable, but they do not
explain it.

• They also associate death with others rather

than themselves.
 PRESCHOOLERS (4 AND 5 YEARS)
• Most children at the age of 5 years can count
pennies: how ever the opportunity to spend

• money usually does not occur until they

attend school.

• Reading skills also start to develop at this age.

Young children like fairy tales and books about
animals and others children.
 PRESCHOOLERS (4 AND 5 YEARS)
Moral Development

• Preschoolers are capable of prosocial

behavior, that is,

• any action that a person takes to benefit

someone else.
 PRESCHOOLERS (4 AND 5 YEARS)
• The term prosocial is synonymous with kind
and connotes sharing, helping, protecting,
giving aid, befriending.

• Showing affection, and giving encouragement.

• At this stage of development, preschoolers do

not have a fully formed sense of right and
wrong:
 PRESCHOOLERS (4 AND 5 YEARS)
• however, they do develop some internal
controls.

• Moral behavior is largely learned by modeling

initially after parents and later significant
others.

• The preschooler usually behaves well in social

settings.
 PRESCHOOLERS (4 AND 5 YEARS)
• Children who perceive their parents as strict
may become resentful or overly obedient.

• Preschooler usually controls their behavior

because they want love and approval from
their parents.

• Moral behavior to a preschooler may mean

taking turns at play or sharing.
 PRESCHOOLERS (4 AND 5 YEARS)
• Nurses can assist parents by discussing moral
development and encouraging parents to give

• preschoolers recognition for actions such as

sharing.

• It is also important for parents to answer

preschoolers’ why” question and discuss values
with them.
 PRESCHOOLERS (4 AND 5 YEARS)
Spiritual Development

• Many preschoolers enroll in Sunday school or

faith oriented classes.

• The preschooler usually enjoys the social

interaction of these classes.
 PRESCHOOLERS (4 AND 5 YEARS)
• According to fowler, children from the ages of
4 to 5 years are at the intuitive- projective
stage of spiritual development.

• Faith at this stage is primary a result of the

teaching of significant others, such as parents
and teachers.
 PRESCHOOLERS (4 AND 5 YEARS)
• Children learn to imitate religions behavior,
for example, bowing the head in prayer,

• although they don’t understand the meaning

of the behavior.
 PRESCHOOLERS (4 AND 5 YEARS)
• Preschoolers require simple explanations,
such as those in picture books, of spiritual
matters.

• Children at this age use their imaginations to

envision such ideas as angels or the devil.
 PRESCHOOLERS (4 AND 5 YEARS)
Health Risks
• Preschoolers often have health problem
similar to those they had in toddler hood.

• Respiratory tract problems and communicable

diseases frequently occur as the preschooler

• interacts with other children at nursery

schools and day care.
 PRESCHOOLERS (4 AND 5 YEARS)
• Accidents and dental carries continue to be
problems during this age.

• Congenital abnormalities such as cardiac

disorders and

• hernias are often corrected at this age.

 PRESCHOOLERS (4 AND 5 YEARS)
Health Assessment and Promotion

• During assessment the preschooler can often

participate in

• answering questions with assistance from

parents or caregivers.
 PRESCHOOLERS (4 AND 5 YEARS)
• For instance children who attend preschool
can describe the typical lunch and

• how much of it they usually eat

• Preschoolers can also describe the type of

activities they enjoy.
 PRESCHOOLERS (4 AND 5 YEARS)
DEVELOPMENT ASSESSMENT GUIDELINES FOR
THE PRESCHOOLER

• In these four development areas, does the

preschooler do the following?
 PRESCHOOLERS (4 AND 5 YEARS)
PHYSICAL DEVELOPMENT

• Demonstrate physical growth (weight, height)

within normal range.
• Manifest vital signs within normal range for age.
• Exhibit vision and hearing abilities within normal
range.
 PRESCHOOLERS (4 AND 5 YEARS)
MOTO DEVELOPMENT
• Perform gross and fine motor milestones
within the normal range for age. For example
by 5 years of age is the preschooler able to do
the following?
– Jump rope and skip.
– Climb playground equipment
– Ride a bicycle with training wheels.
– Print letters and numbers.
 PRESCHOOLERS (4 AND 5 YEARS)
PSYCHOSOCIAL DEVELOPMENT
• Perform psychosocial development
milestones for age.

• For example, by 5 years of age is the

preschooler able to do the following?
PRESCHOOLERS (4 AND 5 YEARS)
Separate easily from parents.

 Display imagination and creativity

Enjoy playing with peers in cooperative

activities.

Understand right from wrong and respond

to others expectations of behavior.
PRESCHOOLERS (4 AND 5 YEARS)
Identify four colors.

