PRESENTED BY:

MISS TINA ANN JOHN

I.M.SC (N)

TERMINOLOGY

Genetics: Genetics involves the potential for human function determined by a

persons inheritance of 46 single chromosomes, or 23 pairs, that carry
information from the birth parents.
Environment: Environment defines the context in which a person exists,
including both animate and inanimate surroundings.
Perception: Perception is a highly individual, cognitive, neurosensory process
that allows each person to experience the environment uniquely.
Critical Period: A critical period is a time during which specific environmental or
biologic events must occur for development to proceed normally.
Growth: Growth means the physical increase in the bodys size and appearance
caused by increasing numbers of new cells.
Nature & Nurture: Two primary factors drive growth & development- genetics &
environment. These primary factors are also called nature & nurture.
Development: Development is the process of ongoing change, reorganization
and integration that occurs throughout life.
Developmental Tasks: The tasks expected to be achieved by the child at each
stage of development.

Life Process: It is the period of time during which the human being, animal has
to live and function in normal conditions.

Embryo: The stage of development between the 2nd & 8th weeks.
Fetus: Child in -utero between the 3rd month of gestation & birth.
Puberty: It is the period of rapid physical change & personality growth in which
the child achieves most of the adults bodily stature

LIFE PROCESS

Today, it is recognized that what happens before birth

is essential in a complete understanding of what
happens after birth.

Important Characteristics of the Prenatal Development:

Hereditary Endowment

Rapid Growth & Development

Conditions in Prenatal Environment

Attitudes of Significant People

TIMETABLE OF PRENATAL DEVELOPMENT:

Period of the Ovum (conception-end of second week)

Practically unchanged in size because of lack of outside source of
nourishment
Rapid internal development
Implantation in uterine wall about 10-14 days after fertilization.
With implantation, the ovum becomes a parasite.

Period of the Embryo (end of second week-end of second lunar

month)
All important external and internal features start to develop and
function
Sex organs well enough developed to distinguish sex of embryo
By end of period, embryo measures 11/2 to 2 inches in length and
weighs about 500 gms.
Growth in the head, region is proportionately much greater than the
rest of the body
Accessory apparatus- placenta, umbilical cord and amniotic sac
develops.

Period of Fetus (End of second lunar month- birth)

External & internal features continue growth and development

Growth follows the laws of developmental direction
Internal organs assume nearly adult positions by fifth lunar month
Nerve cells present since third week, increase rapidly in number during the second,
third, and fourth months
Age of viability reached by sixth or seventh month
Fetal activity (e.g. kicking, squirming) begins between second and third month.

Conditions affecting Prenatal Development:

Maternal Nutrition
Vitamin Deficiency
Maternal Health
RH factor
Drugs
X-Ray & Radium
Alcohol
Tobacco
Parental Age
Maternal Emotions
Uterine Crowding

POTENTIAL PHYSICAL HAZARDS OF DIFFERENT PRENATAL DEVELOPMENT :

Period Of Ovum:

Period of the Embryo:

The possibility that the fertilized ovum will die of starvation before it becomes implanted in the
uterine wall due to the time needed to pass down from the fallopian tube.
Lack of preparation of the uterine wall to receive the fertilized ovum due to an imbalance between
the mothers pituitary gland & ovaries.
Attachment of the fertilized ovum to the wall of the fallopian tube- a tubal pregnancy- resulting in
lack of nourishment or space for growth.
Attachment of the fertilized ovum to a small area of fibroid tissue in the uterine wall which would
prevent it from receiving nourishment.
Miscarriages or spontaneous abortion due to unfavourable conditions in the maternal environment
such as malnutrition, glandular disorders, emotional stress, etc which may cause the embryo to
be dislodged from its place in the uterine wall.
Developmental irregularities which are more likely to occur now than during the period of the fetus.

Period of the Fetus:

Possibility of miscarriage up to the fifth lunar month, especially at times when womens menstrual
period would normally occur.
Premature birth with its complications and possibility of death
Postmature birth with its complications and possibility of death.
Complications of delivery resulting from postmaturity of the fetus, unfavourable position of the fetus
in the uterus and glandular imbalance due to maternal stress.
Developmental irregularities caused by conditions similar to those of the period of the embryo may
retard the development of the fetus or affect the development of fetal features especially the brain.

Unfavourable Attitudes toward the Unborn Child:

Not wanting the Child

Not wanting the child at that time
Not wanting children of multiple birth
Strong desire for a child of given sex
Strong desire for a particular type of child
Wanting to have a miscarriage or abortion
Scorn for the child.

