CHAPTER 10. Human Growth and Development
Donna M. Defazio Quinn
OBJECTIVES
At the conclusion of this chapter, the reader should be able to:
1. Define growth and development.
2. Identify the stages of growth and development.
3. Compare Freud’s theory of psychosocial development with Erikson’s psychosocial stages.
4. List Piaget’s four stages of cognitive development.
5. Explain the five stages of language development.
6. Describe the effects of positive influence on the development of self-esteem.
7. Identify eight factors that could influence growth and development.
I. OVERVIEW OF GROWTH AND DEVELOPMENT
A. Definition
1. Growth and development
a. Often used interchangeably
b. Each has distinct definition
2. Growth
a. Implies a change in quantity (quantitative change)
(1) An increase in physical size of a whole or any of its parts
(2) Can be measured in:
(a) Inches, centimeters (height)
(b) Kilograms, pounds (increased organ mass, weight)
(c) Numbers (increased vocabulary, increased number of relationships with others, increased number of physical skills that can be performed)
b. Increase in number and size of cells
(1) Reflected in an increase in the size and weight of the whole or any of its parts
3. Development
a. A complex concept not easily measured or studied
b. Gradual growth and expansion; viewed as a qualitative change
(1) Increased function (skill) and complexity (capacity)
(2) Occurs through growth, maturation, and learning
c. Move from lower case to a more advanced stage of complexity
(1) Continuous, orderly series of conditions
(2) Leads to activities, new motives for activities, and eventual patterns of behavior
(3) Expansion of capabilities to provide greater facility in functioning
d. Developmental process
(1) Continuous, complex, and irreversible
(2) Involves aging
(a) Most rapid during fetal stage
(b) Is a lifelong process
e. Progression of development
(1) Simple to complex
(a) Infant’s vocalizations before speech refinement
(2) Sequence of changes leading to particular attainments
(3) General to specific
(a) Infant’s palmar grasp before acquiring finer control of pincer grasp
(4) From head to toe (cephalocaudally)
(a) Infant gains head and neck control before gaining control of trunk and limbs.
(5) From inner to outer (proximodistally)
(a) Control of near structures before control of structures farther away from the body center
(b) Infant coordinates arms to reach before gaining hand and finger coordination.
f. Predictability of development
(1) Sequence of development is invariable.
(2) Precise age will vary.
(3) Wide normal range allows for individual variances.
g. Uniqueness of development
(1) Each child has own genetic potential for growth and development.
(2) May be deterred or modified at any stage
II. FACTORS INFLUENCING GROWTH AND DEVELOPMENT
A. Genetics (heredity)
1. Inherent characteristics influence development.
a. Sex of child directs pattern of growth and behavior of others toward child.
b. Physical characteristics are inherited.
(1) Can influence how child grows and interacts with environment
B. Gender
1. Sex differences that influence behaviors in childhood
a. Boys
(1) More aggressive physically
(2) Engage in rough and tumble play
(3) Aggressive fantasies
(4) Competitive behavior more common
(5) Difficulty sitting still
(6) Engage in more exploratory behavior
(7) High activity level in presence of other boys
(8) Greater impulsiveness
(9) Subject to distraction
(10) More extensive sphere of relationships
(11) Highly oriented toward peer groups
(12) Congregate in large groups
(13) View themselves as more powerful and with more control over events
(14) Respond to a challenge, especially when it appeals to their ego or competitive feelings
b. Girls
(1) More aggressive verbally
(2) More likely to associate in pairs or small groups
(3) Involved in more intense relationships with a few close friends
(4) More concerned with the welfare of the group
(5) More apt to compromise in situations involving conflict
(6) May be superior regarding motivation to achieve
(7) More likely to comply to adult commands
(8) More nurturing or helping behavior
C. Environment
1. Before birth
a. Prenatal factors
(1) Maternal disease (diabetes)
(2) Alcohol intake
(a) Exhibit prenatal and postnatal growth deficiencies in height and weight
(b) May produce significant central nervous system alterations that may not be evident until the child is older
(3) Fetal exposure to drugs such as marijuana, cocaine, and heroin
(a) Associated with intrauterine growth retardation and prematurity
(4) Smoking may produce smaller infant.
b. Socioeconomic status
D. Culture
1. Includes habits, beliefs, language, values, ethnicity, demographic setting, socioeconomic class, parental occupation, and family structure
a. Attitude and expectations differ with respect to the sex of the child.
E. Lifestyle
1. Different family structures
a. Two parents
b. One parent
c. Extended family
d. Other variations
2. Family relationships a major determinant of how children grow and progress
F. Nutrition
1. Single most important influence on growth
2. Satisfactory nutrition closely related to good health throughout lifetime
3. Malnutrition
a. Defined as undernutrition, primarily resulting from insufficient calorie intake
b. Need a continuous supply of nutrients
c. Poor nutrition may have negative influence on development from time of implantation of ovum until birth
d. Severe maternal malnutrition associated with permanent reduction in total number of fetal brain cells
(1) Has critical effect on child’s intellectual functioning
e. Malnutrition may result from:
(1) Inadequate dietary intake
(a) Quality
(b) Quantity
(2) Disease that interferes with:
(a) Appetite
(b) Digestion
(c) Absorption
(3) Excessive physical activity
(4) Inadequate rest
(5) Disturbed interpersonal relationships
(6) Other environmental or psychological factors
G. Health status
1. Diseases that affect growth and development
a. Skeletal (dwarfism)
b. Chromosome anomalies (Turner syndrome)
c. Disorders of metabolism
(1) Vitamin D–resistant rickets
(2) Mucopolysaccharidoses
(3) Endocrine disorders
d. Klinefelter syndrome and Marfan syndrome
e. Chronic illness
f. Congenital cardiac anomalies
g. Respiratory disorders
(1) Cystic fibrosis
h. Digestive malabsorptive syndromes
i. Defects in digestive enzyme systems
j. Metabolic diseases
H. Neuroendocrine
1. Possible relationship exists between hypothalamus and endocrine system that influences growth.
2. Peripheral nervous system may influence growth.
a. Muscles deprived of nerve supply degenerate.