Exhibit increasing vocabulary using

complete sentences and all parts of speech.

Cooperate in doing simple chores (e.g.

putting away toys)

Demonstrate awareness of sexual

differences.
 PRESCHOOLERS (4 AND 5 YEARS)
DEVELOPMENT IN ACTIVITIES OF DAILY LIVING

 Demonstrate development of toilet training.

 Perform simple hygiene measures.
 Dress and undress self.
 Engage in bedtime rituals and demonstrate
ability to put self to sleep.
 PRESCHOOLERS (4 AND 5 YEARS)
Health Promotion Guidelines for Preschooler
• Promoting health and wellness includes such
area as

• accident prevention, dental health.

• Good nutrition, cognitive stimulation, and

sufficient sleep.
 PRESCHOOLERS (4 AND 5 YEARS)
HEALTH EXAMINATIONS
• Every 1 to 2 years.
PROTECTIVE MEASURES
• Screenings for tuberculosis and any other
preventable diseases.

• Vision and hearing screening.

• Regular dental screenings and fluoride

treatment.
 PRESCHOOLERS (4 AND 5 YEARS)
PRESCHOOLER SAFETY

• Educating child about simple safety rules (e.g.,

crossing the street)
• Teaching child to play safety (e.g. bicycle and
playground safety)
• Educating to prevent poisoning:; exposure to toxic
materials
 PRESCHOOLERS (4 AND 5 YEARS)
NUTRITION

• Importance of nutritious meals and snacks

ELIMINATION

• Teaching proper hygiene(e.g. washing hands after

using bathroom)
 PRESCHOOLERS (4 AND 5 YEARS)
REST/SLEEP
• Dealing with sleep disturbances (e.g. night
terrors, sleepwalking)
PLAY
• Providing times for group play activities
• Teaching child simple games require
cooperation and interaction
• Proving toys and dress-ups for role – playing.
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

• The school- age period starts when children

are about 6 year’s age, when the deciduous
teeth are shed.

• This period includes preadolescent

(prepuberty) period.

• It ends at about 12 years, with the onset of

puberty.
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

• Puberty is the age when the reproductive

organs became function and secondary sex
characteristics develop.

• Because the average age of onset of puberty

is 10 for girls and 12 for boys,

• some people define the school – age years as

6 to 10 for girls and 6 to 12 for boys.
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

• Skills learned during this stage are particularly

important in relation to work later in life.

• In general, the period from 6 to 12 years is

one of significant growth.
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

Physical Development

• The school-age child gains weight rapidly and

thus appears less thin than previously.

• Individual differences due to both genetic and

environmental factors are obvious at this time.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
1. Weight

• At 6 years boys tend to weight about 21 kg

about 1 kg more than girls.

• The weight gain of schoolchildren from 6 to

12 years of age averages about 3.2 kg per
year,
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• but the major weight gains occur from age 10
to 12 for boys and from 9 to 12 for girls.

• By 12 years of age boys and girls weight on

the average 40 to 42 kg girls are usually
heavier.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
2. Height
• At 6 years both boys and girls area about the
same height 115 cm (46 in )

• they are about 150 cm (60in)by 12 years.

• Before puberty, children of both sexes have a

growth spurt,
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• girls between 10 and 12 years and boys
between 12 and 14 years.

• Thus girls may be taller than boys at 12 years.

• The extremities tend to grow more quickly

than the trunk;
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

• thus school-age children’s bodies appear

somewhat ill proportioned.

• By 6 years of age the thoracic curvature starts

to develop and the lordosis disappears.

• Full adult posture is not assumed however,

until after the complete development of the
skeletal musculature during the adolescent
period.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
3. Vision
• The depth and distance perception of children
6 to 8 years of age is accurate.

• By age 6 children have full binocular vision.

The eye muscles are well developed and

• coordinated, and both eyes can focus on one

object at the same time
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Because the shape of the eye changes during
growth, the farsightedness of the

• preschool years gradually changes to 20/20

vision during the school-age years;

• 20/20 vision is usually well established

between 9 and 11 years of age.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
4. Hearing and Touch

• Auditory perception is fully developed in

school-age children, who are able to identify

• fine differences in voices, both in sound and in

pitch.
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)
• At this stage, children also have a well-
developed sense of touch and are able locate
points of heat and cold on all body surfaces.

• They are also able to identify an unseen

object, such as a pencil or a book, simply by
touch.

• This ability is called stereognosis.

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
5. Prepubertal Changes

• Little change takes place in the reproductive

and endocrine systems until the prepuberty
period.

• During prepuberty, at about age 9 to 13

endocrine functions slowly increase.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• This change in endocrine function can result in
increase perspiration and

• more active sebaceous glands.