NEONATE: BIRTH-28 DAYS:

Birth is not the beginning of life instead it is merely an interruption in the

developmental pattern that began at the time of conception.
The neonatal period is the first 28 days of life
The average full- term neonate weighs 3.4 kg, 50 cm in length and has
a head circumference of 35 cm.
Neonates lose up to 10 % of their birth weight in the first few days of
life, primarily through fluid losses by respiration, urination, defecation,
and low fluid intake.
Behaviorally, the newborn has periods of sucking, crying, sleeping and
activity.
Newborns respond to sensory stimuli, particularly the caregivers face,
voice and touch.
Early cognitive development begins with innate behaviours, reflexes and
sensory functions.

Infant (1 month to 1 year):

Growth and development are more rapid during the first 12 months of life than they will
ever be again.
The infant depends completely on caretakers to provide for basic needs of food and
sucking, warmth and comfort, love and security, and sensory stimulation.
Infants double their birth weight by 5 months and triple it by 12 months
Their length increases about 1 inch per month during the first 6 months and then inch
per month to the end of first year.

Toddler (1-3 year):

Rapid development of motor skills allows the child to participate in feeding, dressing and
toileting.
Toddlers walk in an upright position with a broad-gait, bowed legs, protruberant abdomen
and arms flung out to the side for balance.
Toddlers do not understand concepts of right and wrong.
Toddlers are generally able to speak in short sentences. By 3 years, they begin mastery of
speech, are possessive of their toys.

Preschool Child (3-5 years):

Children refine the mastery of their bodies and eagerly await the beginning of formal
education.
Physical development continues to slow, whereas cognitive development and
psychological development accelerates.
Three year olds are able to recognize persons, objects and events by their outward
appearance.
Preschoolers are increasingly able to solve problems intuitively on the basis of one aspect
of a situation. They also have a great sense of imagination which contributes to the
development of fears.

School Age Child (6-12 years):

Foundation for adult roles in work, recreation and social interactions is laid during the
middle years of childhood.
Education at schools expands the childs world and transitions the child from a life of
relatively free play to a life of structured play, learning and work.
Holding a pencil and printing letters and words are evidence of fine motor coordination
improvement in 6 year olds. By 12 years the child makes detailed drawings and writes
sentences in script and cursive.
middle childhood years are often referred to as the age of the loose tooth, because
children often lose all of their primary teeth during period.
The secondary teeth are much larger in proportion and are often referred to as tomb
stone teeth.
The school age child prefers same sex peers to opposite sex peers

Pre adolescent (10-12 years):

Children experience more emotional and social pressures than youngsters 30 years ago.
This transitional period between childhood and adolescence is called preadolescence.
Physically it refers to the beginning of the second skeletal growth spurt, when the physical
changes such as the development of pubic hair and female breasts begin.

Adolescent (13-18 years):

Adolescence is the transition from childhood to adulthood, usually between 13 and 18

years of age but sometimes extending until graduation from college.
Physical changes occur rapidly during adolescence. Sexual maturation occurs with the
development of primary and secondary sexual characteristics.
Girls attain 90-95 % percent of their adult height by menarche (onset of menstruation) and
reach their full height by 16-17 years of age. Boys continue to grow taller until 18-20 years
of age.
Language development is fairly complete by adolescence, although vocabulary continues
to expand.
The search for personal identity is the major task of the adolescent.

Young Adult (19-35 years):

Young adulthood is somewhere between the late teens and the mid to late 30s, during this
stage the individual moves away from the family, marries or live single.
Young adults are more active and adapt to new experiences and newly acquired
independence.
Young adults have reached physical maturity, have achieved the highest level of cognitive
ability according to Piaget, and have expected to exhibit a high degree of psychosocial
maturity.
A rich and stimulating environment for the growing and maturing adult encourages the
development of full creative potential.
The emotional health of young adults is related to their ability to effectively address
personal and social tasks.

Middle Age Adults (40-65 years):

Middle adulthood usually refers to those years between 40-65 years and is often described
as that period when one has both grown children and older adult parents.
Most of them have experienced personal and career achievements along with socioeconomic stability.
Adjusting and accepting the physiological changes are a major task for the middle adult.
Climacteric is a term used to describe decline in the reproductive capacity and
accompanying changes brought about by the decrease in sexual hormones.
The middle adult takes on the duty of guiding and caring for the next generation.
They find a particular joy in assisting their children and helping other young adults to
achieve their potentials.

Older Adult (70 years and above):

Older adults are physically active, intelligent and socially engaged.

The older adult must adapt to the physical changes of aging.
Long term memory for newly learnt things decrease as the age advances.
Four common disorders that affect the cognitive development of an older adult are
Delirium, Dementia and Alzheimers disease, Depression.
The older adult has to adapt too many psychosocial changes that occur with aging Older
adults desire to work as long as they are physically able.
These losses require individuals to go through a phase of grieving. As age advances
many older adult tend to live alone.