3. All hormones affect growth in some manner.
a. Growth hormone, thyroid hormone, and androgens given to a person deficient in these hormones
(1) Stimulates protein anabolism
(2) Produces retention of elements essential for building protoplasm and bony tissue
I. Play
1. Activity with meaning and purpose
2. May be directly related to expanding:
a. Social development
b. Intellectual development
c. Motor development
d. Language development
3. Play used to accomplish developmental tasks and master the environment
J. School
1. Contributes to development in the form of:
a. Skill training
b. Cultural transmission
c. Self-actualization
K. Neighborhood
1. Offers child opportunity to experience world outside the home
a. Accepting
b. Supportive of child’s physical and psychosocial needs
c. Reinforcing of child’s self-confidence and safety
L. Season, climate, and oxygen concentration
1. Some evidence that:
a. Growth in height faster in spring and summer months
b. Growth in weight more rapid in autumn and winter
2. Effects of hypoxia on growth
a. Children with disorders that produce chronic hypoxia characteristically smaller than same children of chronological age
b. Children native to high altitudes smaller than children of lower altitudes
M. Stress
1. Abnormal conditions that tend to disrupt normal functions of the body or mind
2. Imbalance between environmental demands and coping resources
3. Some children more vulnerable than others
a. Affected by age, temperament, life situation, and state of health
b. Response can be behavioral, physiological, or psychological
4. Methods of coping
a. Respond by trying to change the circumstance (primary control coping)
(1) Tantrums
(2) Aggressive behavior
b. Trying to adjust to circumstances (secondary control coping)
(1) Withdrawal
(2) Submission
5. Fear
a. Emotional reaction to a specific real or unreal threat or danger
(1) Child perceives threat
(a) Person
(b) Animal
(c) Situation
(2) Perceives threat to be stronger than himself or herself and capable of harm
b. Alleviate fear by:
(1) Presence of adult who will offer protection
(2) Becoming familiar with source of threat (animal)
N. Media
1. Television
a. Pervasive force
b. Primary source of socialization in children
c. Major source of information
(1) Unhealthy messages regarding sex and violence
(2) Alcohol consumption synonymous with having a good time
(3) Food products promoting unhealthy nutritional practices
2. Internet
a. Instantaneous access to unlimited material; informative and detrimental
b. Potential exposure to illegal activities
(1) Parental controls need to be in place to limit Internet access to age-appropriate sites.
3. Reading materials
a. Books, newspapers, magazines
(1) Provide enjoyment
(2) Increase child’s knowledge
4. Movies
a. Not closely associated with reality
b. Usually provide opportunity for desirable social learning
c. Child may be unable to distinguish between reality and fantasy.
(1) Results in fears
5. Cell phone
a. Continuous contact with others
(1) Parents
(2) Friends
O. Responsible adults
1. Can influence positive choices (life decisions, media, social, etc.)
2. Interact with child to identify right from wrong
III. STAGES OF GROWTH AND DEVELOPMENT (Box 10-1)
A. Prenatal
1. Period of life from conception to birth
a. Crucial period in developmental process
b. Health and well-being of the infant directly related to adequate prenatal care
c. Direct relationship between maternal health and certain manifestations in the newborn
B. Newborn or neonatal
1. From birth through the first month of life
2. Major physical adjustment to extrauterine existence
C. Infancy
1. Begins at end of first month of life and ends at 1 year of age
2. Period of rapid motor, cognitive, and social development
3. Establishes basic trust
a. Foundation for future relationships
D. Early childhood (Box 10-2)
1. Toddler
a. From 1 to 3 years
2. Preschool
a. From 3 to 6 years
3. Characteristics of early childhood
a. Intense activity and discovery
b. Marked physical and personality development
c. Motor development advances steadily.
d. Acquire language skills.
e. Expand social relationships.
f. Learn role standards.
g. Gain self-control and mastery.
h. Develop increasing awareness of dependence and independence.
i. Begin to develop self-concept.
BOX 10-2
EMERGING PATTERNS OF BEHAVIOR FROM 1 TO 5 YEARS OF AGE*
15 Months
Motor: Walks alone; crawls up stairs
Adaptive: Makes a tower of three cubes; makes a line with crayon; inserts raisin in bottle
Language: Jargon; follows simple commands; may name a familiar object (e.g., ball)
Social: Indicates some desire or needs by pointing; hugs parents
18 Months
Motor: Runs stiffly; sits on small chair; walks up stairs with one hand held; explores drawers and wastebaskets
Adaptive: Makes a tower of four cubes; imitates scribbling; imitates vertical stroke; dumps raisin from bottle
Language: Ten words (average); names pictures; identifies one or more parts of body
Social: Feeds self, seeks help when in trouble; may complain when wet or soiled; kisses parents with pucker
24 Months
Motor: Runs well; walks up and down stairs, one step at a time; opens doors; climbs on furniture; jumps
Adaptive: Tower of seven cubes (6 at 21 months); scribbles in circular pattern; imitates horizontal stroke; folds paper once imitatively
Language: Puts three words together (subject, verb, object)
Social: Handles spoon well; often tells immediate experiences; helps to undress; listens to stories when shown pictures
30 Months
Motor: Goes up stairs alternating feet
Adaptive: Tower of nine cubes; makes vertical and horizontal strokes, but generally will not join them to make a cross; imitates circular stroke, forming closed figure
Language: Refers to self by pronoun “I”; knows full name
Social: Helps put things away; pretends in play
36 Months
Motor: Rides tricycle; stands momentarily on one foot
Adaptive: Tower of ten cubes; imitates construction of “bridge” of three cubes; copies circle; imitates cross
Language: Knows age and sex; counts three objects correctly; repeats three numbers or a sentence of six syllables
Social: Plays simple games (in “parallel” with other children); helps in dressing (unbuttons clothing and puts on shoes); washes hands
48 Months
Motor: Hops on one foot; throws ball overhand; uses scissors to cut out pictures; climbs well
Adaptive: Copies bridge from model; imitates construction of “gate” of five cubes; copies cross and square; draws man with two to four parts besides head; identifies longer of two lines
Language: Counts four pennies accurately; tells a story
Social: Plays with several children with beginning of social interaction and role-playing; goes to toilet alone
60 Months
Motor: Skips
Adaptive: Draws triangle from copy; names heavier of two weights
Language: Names four colors; repeats sentence of ten syllables; counts ten pennies correctly
Social: Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing
From Kliegman RM, Behrman RE, Jenson HB, et al: Nelson textbook of pediatrics, ed 18, Philadelphia, 2007, Saunders.