• Girls may have a sticky vaginal discharge

(leucorrhea) prior to puberty.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
6. Motor Abilities
• During the middle years (6 to 10) children
perfect their muscular skills and coordination.

• By 9 years most children are becoming skilled

in games of interest, such as football or
baseball.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• These skills are often associated with school
and many of them are learned there.

• By 9 years most children have sufficient fine

motor control for such activities as drawing,

• building models, or playing musical

instruments.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Psychosocial Development
• According to Eriksson, the central task of
school-age children is industry versus
inferiority.

• At this time children begin to create and

develop a sense of competence and
perseverance (determination).
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• School-age children are motivated by
activities that provide a sense of worth.

• They concentrate on mastering skills that will

help them function in the adult world.

• Although children of this age work hard to

succeed,
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• they are always faced with the possibility of
failure, which can lead to a sense of inferiority.

• If children have been successful in previous

stages, they are motivated to be industrious

• and to cooperate with others toward a

common goal.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Freud described the period from 6 through 12
years of age as the latency stage.

• During this time the focus is on physical and

intellectual activities,

• while sexual tendencies seem to the

repressed (withdrawn)
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• In school children have the restraints of the
school system imposed on their behavior,

• and they learn to develop internal controls.

• Children tend to compare their skills with

those of their peers in a number of areas,
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• including motor development, social
development, and language,

• this comparison assists in the development of

self- concept.

• As school- age children grow older, they learn

to play in group.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• The typical 6 and 7 year-old is a member of a
peer group that is usually informal and

• transitory with the leadership changing from

time to time.

• During this period of socialization with others,

children gradually become less self-centered
and more cooperative within a group.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Peers can have a greater influence than family.
During middle to late childhood, children may

• join a more formalize group of peers, which is

often structured around common interests.

• These groups may consist of children of the

same gender later in the school-age period.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Self- concept continues to mature in this
period. Children recognize similarities and

• differences between themselves and others,

school-age children compare themselves with
other.

• Children who are successfully and receive

recognition for their efforts feel competent
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• and in control of themselves and of their
environment.

• Conversely, children who fell unaccepted by

peers or constantly receive negative feedback

• and little recognition may experience feelings

of inferiority and worthlessness.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Although the focus of interest for this age
group has moved to school, peers and

• other activities, the home remains the crucial

place for the child’s development of high self-
esteem.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Cognitive Development

• According to Piaget, the ages 7 to 11 years

mark the phase of concrete operations.

• During this stage the child changes from

egocentric interactions to cooperative
interaction.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• School-age children also develop an increase
understanding of concepts that are associated

• with specific objects, for example,

environmental conservation or wildlife
preservation.

• Children at this time develop logical reasoning

from intuitive reasoning.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• For example, they learn to add and subtract to
obtain an answer to a problem.

• Children also learn about cause-and- effect

relationships at this age;

• for example they know that a stone will not

float because it is heavier than water.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Money is a concept that gains meaning for
children when they start school.

• By the time they are 7 or 8 years old, children

usually know the value of most coins.

• The concept of time is also learned at this age.

By 6 years of age children enter school:
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• the schedule in school helps them learn time
periods.

• However, it is not until 9 or 10 years of age

that children are able to understand the long
periods of time in the past.

• Knowing the time of day and the day of the

week are
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• relatively easily for children because they
relate time to routine activities.

• For example, a girl may go to school Monday

through Friday, play on Saturday,

• go to Sunday school on Sunday morning, and

go out with her father Sunday afternoon.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Children are beginning to read a clock by the
time they are 6 years old;

• they can learn to read both digital and

numerical clocks.

• Reading skills are usually well developed later

in childhood,
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• and what a child reads is largely influenced by the
family.

• By 9 years of age most children are self-

motivated.

• They compete with themselves, and they like to

plan in advance
•
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• By 12 years they are motivated by inner drive
rather than by competition with peers.

• They like to talk, to discuss different subjects,

and to debate.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Moral Development

• Some school-age children are at Kohlberg’s

stage 1 of the pre-conventional level
(punishment and obedience)

• that is, they act to avoid punished.

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Some school-age children however are at
stage 2 (instrumental-relativist orientation).

• These children do things to benefit

themselves.

• Fairness, that is everyone getting a fair share

or chance, becomes important.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Later in childhood, most children progress to
the conventional level.

• This level has two stages; stage 3 is the “good

boy-nice girl” stage, and

• stage 4 is the law and order orientation.

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Children usually reach the conventional level
between the ages of 10 and 13.

• The child shifts from the concrete interests of

individuals to the interests of groups.