GROWTH & DEVELOPMENT

Lifespan development is a central and critical issue in attempting to understand human

behaviour as it relates to health.

Nature of Human Growth & Development:

human processes of growth and development result from two interrelated factors: heredity
and environment.
Development is a dynamic and continuous process, characterized by a series of ascents,
plateaus and declines as one proceeds through life.
If adjustments are not made at the appropriate level of development, one may have
difficulties in a later stage of life

Genetics and Environment:

Genetics involves the potential for human function determined by a persons inheritance of
46 single chromosomes, or 23 pairs, that carry information from the birth parents.
Environment defines the context in which a person exists, including both animate and
inanimate surroundings.
Change:
Reorganization and Integration

PRINCIPLES OF GROWTH & DEVELOPMENT:

The process of growth and development is continuous and systematic, following a

purposeful sequence.
It is ongoing and complex.
It is distinctive and predetermined and occurs at a discrete rate for each person.
It has both quantitative and qualitative aspects.
It requires experience and practice as well as energy.
It occurs through the adaptation to the conflict of equilibrium versus disequilibrium.
It produces individuality from the interaction of genetic heredity and environment.
Its outcome is the attainment of personal potential.

Factors influencing Growth & Development:

Genetics
Gender:
Health:
Intelligence:
Temperament:
Environment:
Socio-economic status:

Parent-child relationship:
Ordinal position in family
Nutrition

Developmental Theories:

Researchers have studied human development and behaviour since the beginning of the
20th century and have developed theories that explain human responses expected at
certain ages during life.

Psycho analytic theory (Sigmund Freud):

Libido, unconscious mind, id, ego , superego.

Freud described a series of developmental stages through which all people must pass.

Stage

Ages

Focus of
Libido

Major
Development

Adult Fixation
Example

Oral

0 to 1

Mouth, Tongue,
Lips

Weaning off
breast feeding or
Formula

Smoking
Overeating

Anal

1 to 3

Anus

Toilet Training

Orderliness,
Messiness

Phallic

3 to 6

Genitals

Resolving
Oedipus/Electra
Complex

Deviancy, Sexual
dysfunction

Latency

6 to 12

None

Developing
Defense
Mechanism

None

Genital

12 +

Genitals

Reaching Full
Sexual Maturity

If all stages are

successfully
completed then
the person should
be sexually
matured and
mentally healthy

PSYCHO SOCIAL THEORY ( ERIK ERIKSON):

Eriksons (1963) developmental theory was based on Freuds work but was expanded to
include cultural and social influences in addition biologic processes.
Erikson identified eight stages that progress from birth to old age and death
Each stage is characterized by a developmental crisis to be mastered, with possible
successful or unsuccessful resolution of the crisis. Unsuccessful resolution at any one
stage may delay progress through the next stage. But mastery can occur later.

Stage

Oral

Trust vs
Mistrust

Anal

Phallic
Latency

Genital

Young
Adult

Adult

Maturity

Autonomy
vs shame
& doubt
Initiative
vs Guilt
Industry
vs
Inferiority

Identity vs
role
confusion
Intimac
y vs
Isolatio
n
Generate
vs Stagnity

Ego
integrity vs
Despair

Ages

Stages

Charateristic Gained

0 to 1

Trust Vs Mistrust

Trust in caregivers & ability to make things

happen

1 to 3

Autonomy Vs Shame &

Doubt

Self-care skills & demand for more choices

3 to 6

Initiative Vs Guilt

Assertiveness & Aggressiveness

6 to 12

Industry Vs Inferiority

Cultural Skills & Norms; Competence

12 to 18

Identity Vs Role Confusion

Development of Self; Search for Values

18 to 30

Intimacy Vs Isolation

Love & Intimate Relationships

30 to
Adulthood

Generativity Vs Stagnation

A focus on occupational success & creativity.

Often interested in training the next
generation

Late Adult
hood

Integrity Vs Despair

Self- acceptance & Wisdom, integration of all

positive knowledge learned throughout the
stages

DEVELOPMENTAL TASKS (ROBERT .J. HAVINGHURST):

Havinghurst (1972) believed that living and growing are based on learning and that a
person must continuously learn to adjust to changing societal conditions.
He described learned behaviours as developmental tasks that occur at certain periods in
life.
Infancy and Early Childhood:

Middle Childhood:

Achieving physiologic stability

Learning to eat solid foods
Learning to walk and talk
Forming simple concepts of social and physical reality
Learning to relate emotionally to parents, siblings, and other people.
Learning to control the elimination of body wastes
Learning to distinguish between right and wrong
Learning sex differentiation and sexual modesty.
Learning physical skills necessary for games
Learning to get along with age-mates
Developing fundamental skills in reading, writing and mathematics
Developing a conscience, morality and a scale of values
Achieving personal independence.