E. Middle childhood or school-age years
1. From age 6 to 11 or 12 years
2. Child is directed away from family group and centered around peer relationships.
3. Steady advancement in physical, mental, and social development
4. Emphasis on developing skill competencies
5. Social cooperation and moral development take on importance.
a. Relevant for later life stages
6. Critical period in the development of self-concept
F. Later childhood or adolescence and young adulthood
1. From the beginning of the 12th year to the end of the 21st year
2. Period of rapid maturation and change
3. Considered to be a transition that begins with the onset of puberty and extends to the point of entry into the adult world
4. Biological and personality maturation accompanied by physical and emotional turmoil
5. Self-concept redefined
6. In late adolescence, the child begins to internalize all previously learned values and focus on an individual rather than a group identity.
BOX 10-1
DEVELOPMENTAL AGE PERIODS
Prenatal Period: Conception to Birth
Germinal: Conception to approximately 2 weeks
Embryonic: 2 to 8 weeks
Fetal: 8 to 40 weeks (birth)
A rapid growth rate and total dependency make this one of the most crucial periods in the developmental process. The relationship between maternal health and certain manifestations in the newborn emphasizes the importance of adequate prenatal care to the health and well-being of the infant.
Infancy Period: Birth to 12 Months
Neonatal: Birth to 27 to 28 days
Infancy: 1 to approximately 12 months
The infancy period is one of rapid motor, cognitive, and social development. Through mutuality with the caregiver (parent), the infant establishes a basic trust in the world and the foundation for future interpersonal relationships. The critical first month of life, although part of the infancy period, is often differentiated from the remainder because of the major physical adjustments to extrauterine existence and the psychological adjustment of the parent.
Early Childhood: 1 to 6 Years
Toddler: 1 to 3 years
Preschool: 3 to 6 years
This period, which extends from the time the children attain upright locomotion until they enter school, is characterized by intense activity and discovery. It is a time of marked physical and personality development. Motor development advances steadily. Children at this age acquire language and wider social relationships, learn role standards, gain self-control and mastery, develop increasing awareness of dependence and independence, and begin to develop a self-concept.
Middle Childhood: 6 to 11 or 12 Years
Frequently referred to as the “school age,” this period of development is one in which the child is directed away from the family group and centered around the wider world of peer relationships. There is steady advancement in physical, mental, and social development, with emphasis on developing skill competencies. Social cooperation and early moral development take on more importance with relevance for later life stages. This is a critical period in the development of the self-concept.
Later Childhood: 11 to 19 Years
Prepubertal: 10 to 13 years
Adolescence: 13 to approximately 18 years
The tumultuous period of rapid maturation and change known as adolescence is considered to be a transitional period that begins at the onset of puberty and extends to the point of entry into the adult world—usually high school graduation. Biological and personality maturation are accompanied by physical and emotional turmoil, and there is redefining of the self-concept. In the late adolescent period, the young person begins to internalize all previously learned values to focus on an individual, rather than a group, identity.
From Hockenberry MJ: Wong’s essentials of pediatric nursing, ed 8, St Louis, 2009, Mosby.
IV. ASSESSMENT OF GROWTH AND DEVELOPMENT
A. Assessment of growth
1. Obtain accurate assessments at regular intervals.
2. Record and plot data on growth charts.
a. Allows for comparison with statistical norms
3. Assessments include:
a. Height
b. Weight
c. Head circumference
d. Body mass index
B. Assessment of development
1. Complex process
2. Gather data from many sources.
a. Observations
(1) Activities of daily living (eating, playing, dressing)