• The motivation for moral action at this stage is

to live up to what significant others think of
the child.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Spiritual Development

• According to fowler, the school age child is at

stage 2 in spirit development,

• the mythic-literal stage. Children learn to

distinguish fantasy from fact.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Spiritual facts are those beliefs that accepted
by a religious group,

• where’s fantasy is thoughts images formed in

the child’s mind.

• Parent and the ministers or priest help the

child distinguish fact from fantasy.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• These still influence the child more than peers
in spiritual matters.

• When children do not understand such events

as the creating of the world, they use fantasy
to explain them.

• The school child needs to have concepts such

as prayer presented in concrete terms.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• For example, the child thinks of God as having
human qualities, such as a kind old man or a

• person who punishes when behavior does not

meet his standards.

• School-age children may ask many questions

about God and religion in these years and
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• will generally believe that God is good and
always present to help.

• Just before puberty, child becomes aware that

their players are not

• always answered and become disappointed.

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• At this age, some children reject religion
whereas others continue to accept it.

• This decision is largely influenced by the

parents.

• If a child continues religious training, the child

is ready to apply reason rather than blind
belief in situations.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Health Risk
• School-age children continue to have as many
communicable diseases, dental caries, and
accidents as preschoolers.

• Another health concern is the increasing

number of overweight children
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Being overweight is the most common
nutritional problem among children and

• contributes to increasing incidence of

hypertension and type 2 diabetes in children

• Obesity in childhood can lead to obesity and

increase risk for diabetes, hypertension
cardiovascular disease among adults.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Health Assessment and Promotion

• During the assessment interview the nurse

responds to questions from the parent or

• other caregiver, gives appropriate feedback,

and lends encouragement and support.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• The nurse also demonstrates interest in the
child and enthusiasm for the child’s strengths.

DEVELOPMENT ASSESSMENT GUIDELINES FOR

THE SCHOOL-AGE CHILDREN

• In these four developmental areas, does the

school- age child do the following?
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
PHYSICAL DEVELOPMENT

• Demonstrate physical growth (weight, height)

within normal range.

• Manifest vital signs within normal range for

age.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Exhibit vision and hearing abilities within
normal range.

• Demonstrate male or female prepubertal

changes within normal range.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
MOTOR DEVELOPMENT
• Possess coordinated motor skills for age.

• For example, by 12 years of age, is the child

able to do the followings?
– Do tricks on a bike, climb a tree, shinny up a rope.
– Throw and catch a small ball
– Play a musical instrument
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
PSYSCHOSOCIAL DEVELOPMENT

• Perform psychosocial developmental

milestones for age.

• For example, by 12 years of age is the child

able to do the followings?
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Make friends of the same sex and establish a
peer group.

• Became less dependent on family and venture

away from them.

• Interact well with parents

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Control strong and impulsive feelings.

• Articulate an understanding of right and

wrong.

• Participate in organized competitions.

• Read, print and manipulate numbers and

letters easily
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Express positive feelings about school and
school activities.

• Exhibit a concept of money and make change

for small amounts of money.

• Express self in a logical manner and talk

problems.
 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
• Enjoy riddles and read and understand
comics.

• Invest in a hobby or collection.

• Like to help others.

• Thinks of self as likable and healthy.

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
DEVELOPMENT IN ACTIVITIES OF DAILY LIVING

• Demonstrate concern for person Cleanliness

and appearance.

• Express need for privacy.

 SCHOOL-AGE CHILDREN (6 TO 12
YEARS)
Health Promotion Guidelines for School-Age
children

HEALTH EXAMINATIONS
• Annual physical examination or as
recommended
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)
PROTECTIVE MEASURES
• Periodic vision, speech, and hearing
screenings.

• Regular dental screenings and fluoride

treatment.

• Providing accurate information about sexual

issues (e.g. reproductive, AIDS).
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

SCHOOL-AGE CHILD SAFETY

• Using proper equipment when participating in

sports and other physical activities (e.g.
helmets, pads)

• Encouraging child to take responsibility for

own safety (e.g. participating in bicycle and
water safety courses.)
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

NUTRITION
• Importance of child not skipping meals and eating a
balance diet
• Experiences with food that may lead to obesity.

ELIMINATION
• Utilizing positive approaches for elimination
problems

•
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

PLAY AND SOCIAL INTERACTIONS

• Providing opportunities for a variety of

organize group activities

• Accepting realistic expectations of child’s

abilities
 SCHOOL-AGE CHILDREN (6 TO 12 YEARS)

• Acting as role models in acceptance of other

persons who may be different.

• Providing a home environment that limits TV

viewing and video games and

• encourages completion of homework and

healthy exercise
THANK YOU FOR YOUR TIME

04/28/25 290