Adolescence
Accepting ones body and using it effectively
Achieving a masculine or feminine gender role
Achieving emotional independence from parents and other adults
Preparing for a career
Preparing for marriage and family life
Desiring and achieving socially responsible behaviour
Acquiring an ethical system as a guide to behaviour

Young Adulthood:
Selecting a mate
Learning to live with a marriage partner
Starting a family and rearing children
Managing a home
Getting started in an occupation
Taking on civic responsibility
Finding a congenital social group
Middle Adulthood:
Accepting and adjusting to physical changes
Attaining and maintaining a satisfactory occupational performance
Assisting children to become responsible adults
Relating to ones spouse as a person
Adjusting to aging parents
Achieving adult social and civic responsibility.
Later Maturity:
Adjusting to decreasing physical strength and health
Adjusting to retirement and reduced income
Adjusting to the death of spouse
Establishing an explicit affiliation with ones age group
Adjusting and adapting social roles in a flexible way
Establishing satisfactory physical living arrangements.

COGNITIVE DEVELOPMENT (JEAN PIAGET):

Piaget (1969) developed a theory of cognitive development from infancy through

adolescence.
Two continual processes of assimilation and accommodation stimulate intellectual growth
in the child.
Sensorimotor Stage (birth- 24 months).
Preoperational Stage (ages 2-7 years).
Concrete operational stage (7-11 years).
Formal operational stage (age 11 or older).

Moral Development (Lawrence Kohlberg and Carol Gilligan)

Kohlberg (1969) developed a theory of moral development in levels that closely follow
Piagets theory of cognitive development.
Preconventional level
Stage I- punishment & obedience orientation:
Stage II- instrumental relativist orientation:
Conventional level
Stage III- good boy- good girl
Stage IV- law & order orientation

post conventional level

Stage V- social contact, utilitarian orientation
Stage VI- universal ethical principle orientation

Gilligans theory views females as developing a morality response and

care and males as developing a morality of justice.

Personality Development (Sullivan ):

Level I-SelfishnessLevel II- Goodness

Level III- Non violence
Infancy (birth -18 months):
Childhood (18months 6 yrs):
Juvenile (6-9 yrs):
Pre adolescence (9-12 yrs):
Early Adolescence (12-14 yrs):
Late Adolescence (14-21 yrs):

Faith Development (James Fowler):

Stage I- Intuitive- projective faith:

Stage II- Mythical-literal faith
Stage III- Synthetic- conventional faith:
Stage IV- Individuative-reflective faith:
Stage V- Conjunctive faith
Stage VI- Universalizing faith:

FUNCTIONAL HEALTH & ANTICIPATORY GUIDANCE ACROSS THE LIFESPAN

Knowledge of lifespan development and an understanding of how humans operate

physiologically as well as behaviourally are basic components of nursing.
Anticipatory guidance focuses on preparing the person or family for unfamiliar or upcoming
events. It allows clients to prepare for new roles or experiences.
Health Perception and Health Management
Fetus:
The intrauterine environment and its effects on the growing fetus have a
lifelong impact on health and function.
Maternal factors, including the mothers general health, health history, drug
and alcohol use, some infectious diseases, smoking, exposure to toxins, diet
and stress are important determinants for fetal out come.
Encourage pregnant mothers to seek prenatal care early in pregnancy. They
need to avoid exposure to hazards and maintain a lifestyle that will create
the optimal fetal environment.
Infant:
They continue to depend on their primary caregivers for health promotion.
Encourage families to seek well-child care for regular health monitoring,
immunizations and preventive teaching.

Neonate:
They are particularly prone to infections because of immaturity of their immune
systems.
The effects of economic and living conditions on infant health are evidenced by a
greater incidence of infections among infants from families of low socio- economic
status.
The chief health concern for infants is safety as they are at risk for accidents as they
develop motor skills.
Toddlers & Preschoolers:
They are also prone to infections as they are exposed to day care facilities,
immunization is the preventive measure.
Safety and accident prevention are the focus of healthcare.
Anticipatory guidance for parents includes:
Provide safe environment for exploration
Use of proper restraints
The parents are advised to see the world at the childs level and protect against
danger at that level.
School age child & Adolescent:
Minor illness and accidents continue to be the most common health problems of
school age children.
Good hygiene practices are paramount.
Adolescence is a trying out of different identities and testing limits, coupled with a
perception of invulnerability.
Adolescent health problems are related to lifestyle factors and risk taking behaviours.