(2) Communication patterns
(3) Interaction skills
(4) Emotional responses
b. Interviews
c. Physical exams
d. Interactions with child and parents
V. THEORIES OF DEVELOPMENT—OVERVIEW (Table 10-1)
A. Freudian
1. Psychosocial
2. Emphasis on development of personality
B. Erikson
1. Psychosocial development
C. Piaget
1. Cognitive development
D. Kohlberg
1. Moral development
E. Sullivan
1. Interpersonal development
F. Skinner, Watson
1. Learning theory; behaviorism.
2. Focus entirely on behavior.
3. Internalize processes such as thoughts and feelings.
G. Maslow
1. Humanistic
2. Focus on characteristics that contribute to healthy personality development.
| Stage/ Age | Psychosexual Stages (Freud) | Psychosocial Stages (Erikson) | Cognitive Stages (Piaget) | Moral Judgment Stages (Kohlberg) |
|---|---|---|---|---|
|
I. Infancy (Birth–1 year)
|
Oral-sensory | Trust vs mistrust | Sensorimotor (birth–2 years) | |
|
II. Toddlerhood (1–3 years)
|
Anal-urethral | Autonomy vs shame and doubt | Preoperational thought, preconceptual phase (transductive reasoning, [e.g., specific to specific]) (2-4 years) |
Preconventional (premoral) level
Punishment and obedience orientation
|
|
III. Early childhood (3–6 years)
|
Phallic- locomotion | Initiative vs guilt | Preoperational thought, intuitive phase (transductive reasoning) (4-7 years) |
Preconventional (premoral) level
Naïve instrumental orientation
|
|
IV. Middle childhood (6–12 years)
|
Latency | Industry vs inferiority | Concrete operations (inductive reasoning and beginning logic) (7-11 years) |
Conventional level
Good-boy, nice-girl orientation Law-and-order orientation
|
|
V. Adolescence (12–18 years)
|
Genitality | Identity and repudiation vs identity confusion | Formal operations (deductive and abstract reasoning) (11-15 years) |
Postconventional or principled level
Social-contract orientation
Universal ethical principle orientation (no longer included in revised theory)
|
VI. FREUDIAN (Table 10-2)
A. Three components of personality
1. Id
a. Develops during birth
b. The unconscious mind
c. Inborn component that drives instincts
d. Obeys pleasure principle of immediate gratification of needs
(1) Raw libido seeking pleasure
2. Ego
a. Develops during toddler years
b. Represents the conscious mind
(1) Reality component
(2) Mediates conflict
c. Functions as conscious or controlling self
d. Finds realistic means of gratifying instincts
e. Blocks irrational thinking of the Id
3. Superego
a. Develops during preschool years
b. Conscience
c. Functions as moral arbitrator
(1) Puts good or bad labels on behavior
d. Represents the ideal
e. Prevents individual from expressing undesirable instincts that could threaten social order
B. Psychosexual development (Table 10-3)
1. Stages of development
a. Oral
b. Anal
c. Phallic
d. Latency
e. Genital
2. Sexual instincts significant in development of personality
3. Psychosexual used to describe any sensual pleasure
4. Theory focuses on desire to satisfy biological needs.
a. Theory difficult to verify
b. Of little value when attempting to predict future behaviors
c. Psychosexual development usually complete by 6 years of age
| Stage | Age | Source of Pleasure | Personality Traits |
|---|---|---|---|
| Oral | Birth to 1 year |
Oral activities
Sucking
Biting
Chewing
Vocalizing
|
Pessimism or optimism
Determination or submission
Gullibility or suspiciousness
Admiration or envy
Cockiness or self-belittlement
|
| Anal | 1 to 3 years |
Anal region
Withhold or expel feces
|
Stinginess or overgenerosity
Constrictedness or expansiveness
Rigid punctuality or tardiness
Stubbornness or acquiescence
Orderliness or messiness
|
| Phallic | 3 to 6 years | Genitals |
Brashness or bashfulness
Stylishness or plainness
Gaiety or sadness
Blind courage or timidness
Gregariousness or isolationism
|
C. Oral stage
1. Birth to 1 year of age
2. Sources of pleasure
a. Sucking
b. Biting
c. Chewing
d. Vocalizing
3. Oral personality traits
a. If met, child develops positive personality traits; if need is not met, child develops negative personality traits.
(1) Pessimism or optimism
(2) Determination or submission
(3) Gullibility or suspiciousness
(4) Admiration or envy
(5) Cockiness or self-belittlement
D. Anal stage
1. One to 3 years of age
2. Focus on anal region
3. Child develops ability to withhold or expel feces at will.
4. Toilet training can have lasting effects on personality development.
5. Anal personality traits
a. Stinginess or overgenerosity
b. Constrictedness or expansiveness
c. Rigid punctuality or tardiness
d. Stubbornness or acquiescence
e. Orderliness or messiness
E. Phallic stage
1. Three to 6 years of age
2. Focus on genitals
3. Recognition of difference between sexes
4. Phallic personality traits
a. Brashness or bashfulness
b. Stylishness or plainness
c. Gaiety or sadness
d. Blind courage or timidness
e. Gregariousness or isolationism
F. Latency period
1. Six to 12 years of age
2. Elaboration of previous learned traits and skills
3. Physical and psychic energies funneled into acquiring knowledge of vigorous play
G. Genital stage
1. Twelve years and over
2. Begins at puberty
3. Genital organs a major source of sexual tensions and pleasures
4. Energy used to form friendships and prepare for marriage
H. Nursing implications of Freud’s theory
1. Children and parents may have many questions concerning:
a. Normal sexual development
b. Sex education
2. Nurses must understand normal sexual growth and development.
a. Assist children and parents to form healthy attitudes about sex.
| Piaget’s Periods of Cognitive Development | Freud’s Stages of Psychosexual Development | Erikson’s Stages of Psychosocial Development | Kohlberg’s Stages of Moral Development | |
|---|---|---|---|---|
| Infancy |
Period 1 (birth-2 yr): Sensorimotor period
Reflexive behavior is used to adapt to environment; egocentric view of the world; development of object permanence
|
Oral stage
Mouth is a sensory organ; infant takes in and explores during oral passive substage (first half of infancy); infant strikes out with teeth during oral aggressive substage (latter half of infancy).
|
Trust vs mistrust
Development of a sense that the self is good when consistent, predictable, reliable care is received; characterized by hope.
|
Premorality or preconventional morality, stage 0 (0-2 yr): Naiveté and egocentrism
No moral sensitivity; decisions are made on the basis of what pleases the child; infants like or love what helps them and dislike what hurts them; no awareness of the effect of their actions on others. “Good is what I like and want.”
|
| Toddlerhood |
Period 2 (2-7 yr): Preoperational thought
Thinking remains egocentric, becomes magical, and is dominated by perception.
|
Anal stage
Major focus of sexual interest is anus; control of body functions is major feature.
|
Autonomy vs shame and doubt
Development of sense of control over the self and body functions; exerts self; characterized by will
|
Premorality or preconventional morality, stage 1 (2-3 yr): Punishment-obedience orientation
Right or wrong is determined by physical consequences: “If I get caught and punished for doing it, it is wrong. If I am not caught or punished, then it must be right.”
