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In normal cephalocaudal growth,
the child gains control of the head and neck before the trunk and limbs
In normal proximodistal growth
the child controls arm movements before hand movements.
For example, the child reaches for objects before being able to grasp them
Psychoanalytic approach; looks at sexual energy and ways people learn to control impulses
psychosocial approach looks at 8 stages throughout lifespan that each have crisis
cognitive theorist looks at intellectual development – how children learn as they grow
examined children’s moral development as they develop, based on Piaget’s stages;
oral – pleasure derives from mouth
Freud - Infants
the baby obtains pleasure and comfort through mouth.
When a baby is NPO, offer a pacifier if not contraindicated. Alter painful procedures, offer a baby a bottle or pacifier or have the mother breast feed
sensorimotor; 6 substages
–object permanence and “stranger anxiety”
Piaget - Infant
The baby learns from movement and sensory input
Use crib mobiles, manipulative toys, wall murals, and bright colors to provide interesting stimuli and comfort.Use toys to distract the baby during procedures and assessments
trust vs. mistrust
Erikson - Infant
The baby establishes a sense of trust when when basic needs are met
Hold the hospitalized baby often.Offer comfort after painful procedures. meet the baby's needs for food and hygiene.Encourage parents to room in .Manage pain effectively with use of pain medications and other measures.
- not much knowledge of body !
- reaction to illness: separation anxiety- protest, despair, detachment (denial)
Freud on toddlers?
anal learns control over body functions
- Ask about toilet training and the child's rituals and words for elimination during the admission history
- continue the child's normal patterns of elimination in the hospital
- do not begin toilet training during illness or hospitalization
- accept regression in toileting during illness or hospitalization
- have potty chairs available in the hospital and childcare centers
Piaget on toddlers?
- pre-operational – egocentrism,
- transductive reasoning, magical thinking
- Sensorimotor stage (end); preoperational stage ( beggining)
- The child shows increasing curiosity and explorative behavior
- language skills improve
- name objects and give explanations to the child
Erikson on toddlers?
autonomy vs. shame and doubt
Knowledge of body: maybe body parts
Reaction to illness: separation anxiety ( same as infant)
- Nursing implications:
- allow self feeding opportunities
- encourage the child to remove and put on own clothes, brush teeth, or assist with hygiene
- if restraint for a procedure is necessary, proceed quickly providing explanations and comfort
- ensure safe surroundings to allow opportunities to manipulate objects
- name objects and give explations
Freud On pre-schoolers?
phallic – focus on genitalia and differences between girls and boys
The child initially identifies with the parent of the opposite sex but by the end of this stage has identified with the same sex parent.
- Nursing implications:
- Be alert for children who appear more comfortable with male or female nurses, and attempt to accommodate them. Encourage parental involvement in care
Piaget on preschoolers?
- egocentrism, transductive reasoning, magical thinking
Preoperational stage: the child is increasingly verbal but has some limitations in thought process. causality is often confused, so the child may feel responsible for causing an illness
- Nursing implications:
- assess children's concerns as expressed through their drawings.
- accept the child's choices and expressions of feelings.
- offer explanations about all procedures and treatments
- clearly explain that the child is not responsible for causing illness
Erikson on preschoolers
initiative vs. guilt: child likes to initiate play activities
- Knowledge of body: very primitive ideas
- Reaction to illness: fear of mutilation
- plan for playtime and offer variety of materials from which to choose
- offer medical equipment for play to lessen anxiety about strange objects
Freud on school age
- latency - quieter sexual stage
- child places importance on privacy and understanding the body
- Provide gowns. covers, and underwear
- knock on door before entering
- explain treatments and procedures
Piaget on school age?
concrete operations - accurate understanding of cause and effect; can follow rules, can see another’s point to view
Child is capable of mature thought when allowed to manipulate and see objects
- Give clear instructions about details of treatment
- show equipment that will be used in treatment
Erikson on school age?
Industry VS inferiority: the child gains a sense of self-worth from involvement of activities.
- encourage the child to continue with school work while hospitalized
- encourage the child to bring fav pastimes to the hospital
- help the child adjust to the limitations on fav activities
- Knowledge of body: may know a lot
- Reaction to illness: punishment for previous bad behavior
Freud on adolescent
genital – growth to sexual maturity, relationships
- Ensure access to gynecologic care for adolescent girls
- provide information on sexuality
- ensure privacy during health care
- have brochures and videos available for teaching about sexuality
Piaget on adolescents?
- formal operations – ability to think abstractly, can reason and consider outcomes
- capable of mature abstract thought
- give clear and complete information about health care and treatments
- offer both written and verbal instructions
- continue to provide education about disease to the adolescent with a chronic illness, as mature thought now leads to greater understanding
Erikson on adolescents?
identity vs. role confusion: the adolescent's search for self-identity leads to independence from parents and reliance on peers
- take the health history and perform examinations w/o parents present
- introduce the adolescent to other teens with the same health condition
Knowledge of body: may know more than you!
Reaction to illness: concern about body image