Adult and Older Adult:

Independence from family of origin, career development and family
establishment characterize young adulthood
Unhealthy practices begun in adolescence can aggravate the health
status of the young adult.
Health problems common to the middle adulthood group includes
hypertension, adult-onset diabetes, elevated serum cholesterol
concentration and serious illness (e.g. cancer, cardiac disorder)
Older adult may find that age- related changes impair their ability to
manage health independently.
Alterations in hearing, vision and mobility affect practices such as
hygiene, diet and exercise. Changes in sensory and motor abilities
intensify safety needs and make falls a major source of injury.
Anticipatory guidance includes:
Health teaching for behaviour modifications, such as following a
regular program of exercise, reducing stress and maintaining an
appropriate diet.
Encourage adults to have regular physical examinations and to seek
referrals as may be warranted for physical or mental health and for
relational challenges such as marital or family relationships that may
benefit from counseling.

ACTIVITY & EXERCISE:

Newborn & Infant:

Newborns and infants are prone to respiratory difficulties as a result of the relative
immaturity of their airways and lung structures.
Infants explore their world through motor activities, leading to problems related to safety
and injury.
Anticipatory guidance includes:
Work with the adult caregivers to help them understand what factors constitute
danger.
Close supervision of motor activities and if needed of respiratory function is a central
teaching element.
Provide information about ways to provide a stimulating environment and how to
evaluate appropriate toys.

Toddlers & Preschooler:

The occurrence of respiratory tract infections and the management of congenital problems
of the heart and lungs are the leading health problems affecting activity level of these age
groups.
Anticipatory guidance includes:
Prevention of respiratory tract infections and early treatments when they occur.
Families with children with congenital problems need support and individual teaching.

School-age child & Adolescence:

Prevention of respiratory tract infections and early treatments when they

occur.
Families with children with congenital problems need support and individual
teaching.

Respiratory tract infections continue to occur as a result of contact with

classmates.
Activity related fractures are also common, sport injuries.
Inactivity in some school children are also common.
Anticipatory guidance includes:
Help families to understand ways that children of these age groups can
minimize health problems and prevent injury is the focus.
Provide children with safety wears when in competitive sports.
Families should encourage their children to spend some of their leisure
time in physical activities.

Adult & Older Adults:

Changes in motor abilities are noticeable in adulthood.

Effects of smoking or other pollution sources on respiration become
apparent with aging.
Health concerns include- decreased vital lung capacity, reduced stroke
volume and force of heart contractions, ischaemia of tissues result
Anticipatory guidance includes:
Encouragement in participations in regular exercise programme
To maintain a low-fat, high-fibre diet
To develop pleasurable leisure activities

NUTRITION & METABOLISM:

Newborn & Infant:

Infancy is a period of high metabolic rate and high nutritional need.

Increased metabolic rate and immature renal function lead to high fluid requirements.
Breast milk usually provides enough fluid for infants.
Formula preparations may be too dilute, or concentrated which leads to poor weight
gain, fluid overload and difficulty concentrating urine, and poor function of the
newborns kidneys.
Health problems related to nutrition focus mainly on an infants receiving adequate
amounts of milk and properly prepared formula feed, feeding problems.
Anticipatory guidance includes:
Teach family caregivers about infant nutrition and feeding.
Proper preparation of formula, monitoring of the physical growth.
Help caregivers understand when and how to introduce new foods.
Teach caregivers how to use a thermometer and when to call a health care
provider.
Nutritious food may be burdensome for low- income families-inform them about
food assistance programs in the community

Toddlers & Preschooler:

Appetite during toddler and preschool years is extremely variable.

Toddlers usually have a smaller diet than infants do.
Health problems relate to family concerns regarding the adequacy of nutrient intake,
because caregivers are beginning to have less control over what children eat.
Anticipatory guidance includes:
Encourage caregivers to provide a variety of easy- to eat but nutritious food, so
that children can select enough for sufficient nutrition.
Encourage children to develop good hygiene practices such as washing their
hands and brushing their teeth.
Adult caregivers should clean their childrens teeth and at the same time model
appropriate hygiene behaviours and make learning fun.
Children should first visit the dentist at about their second birthday

School- age child & Adolescent:

The food choices of school-age children and adolescents are connected to peer
influences and media advertisements.
Adolescence is a period of rapid growth and high nutritional requirements.
Adolescents may have difficulty eating sufficient amounts of the right kinds of food to
meet requirements for physical growth and physiologic change.
They are at risk for less than adequate amounts of iron, calcium and zinc.
A conflict between eating and the desire to remain thin is expressed in the health
problems of fad dieting, bulimia and anorexia. Others may respond to stress by
overeating leading to obesity. These health problems may set lifelong patterns.