|
| Preschool age |
Phallic or Oedipal/Electra stage
Genitals become focus of sexual curiosity; superego (conscience) develops; feelings of guilt emerge.
|
Initiative vs guilt
Development of a can-do attitude about the self; behavior becomes goal-directed, competitive, and imaginative; initiation into gender role; characterized by purpose
|
Premorality or preconventional morality, stage 2 (4-7 yr):
Instrumental hedonism and concrete reciprocity
Child conforms to rules out of self-interest: “I’ll do this for you if you do this for me”; behavior is guided by an “eye for an eye” orientation. “If you do something bad to me, then it’s OK if I do something bad to you.”
|
|
| School age |
Period 3 (7-11 yr): Concrete operations
Thinking becomes more systematic and logical, but concrete objects and activities are needed.
|
Latency stage
Sexual feelings are firmly repressed by the superego; period of relative calm
|
Industry vs inferiority
Mastering of useful skills and tools of the culture; learning how to play and work with peers; characterized by competence
|
Morality of conventional role conformity, stage 3 (7-10 yr): Good-boy or good-girl orientation
Morality is based on avoiding disapproval or disturbing the conscience; child is becoming socially sensitive. Kohlberg’s stages of moral development
Morality of conventional role conformity, stage 4 (begins at about 10-12 yr): Law and order orientation
Right takes on a religious or metaphysical quality.
Child wants to show respect for authority, and maintain social order; obeys rules for their own sake.
|
| Adolescence |
Period 4 (11 yr to adulthood): Formal operations
New ideas can be created; situations can be analyzed; use of abstract and futuristic thinking; understands logical sequences of behavior
|
Puberty or genital stage
Stimulated by increasing hormone levels; sexual energy wells up in full force, resulting in personal and family turmoil
|
Identity vs role confusion
Begins to develop a sense of “I”; this process is lifelong; peers become of paramount importance; child gains independence from parents; characterized by faith in self
|
Morality of self-accepted moral principles, stage 5: Social contract orientation
Right is determined by what is best for the majority; exceptions to rules can be made if person’s welfare is violated; the end no longer justifies the means; laws are for mutual good and mutual cooperation.
|
| Adulthood |
Intimacy vs isolation
Development of the ability to lose the self in genuine mutuality with another Characterized by love
|
|||
|
Generativity vs stagnation
Production of ideas and materials through work; creation of children; characterized by care
|
Morality of self-accepted moral principles
Stage 6: Personal principle orientation
Achieved only by the morally mature individual; few people reach this level; these people do what they think is right, regardless of others’ opinions, legal sanctions, or personal sacrifice; actions are guided by internal standards; integrity is of utmost importance; may be willing to die for their beliefs
|
|||
|
Ego integrity vs despair
Realization that there is order and purpose to life; characterized by wisdom
|
Morality of self-accepted moral principles
Stage 7: Universal principle orientation
This stage is achieved by only a rare few; Mother Theresa, Gandhi, and Socrates are examples; these individuals transcend the teachings of organized religion and perceive themselves as part of the cosmic order, understand the reason for their existence, and live for their beliefs.
|
VII. ERIKSON (see Table 10-2)
A. Theory of psychosocial development most widely used
1. Outlines a sequence of phases of psychosocial development
2. Provides a theoretic basis for much of the emotional care that is given to children
B. Emphasis on healthy personality rather than pathological approach
1. Stresses rational and adaptive natures of individual
2. Explains child’s behaviors in mastering developmental tasks
C. Eight stages of development
1. Each stage has two components—favorable and unfavorable aspect of conflict.
2. Progression to next stage depends on resolution of conflict.
3. Conflict never mastered completely—remains a recurrent problem throughout life.
D. Trust versus mistrust stage (stage I)
1. Birth to 1 year of age
2. “Getting” and “taking in” from all the senses
3. Exists only in relation to something or someone
4. Consistent, loving care by mother essential to development of trust
5. Mistrust develops when:
a. Trust-promoting activities absent
b. Basic needs inconsistently or inadequately met
6. Individual develops quality of hope and belief that one can attain deep and essential wishes.
a. Results in faith and optimism
E. Autonomy versus shame and doubt (stage II)
1. One to 3 years of age
2. Development centered on child’s ability to control his or her body, himself or herself, and the environment
3. Uses his or her power to do things independently
a. Walking
b. Climbing
c. Selection and decision-making
4. Learns to conform to social rules
5. Doubt and shame arise when:
a. Child made to feel unimportant or self-conscious
b. Choices are disastrous
c. Shamed by others
d. Forced to be independent when he or she is capable of assuming control
6. Achieves autonomy through imitation
a. Parents are key socializing intermediaries.
b. Results in self-control and willpower
F. Initiative versus guilt stage (stage III)
1. Three to 6 years of age
2. Characterized by vigorous, intrusive behavior and a strong imagination
3. Explores physical world with all senses
4. Develops a conscience
5. Responds to an inner voice that warns and threatens
6. Guilt arises when:
a. Child undertakes goals or activities that are in conflict with those of parent
b. Made to feel activities are bad
7. Achieves initiative through identification
a. Family is key socializing agent.
b. Results in direction and purpose; ability to imagine and pursue
G. Industry versus inferiority stage (stage IV)
1. Six to 12 years of age
2. Carries tasks and activities through to completion
3. Learns to compete and cooperate with others
4. Learns rules
5. Successful child develops a sense of mastery and self-assurance.
6. Inferiority develops when:
a. Too much is expected of child
b. Child believes he or she cannot meet standards set for him or her by others.