Anticipatory guidance includes:

It depends on the teaching and attempting to influence peer groups in a positive
way to encourage good nutrition.
Meeting the nutritional needs of low-income families is a challenge and requires
the use of community resources to feed all the family members adequately.

Adult & Older Adult:

Metabolic activity decreases in adults, but the need for adequate

nutrition does not.
Bone growth which is accelerated during adolescence, continues in
young adulthood.
During child bearing years, nutrition is particularly important both for the
woman and for the outcome of pregnancy.
Obesity, bulimia or anorexia may begin or continue to be a problem.
Metabolic disorders such as diabetes may be manifested in childhood,
adolescence, young adult years or older adult years.
Anticipatory guidance includes:
Providing clients with access to reliable information about nutrition
so that they can separate fact from myth.
Referrals to dieticians, nutrition classes and support groups may be
beneficial.

ELIMINATION:

Newborn & Infant:

Newborn kidneys are unable to handle high solute levels or concentrate urine, breast
milk usually provides enough fluid for infants.
Errors in formula preparation can damage tissue and the immature kidney is not
efficient in removing drugs or other substances from the body.
Infants are too immature to have control over their bowel movements or bladder
elimination leading to skin problems
Anticipatory guidance includes:
Teach caregivers about the importance of correct formula preparation.
Direct teaching of proper diapering, disposal of stool and skin care
Teaching on the different skin disorders and the treatment.

Toddler & Preschooler:

Between 2 and 3 years, toddlers begin to develop control over elimination. Selftoileting involves recognition of inner signals of the need to eliminate, delaying
elimination until at the toilet, handling, clothing and performing proper hygiene.
Health problems relate to skin care and delay in progressing toward continence.
Anticipatory guidance includes:
Help caregivers understand that the attitudes they convey during this time and
their reactions to accidents influence not only a childs feelings about body
function but also feelings about personal mastery and competency.
Patience and allowing children to progress at their own pace are necessary
during this stage.

School age child & Adolescent:

Older school- age children occasionally have difficulty with nocturnal enuresis or bed
wetting. Nocturnal enuresis after the age of 6 yrs is a matter of concern.
Direct anticipatory guidance includes:

toward helping family members understand nocturnal enuresis

Psychosocial support is essential in cases of enuresis.

Adult & Older Adult:

Continence may be disrupted by normal life events such as pregnancy, childbirth, which
results in changes in the pelvic musculature.
Decreasing estrogen levels that occur during menopause causes an increased occurrence
of female stress incontinence.
In older adults alterations in innervations and changes in muscle tone may produce
incontinence or nocturia, constipation & fluid retention.
Anticipatory guidance includes:
Shape client teaching to the specific problem related to elimination
Teach how to manage alterations or therapies clients can use to regain continence.

Sleep & Rest:

Newborn & Infant:

As babies mature, their sleep periods consolidate and become longer.
Infants are in the process of organizing sleep and rest.
Health problems of sleep in infancy are usually related to problems in the maturation
of neurologic integration

Anticipatory guidance includes:

Advise caregivers that infants normally organize their own sleep patterns.
Health care provider should assess any deviation from the normal pattern
Remind family members that young infants should sleep on their backs on a firm
mattress.
Toddler & Preschooler:
Toddlers and preschoolers have organized sleep patterns, most sleep occurs during
night with one or two naps during the day.
During the second year of life, nightmares often emerge as cognitive development
leads to increased memory and the ability to represent experiences mentally, including
fearful situations.
Anticipatory guidance includes:
Advise caregivers to reassure anxious children in an unhurried manner and by
quiet voice.
Caregivers should monitor childrens television watching for potentially frightening
images.
School age child & Adolescent:
School children sleep with less difficulty.
Night-time bed- wetting, a common problem in young children may persist and disrupt
sleep.
Nightmares continue to occur in children of early school age, producing night time
awakenings.
Adolescents actually have increased sleep needs as a result of rapid growth and
endocrine changes.

Anticipatory guidance includes:

Encourage caregivers to reassure their school age child regarding nightmares.
Counsel adolescents regarding time management and balance of activities, so
that they can be active and yet get enough sleep.
Adult & Older Adult:
Adult sleep problems are often linked to stress and work schedules that lead to sleep
deprivation.
Sleep patterns in older adults often are within the range of normal, environmental
situations can alter the sleep pattern of the older adult.
Anticipatory guidance includes:
Counseling the adult and older adult on the doing of activities that foster sleep
such reading, listening to soft music, a warm bath etc.
Insomnia and sleep apnea are common sleep disorders which need careful
assessment and intervention.