7. Achieves industry through education
a. Teachers and peers are socializing agents.
b. Develops competence, skill, and intelligence to complete task
H. Identity versus role confusion stage (stage V)
1. Twelve to 18 years of age
2. Characterized by marked physical changes
3. Engrossed in how he or she appears to others as compared with his or her own self-concept
4. Struggle with:
a. Ability to maintain current role and future role as defined by peers
b. Integrating concepts and values with those of society
c. Decision for an occupation
5. Role confusion develops when unable to resolve core conflicts.
6. Mastering identity results in devotion and fidelity.
7. Achieves identity through peer pressure and role experimentation
I. Intimacy versus isolation stage (stage VI)
1. Occurs in early adulthood
2. Intimacy established on a sense of identity
3. Capacity to develop:
a. An intimate love relationship
b. Intimate interpersonal relationships with friends, partners, and significant others
4. Isolation develops when intimacy not present.
5. Intimacy develops when there is mutuality among peers.
6. Key socializing agents
a. Lovers
b. Spouses
c. Close friends
7. Develops affiliation and love
J. Generativity versus stagnation stage (stage VII)
1. Young and middle adulthood
2. Creation and care of next generation
3. Essential element is to nourish and nurture.
4. Failure results in self-absorption and stagnation.
5. Key socializing agents are spouse, children, and cultural norms.
a. Results in production and care; commitment and concern for what has been generated
K. Ego integrity versus despair stage (stage VIII)
1. Old age
2. Results from satisfaction with life and acceptance of what has been
3. Despair is a result of remorse for what might have been.
4. Ego integrity results in renunciation and wisdom and concern with life in the face of death.
5. Process achieved through introspection.
VIII. PIAGET: COGNITIVE DEVELOPMENT (see Table 10-2)
A. Provides a basis for learning about and understanding cognitive development
1. Believes learning should be geared to the child’s level of understanding and that the child should be an active participant in the learning process
2. Cognitive development is a process by which developing individuals become acquainted with the world and objects it contains.
a. Allows child ability to:
(1) Reason abstractly
(2) Think in a logical manner
(3) Organize intellectual functions into higher structures
B. Sequence of four stages of intellectual development (sensorimotor, preparational, concrete operational, formal operational)
1. Prior practice or teaching has little effect on development of new cognitive skills.
2. Suitable cognitive maturity or readiness necessary to progress to next stage
C. Sensorimotor (stage I)
1. Birth to 2 years of age
2. Consists of substages that are governed by sensations through which simple learning takes place
3. Progresses from simple reflex activities to simple repetitive behaviors that imitate behaviors
4. Develops sense of cause and effect
a. Directs behavior toward object
b. Solves problems through trial and error
c. High level of curiosity
d. Develops sense of self through interactions with environment
(1) Able to differentiate self from environment
5. Awareness that object has permanence
a. Important prerequisite for all other mental activity
D. Preoperational (stage II)
1. Two to 7 years of age
2. Egocentricity is predominant characteristic.
a. Defined as inability to put oneself in place of another
3. Interprets objects and events in terms of their relationship or use of them
4. Sees only his or her perspective
a. Cannot see another’s point of view
5. Preoperational thinking is concrete and tangible.
6. Lacks ability to make deductions or generalizations
7. Thoughts dominated by what he or she sees, hears, and experiences
8. Increasing ability to use language to represent objects in his or her environment
9. Increasing ability to elaborate on concepts and make simple associations between ideas
10. Cannot understand that for every action or operation, there is an action or operation that cancels it
11. Develops intuitive reasoning later in stage
12. Begins to understand weight, length, size, and time
E. Concrete operational (stage III)
1. Seven to 11 years of age
2. Thoughts become more logical and coherent.
3. Able to problem solve
4. Classifies, sorts, orders, and organizes facts
5. Able to deal with a number of different aspects of a situation simultaneously
6. Unable to deal with abstract
7. Problem solves in concrete, systematic fashion, based on what he or she can perceive
8. Thoughts become less self-centered
9. Can consider points of view other than his or her own
10. Develops socialized thinking
F. Formal operational (stage IV)
1. Twelve to 15 years of age
2. Characterized by adaptability and flexibility
3. Can think in terms of the abstract
4. Able to draw conclusions from a set of observations
5. Can make and test hypotheses
6. May confuse the ideal with the practice
IX. KOHLBERG: MORAL DEVELOPMENT (see Table 10-2)
A. Based on cognitive development theory
1. Provides anticipatory guidance to parents about expectations and discipline of children
B. Proceeds in an invariant sequence of six stages
C. Cannot acquire higher levels of moral reasoning until appropriate cognitive development has occurred
D. Preconventional level of morality
1. Morality is external.
a. Children conform to rules imposed by adults.
2. Stage 1—the punishment and obedience orientation (age 2-3 years)
a. Child determines whether action good or bad based on consequences
b. Obeys those in power
c. Avoids punishment
d. Possesses no concept of the underlying moral order
3. Stage 2—the instrumental relativist orientation (age 4-7 years)
a. The right behavior is that which satisfies the child’s own needs.
b. Possesses elements of fairness, reciprocity, and equal sharing
c. Do not possess elements of loyalty, gratitude, or justice
E. Conventional level
1. Child concerned with:
a. Conformity and loyalty
b. Maintaining, supporting, and justifying the social order
c. Personal expectations of those significant to him or her
2. Child values maintenance of family regardless of consequences.
3. Stage 3—the interpersonal concordance or “good boy–nice girl” orientation (age 7-10 years)
a. Behavior that meets approval of others viewed as good
b. Conformity to the norm is the “natural” behavior.
c. Earn approval by being “nice”
4. Stage 4—the “law and order” orientation (age 10-12 years)
a. Correct behavior is:
(1) Obeying rules
(2) Doing one’s duty
(3) Showing respect for authority
(4) Maintaining social order
b. Rules and authority can be social or religious.
F. Postconventional, autonomous, or principled level
1. Child reaches cognitive formal operational stage.
2. Attempts to define moral values and principles
3. Stage 5—the social contract, legalistic orientation (adolescence)
a. Correct behavior defined in terms of general individual rights and standards agreed to by society
b. Emphasis on:
(1) Legal point of view
(2) Possibility of changing law in terms of societal needs and rational considerations
4. Stage 6—universal ethical principles (principles conscience)
a. Moral reasoning based on abstract reasoning
b. Uses universal ethical principles
(1) Action is never a means, but always an end in itself.
c. People rarely if ever reach stage 6.
X. SULLIVAN
A. Interpersonal development
1. Recognizes importance of environment in development
2. Has some predictive value
3. Does not recognize biological maturation process
B. Emphasis on interpersonal relationships and importance of social approval or disapproval in developing a self-concept
1. Unfavorable reactions result in tension and anxiety.
2. Favorable reactions result in comfort and security.
C. Infants
1. Mother gratifies and comforts child.
2. Relationship gradually extends to other family members.
D. Toddler
1. Becomes more outgoing
2. Directs social gestures to wider audience
a. Relatives
b. Neighborhood children
3. Engages in aspects of social learning
a. Peer play
b. Family events
E. School age
1. Wider range of relationships
a. Authority figures at school and in community
2. Develops peer relationships
3. Shares intimacy and common interests with peers
F. Adolescent
1. Personal identity
a. Friends of same sex
b. Friends of opposite sex
XI. SKINNER, WATSON: LEARNING THEORY
A. Learning occurs when behavior changes as a result of experience.
B. Conditioning
1. Learning through association
a. Establishing a connection between a stimulus and a response
2. Operant or instrumental conditioning
a. Involves rewards or reinforcements to encourage specific behaviors
b. Applicable to toddler and preschooler learning
3. Avoidance conditioning
a. Discourages undesirable behaviors through punishment
b. Success depends on child’s subjective assessment of reward or punishment.
C. Child
1. Acquires new behaviors
2. Produces alterations in existing behavior through:
a. Forming associations through conditioning
b. Observing models
3. Behavior is determined (conditioned) by:
a. Environmental events
b. Experiences
c. Consequences
4. Rewarded behaviors are repeated.
5. Punished behaviors are not repeated.
XII. MASLOW: HUMANISTIC THEORY
A. Focuses on attributes or characteristics that contribute to healthy personality development
B. Concerned with uniqueness and potential of individuals
1. Humans motivated by two need systems
a. Basic
(1) Food, water, and shelter
b. Growth needs—internally motivated and reinforced
(1) Beauty
(2) Self-fulfillment
2. Needs arranged in a hierarchy
a. Lower-level needs assume dominance.
b. When one level need is satisfied, the next becomes predominant.
C. Theory does not address developmental stages or shaping of human behaviors.
XIII. BIOLOGICAL GROWTH
A. Age categories
1. Birth to 6 months
2. Six to 12 months
3. Toddlers
4. Preschoolers
5. School-age children
6. Adolescent
7. Adult
B. During childhood, variations in growth of tissues and organs produce changes in body proportions.
C. First year
1. Period of rapid growth
2. Lengthening of trunk
3. Accumulation of subcutaneous fat
D. First year to puberty
1. Legs grow more rapidly.
2. Body becomes slender and elongated.
E. Puberty
1. Feet and hand sizes increase.
a. Appear large in relation to rest of body
b. Source of embarrassment
2. Trunk growth increases.
3. Onset of puberty approximately 2½ years earlier for girls than boys
4. Rapid linear growth followed by lateral growth
5. Child “fills out” during later stages of adolescent growth.
F. Height
1. Occurs as a result of skeletal growth
2. Considered a stable measurement of general growth
3. When maturation of skeleton is complete, linear growth ceases.
G. Weight
1. Weight gain considered indication of satisfactory growth progress in child
2. Variable
3. Subject to numerous intrinsic and extrinsic factors
H. Neurologic growth
1. Rapid brain cell growth from 30 weeks to 1 year of age
2. Growth consists of:
a. Increase in cytoplasm around nuclei of existing cells
b. Increase in number and intricacy of communication with other cells
c. Advancing peripheral axons in relation to expanding body dimensions
3. Brain growth
a. Measured by head circumference
b. Increases six times during first year
4. Lymph tissue
a. Lymph nodes, thymus, spleen, tonsils, adenoids, blood lymphocytes
(1) Increase rapidly
(2) Reach adult dimensions by age 6
(3) Tissue reaches size approximately twice that of adult by age 12.
(a) Rapid decline to stable adult dimension by adolescence
XIV. LANGUAGE DEVELOPMENT
A. Child born with mechanism and capacity to develop speech and language skills
1. Requires intact physiological function of:
a. Respiratory system
b. Speech control center in cerebral cortex
c. Articulation and resonance structures of the mouth and nasal cavity
2. Child also requires:
a. Intact and discriminating auditory apparatus
b. Intelligence
c. A need to communicate
d. Stimulation
B. Components of language
1. Phonology—learned first
a. Basic units of sound that are combined to produce words
2. Semantics of language—learned next
a. Words and sentences convey an expressed meaning.