Cognition & Perception:

Newborn & Infants:

Special senses are important components of cognitive- perceptual development in
infancy. Sensory stimulation is a basic human need.
Infants are prone to middle ear infections, which if become chronic and recurring may
interfere with hearing perception.
Anticipatory guidance includes:
Help families to identify sensory or behavioural cues which indicate the infants
need for food, comfort or contact.
Encourage caregivers to talk with the infant and to respond to infant verbal and
nonverbal communication.

Toddler & Preschooler:

School age child & Adolescent:

Toddlers are still exploring the world through sensorimotor play and preschooler expresses
themselves through imaginative play and language.
Hearing and vision problems may impede developmental progress and may relate to
misperceptions.
At this age, children are developing cognitive skills, such as language and are more verbal about
indicating the presence of pain.
Anticipatory guidance includes:
Parents and caregivers need to be aware that the activity and constant questions of children
are part of normal development.
They can help expand their skills by providing stimulating materials and by helping they
develop their language skills through reading, conversing and explaining.
Encourage parents and other caregivers to obtain regular hearing and vision examinations for
their children as part of well- child care .
Assist caregivers to become observant of subtle behaviour that may be linked to pain or
underlying health problems.
Difficulty with schoolwork may be the first indicator of sensory impairment or of attention deficit
hyperactivity disorder.
Physiological, emotional, and environmental factors may also influence cognitive-perceptual
function.
Anticipatory guidance includes:
Parents and caregivers need to know that high levels of activity do not necessarily mean that
the child is a ADHD.
Provide information on assessment of vision and hearing at a well- child clinic.
Encourage families to be aware of indications of substance use or mental health problems.

Adult & Older Adult:

Hearing and visual acuity diminish with age.

Decline in sensory function can contribute to cognitive misperceptions.
Anticipatory guidance includes:
Remind older adults to seek evaluation of pain, sensory deficits and cognitive changes.
They should not accept abnormalities as a normal part of aging.

SELF-PERCEPTION & SELF- CONCEPT:

Newborn & Infant:

The infants perception of self stems from the relationship with primary
caregivers, in which infants learn a sense of worthiness.
Health problems arise when infants are unable to respond to usual
interactions or when their needs are not met.
Anticipatory guidance includes:
Caregivers and parents need to know that newborns and infants will
not be spoiled by responding to them immediately
Provide guidance by supporting interactions that enhances trust.
Toddler & Preschooler:
The self perception of toddlers and preschoolers is related to their
developmental tasks of autonomy and initiative.
Expression of anger and regression are common.
Anticipatory guidance includes:
Help families to understand the range of normal behaviours.
Provide information about behaviours outside the range that require
further evaluation.

School age child & Adolescent:

Self perception in these age groups may be affected by the timing and rapid change in
puberty.
At these stages the childs self concept is tied with peers and peer relationship.
Poor self perception may make children vulnerable to depression and harmful
behaviours.
Anticipatory guidance includes:
Focus on open communication, interaction with groups that promote development
of positive self- concept.
Health education regarding the consequences of drug use and sexual activity.
Adult & Older Adult:
Throughout the life span, self concept and self perception are reinforced or altered as
a consequence of life-events, interpersonal relationships and generativity, the feeling
that one has contributed to others.
Changes in self-perception can arise from physical changes such as menopause.
Anticipatory guidance includes:
To be supportive of the client and family during periods when self- concept may
be altered.
Referral to support groups, counselors or psychiatrists may be appropriate.

ROLES & RELATIONSHIPS:

Newborn & Infants:

The newborns primary relationship is with the parents or primary caregivers,
and attachment is the foundation of development.
Problems in either part can alter the interaction and interfere with attachment.
Anticipatory guidance includes:

Toddler & Preschooler:

Toddlers and preschoolers are egocentric in their relationships with peers
Anticipatory guidance includes:

Encourage caregivers attachment through providing opportunities for positive interaction

Teaching the importance of reciprocal interactions to parents and caregivers.

Assisting families to understand the response of the child to changing relationships

To recognize when it exceeds normal bounds

School age child & Adolescent:

Peer relationships are increasingly important in the school age years. Time
spent with friends increases, while time spent with parents and family decreases
Adolescent consider peers important in the development of social and intimate
relationship skills.
Anticipatory guidance includes:

Encouraging adolescent to express their feelings on life, sexuality, school work, peer
interactions
Counseling to adolescents who have difficulty in relating to peers, leaving home and family
or managing sexuality appropriately.