3. Gain knowledge of syntax
a. The form or structure of language (rules)
4. Pragmatics
a. Principles specifying how language is used in different contexts and situations
C. Stages of language development
1. Prelinguistic stage
a. Period before child speaks first meaningful word
b. Develops systematically over first 10 to 12 months
c. Involves crying, cooing, and babbling
2. Holophrastic stage
a. Speech consists of one- or two-word statements.
b. Includes holophrases
(1) Single words with meaning of entire sentence
3. Telegraphic stage
a. Speech includes content words only.
b. From 18 to 24 months
4. Preschool period
a. Produce lengthy sentences
b. Speech increases in complexity.
c. From 30 months to 5 years
5. Middle childhood period
a. Refines language skill
b. Increases linguistic competence
c. From 6 to 14 years
d. Uses bigger words
e. Understands complex syntactic structures of language
D. Theories of language development
1. Learning theory
a. Language acquired as child hears and responds to speech.
b. How child learns to speak (two theories)
(1) Operant conditioning—adults reinforce child’s attempt to produce grammatical speech
(2) Acquires language by listening to and imitating speech of adults
2. Nativists theory
a. Inborn linguistic processor specialized for language learning
b. Critical period for language development exists.
c. Most proficient at learning language between 2 years of age and puberty
3. Interactional proponents
a. Child biologically prepared to acquire language
b. Recognizes crucial role of environment in language learning
E. Factors affecting language development
1. Delayed, lack of, or impaired speech can result from:
a. Congenital structural defects of mouth and nasopharynx
b. Hearing deficit
c. Neurological dysfunction
d. Maternal deprivation
e. Emotional factors
F. Guidelines for communicating with children (Box 10-3)
1. Do not exclude child in interactions.
2. Nonverbal communication conveys the most significant message.
BOX 10-3
GUIDELINES FOR COMMUNICATING WITH CHILDREN
▪ Allow children time to feel comfortable.
▪ Avoid sudden or rapid advances, broad smiles, extended eye contact, or other gestures that may be seen as threatening.
▪ Talk to the parent if the child is initially shy.
▪ Communicate through transition objects such as dolls, puppets, stuffed animals before questioning a young child directly.
▪ Give older children the opportunity to talk without the parents present.
▪ Assume a position that is at eye level with child.
▪ Speak in a quiet, unhurried, and confident voice.
▪ Speak clearly, be specific, and use simple words and short sentences.
▪ State directions and suggestions positively.
▪ Offer a choice only when one exists.
▪ Be honest with children.
▪ Allow them to express their concerns and fears.
▪ Use a variety of communication techniques.
From Hockenberry MJ: Wong’s essentials of pediatric nursing, ed 7, St Louis, 2005, Mosby.
G. Communicating with families (Box 10-4)
BOX 10-4
COMMUNICATING WITH FAMILIES
▪ Include all involved family members. One essential step toward achieving a family-centered care environment is to develop open lines of communication with the family.
▪ Encourage families to write down their questions.
▪ Remain nonjudgmental.
▪ Give families both verbal and nonverbal signals that send a message of availability and openness.
▪ Respect and encourage feedback from families.
▪ Families come in various shapes, sizes, colors, and generations.
▪ Avoid assumptions about core family beliefs and values.
▪ Respect family diversity.
From James SR, Ashwill JW: Nursing care of children, Philadelphia, 2007, Saunders.
XV. SELF-CONCEPT AND SELF-ESTEEM
A. Self-concept
1. Perception of whole self
2. Not present at birth
a. Develops gradually as a result of unique experiences
b. Learned during childhood
c. A product of socialization
3. Subjective; may not reflect reality
4. Answers the question “Who am I?” and “What am I?”
5. Formed by:
a. Self-selected mental images
b. Attitudes
c. How he or she thinks others see him or her
B. Self-esteem (Box 10-5)
1. Personal, subjective judgment of one’s worthiness
2. The value an individual places on self
a. Derived from and influenced by social groups
b. Individual’s perception of how he or she is valued by others
3. Factors affecting child’s development of self-esteem
a. Temperament
b. Personality
c. Ability and opportunity to accomplish age-appropriate developmental tasks
d. Significant others
e. Social roles undertaken
f. Expectations of social roles
4. Various needs to develop and preserve self-esteem
a. To feel worthwhile
b. Recognition for achievements
c. Approval of parents and peers
d. Stress inappropiate behavior as unacceptable
e. Constructive communication
(1) Use of “I” messages
(2) Conveys feelings and needs
(3) Does not destroy child’s self-esteem
5. Positive experiences during developmental phases
a. Child successful in early motor/verbal experiences
b. Develops positive self-concept and high self-esteem
c. Receives encouragement and positive recognition form others
d. Exposed to appropriate role models
e. Permitted to experience fear, disappointment, and frustration
f. Encouraged to finish tasks and reach goals
g. Results in an individual with sturdy identity and high level of self-actualizing behavior
6. Negative experiences during developmental phases
a. Leads to negative self-concept and low self-esteem
b. Receives insufficient or negative recognition from others.
c. Expose to inappropriate role models
d. Prevent from finishing tasks and reaching goals
e. Results in an individual with frail identity and self-destructive behavior
BOX 10-5
SELF-ESTEEM IN CHILDREN: COMMUNICATION PRACTICES
| Techniques to Enhance Self-Esteem | Practices That Harm Self-Esteem |
|---|---|
|
▪ Praise efforts and accomplishments.
▪ Use active listening skills.
▪ Encourage expression of feelings.
▪ Acknowledge feelings.
▪ Use developmentally based discipline.
▪ Use “I” statements.
▪ Be nonjudgmental.
▪ Set clearly defined limits and reinforce them.
▪ Share quality time together.
▪ Be honest.
▪ Describe behaviors observed when praising and disciplining.
▪ Compliment the child.
▪ Smile.
▪ Touch and hug the child.
▪ Rock the child.
|
▪ Criticize efforts and accomplishments.
▪ Be too busy to listen.
▪ Tell children how they should feel.
▪ Give no support for dealing with feelings.
▪ Use physical punishment.
▪ Use “you” statements.
▪ Judge the child.
▪ Set no known limits or boundaries.
▪ Give time grudgingly.
▪ Be dishonest.
▪ Use coercion and power as discipline.
▪ Belittle, blame, or shame the child.
▪ Use sarcastic, caustic, or cruel “humor.”
▪ Avoid coming near child even when the child is open to touching, holding, or hugging. Touch and hold only when performing a task.
▪ Avoid comforting through rocking.
|
From James SR, Ashwill JW: Nursing care of children, Philadelphia, 2007, Saunders.
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