Adult & Older Adult:

Adults assume many roles, including those related to career, intimacy, marriage and
parenthood.
Some adults defer parenting in favour of establishing a career
For middle age and older adults, the loss of relationships through relocation, divorce,
death or illness is equally challenging.
Care of elderly parents and managing ones career can cause role conflicts and
altered relationships.
Anticipatory guidance includes:
Support and reference of these people to community resources.
Counsel parents regarding care of children
Reassurance to older adults about the normal aging process.

Sexuality & Reproduction:

Newborn & Infant:

Gender identity primarily depends on biologic characteristics and environmental
influences.
Difficulty in gender identity and related health problem can be stress in the child and
the caregivers.
Anticipatory guidance include:
Careful assessment of the child on birth and immediate interventions to correct
the condition
Assurance and guidance to caregivers for the care of such infants.

Toddler & Preschooler:

The exploratory behaviour of the toddler includes exploration of the
body.
Preschooler recognizes physical differences between the sexes,
identifying gender based body parts and appearances
Anticipatory guidance includes:
Preparing families to expect childrens exploratory behaviour and
interest in sexuality.
Children need to be taught about boundaries of touch by other
people so that they can avoid harmful and inappropriate behaviours.
Communicate the importance of affection and acceptance.
School age child & Adolescent:
School age children have increased curiosity about sexual function,
although peer relationships and friendships are almost exclusively with
children of the same gender.
Puberty is the hallmark of adolescence; it prepares the body for
reproductive function.
Intimate relationships begin to form, both physical and emotional,
though heterosexual relations are maintained, homosexual
experimentation in adolescence is now common.

Anticipatory guidance includes:

Adolescents require adequate information of the pubertal changes that occur during
this period
Be supportive of adolescents who are coming to terms with their sexual orientation
Encourage communication of the adolescent incase of sexual abuse and also teach
parents the signs of abuse in both school and adolescent child.
Adult & Older Adult:
Body structure and function, sexual expression and intimacy are primary aspects of
human function throughout adulthood.
During middle adulthood, women reach menopause and men may have concerns
about waning sexual performance
Aging causes concerns of decreased energy for sexual function in older adults.
Anticipatory guidance includes:
Work with individuals and couples who have sexual and reproductive issues.
Encourage couples to maintain personal intimacy as well as sexual intimacy is
essential throughout life.
Preventing STDs and AIDS is important
Nurse can educate on the appropriate family planning methods or permanent
methods and lifestyle changes to reduce stress.

Values & Beliefs:

Newborn & infants:

Infants have limited understanding of right and wrong
Guidance to parents to accept the child as it reacts and to be caring to the childs
demands.
Toddler & Preschooler:
These children have cognitive development to help them understand rules imposed by
adults and the consequences of their actions.
They are egocentric- considering what they do is only right.
Toddlers and preschoolers learn religious practices through family activities and
imitation even though they do not understand the religious belief fully.
Nurse helps the parents to use this stage to enhance positive behaviours through
rewarding desired actions.
School age child & Adolescent:
Early in school age behaviour becomes more self-directed and children comprehend
the impact of their actions on others.
Schoolchildren tend to follow rules to gain approval from others.
Religious beliefs start with the acceptance of the existence of a deity
Adolescent start to question their and parents beliefs as their moral judgement
develops and peer influences are more on their beliefs

Anticipatory guidance includes:

Nurses help the families to understand the child behaviour moral and spiritual beliefs.
Careful assessment of adolescent who have behavioural or conduct problems.
Adult & Older Adult:
Values and moral development are at the level of autonomous decisions, in which
people apply principles to differing situations.
Spiritual beliefs evolve and are applicable across a variety of situations.
Health problems occur when disharmony exists between spiritual beliefs and life
events.

Conclusion:

The nurses primary role understands the persons position in the process, being aware of
expectations in terms of functional health, and recognizing functional health problems
related to development

BIBLIOGRAPHY:

Fundamentals of Nursing; The Art & Science of Nursing Care;

Carol Taylor, Carol Lillis, Priscilla LeMone; 4th Edition; Lippincott
Publications; Pg.No: 117-169
Fundamentals of Nursing; Human Health& Function;
Ruth. F.Craven, Constance.J.Hirnle; 4th Edition; Lippincott
Publications; Pg.No: 281-291
Child Health Nursing; Care of the Child & Family; Adele
Pellittri; 1999; Lippincott Publications; Pg.No: 60-72.
Maternal & Child Health Nursing; Care of the Childbearing &
Childbearing Family; 3rd Edition; Lippincott Publications; Pg.No:
180-182.
Fundamentals of Nursing Patricia. A. Potter, Anne Griffin Perry;
6th Edition; Elsevier Publications; Pg.No: 172-213, 217-231, 236256.
Net reference

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