Concepts on Growth and Development

Prepared by: Mr. Allen Loyd S. Tan, RN, MAN

General Objective:
•by the end of this lecture, the student will be able
to discuss growth and development of children.
Specific Objectives:
By the end of this lecture, the student will be able to;
Identify the importance of growth and development
Define growth and dvelopment
Mention the principles of growth and development
 List factors affecting growth and development
 Mention types of growth and development
 Identify the stages of development
GROWTH
•Physical maturation
Increase in physical size
Quantitative change of the body
Measured by grams, kilograms, pounds, etc.
Changes in bodily proportions with age
DEVELOPMENT
Physiological maturation
Progressive increase in skill and capacity to
function
Qualitative change of the body
It can be measured through observation
MATURATION
Increase in child’s competence and adaptability.
“readiness”
The level of maturation depends on child’s heredity.
Importance of Growth and
Development for Nurses
 knowing what to expect of a particular child at
any given age
 Gaining better understanding of the reasons
behind illnesses
 Helping in formulating the plan of care
 Helping in parents education in order to achieve
optimal growth development at each stage
Principles of Growth and
Development
 Continous process
 Predicatble sequence
 Dont progress at the same rate
 Not all body parts grow in the same rate at
the same time
 Each stage of GD is affected by the
preceding types of development.
Principles of Growth and
Development
 G and D proceed in regular related directions
 Cephalo-caudal (head down to toes)
 Proximodistal (center of the body to the pheriperal)
 General to specific (In
motor development, the
infant will be able to grasp an object with
the whole hand before using only the
thumb and forefinger).
Factors influencing Growth and
Development
 Heredity (e.g. Chromosomal abnormalities)
 Environmental factors (physical sorroundings,
social environment)
 Pre-natal environment
• Factors related to mother’s during preganancy
• Nutritional deficiencies
• Diabetic mother
• Exposure to radiation
• Infection with german measles
• Smoking
• Use of drugs
Factors related to fetus
Mal-position in uterus
Faulty placental implantation
Post-natal environment
• External environment
• Socio-economic status of the family
• Child’s nutrition
• Climate and season
• Child’s ordinal position in the family
• Number of siblings in the family
• Family structure
 Internal Environment
• Childs intelligence
• Hormonal influences
• Emotions
Types of Growth and
Development
 Types of growth
• Physical growth (ht, wt, head and chest
circcumference)
• Physiologic growth (vital signs)

• Types of development (MCES)

• Motor
• Cognitive
• Emotional
• Social
 MOTOR DEVELOPMENT
• includes the change in motor behavior over the life span and the sequential,
continuous, age-related process of change.
• The soft assembled movements allow exploration and skill refinement. The
mover and the environment are both changed in the process.
 COGNITIVE DEVELOPMENT
• Development of knowledge and skills
• How they process information, how they think, and feel,
how they determined right from wrong.
• How they make decisions and solve problems
• How they learned new things and how they perceived the
world around them.
 EMOTIONAL DEVELOPMENT
• the ability to recognize, express, and manage feelings at different
stages of life and to have empathy for the feelings of others.
• the development of these emotions, which include both positive and
negative emotions, is largely affected by relationships with parents,
siblings, and peers.
 SOCIAL DEVELOPMENT
• the process by which a child learns to interact with others around them.
• they also gain skills to communicate with other people and process their
actions.
Stages of Growth and Development

Prenatal
- Embryonic (conception- 8 w)
- Fetal stage (8-40 or 42 w)
Infancy
-Neonate
Birth to end of 1 month
-Infancy
1 month to end of 1 year
Early Childhood
Toddler
1-3 years
Preschool
3-6 years
Middle Childhood
School age
6 to 12 years
Late Childhood
Adolescent
13 years to approximately 18 years
NEWBORN STAGE

 Is the first 4 weeks or first month of life. It is a

transitional period from intrauterine life to extra
uterine environment.
 Normal newborn infant
• Physical growth
 Weight – 2.700 4 kg
 Wt loss 5 – 10 by 3-4 days after birth
 Wt gain by 10th days of life
 Gain ¾ kg by the end of the 1st month
 Weight

• They loose 5 to 10 of weight by 3-4 days after

birth as aresult of wirhdrawal homones from
mother
• Loss of excessive extra cellular fluid
• Passage of meconium (feces) and urine
• Limited food intake
 Height
• Boys average ht. 50 cm
• Girls average ht. 49 cm
• Normal range for both (47.7- 53.75 cm)
• Head circumference (33-35 cm)
• Head is ¼ total bodt length
• Skull has 2 fontanels (anterior and posterior)
 Anterior fontanel
• Diamond shape
• The junction of the sagittal, corneal and
frontal sutures forms it
• Between 2 frontal 2 parietal bones
• 3-4 cm in lenght and 2-3 cm width
• It closes at 12 – 18 months of age
 Posterior fontanel
• Triangular
• Located between occipital 2 parietal
bones
• Cloes by the end of the 1st month of age
 Chest circumference
• it is 30.5 to 33 cm (usually 23 cm less than the head
circumference)

 Physiological growth
• Vital signs
 Temperature – (36.3 – 37. 2 degree centigrade)
 Pulse - (120 to 160 b/ min)
 Respiration – ( 35 to 50 c / min)
Newborn Senses

 Touch
 Vision
 Hearing
 Taste
 Smell
 TOUCH
• Most highly developed sense
• It is mosty at lips, tongue, ears, and
forehead
• The newborn is usually comfortable
with touch
 VISION
• Pupils react to light
• Bright lights appear to be unpleasant to
newborn infant
• Follow objects in line of vision
 HEARING
• The newborn infant usually makes some
reponses to sound from birth
• Ordinary sounds are heard well before 10
days of life
• the newborn infant responds to sounds with
either cry or eye movement, cessation of
activity and / or startle reaction
 TASTE
• Well developed as bitter and sour fluids are resisited
while sweet fluids are accepted

 SMELL
• Only evidenced in newborn infants search fro the
nipple, as he smell breast milk.
Normal Newborn Infant

 GROSS MOTOR
DEVELOPMENT
• MOTOR DEVELOPMENT
• The newborn’s infant movement are
random, diffuse and uncoordinated.
Reflexes carry out bodily functions and
reesponses to external stimuli.
 FINE MOTOR DEVELOPMENT
• Holds hand in fist
• When crying, he draws arms and legs to body
Neonatal Reflexes
(Primitive Reflexes)
1. BABINSKI / PLANTAR REFLEX
 Occurs after the sole of the foot has been firmly
stroked. The big toe then moves upward or toward the
top surface of the foot, the other toes fans out.
 DISSAPEARANCE: 9 - 12 MONTHS
2. ROOTING REFLEX
 This reflex starts when the corner of the baby’s mouth
is stroked or touched. The baby will turn their head
and open their mouth to follow and root in the
direction of the stroking. This helps find the breast or
bottle to start feeding. This reflex lasts about 4
months.
 DISSAPEARANCE: 2-3 MONTHS
3. MORO / STARTLE REFEX
 Is often called a startle reflex. That’s because it usually
occurs when a baby is startled by a loud sound or
movement. In response to the sound, the baby throws
back his/her head, extends out his/her arms and legs,
cries, the pulls the arms and legs back in.
 DISSAPEARANCE: 5-7 MONTHS
4. GRASP REFLEX
 Is an involuntary movement that your baby starts
making in utero and continues doing until around 6
months of age. It’s a crowed-pleaser of a reflex: This is
the reflex at play when your new born wraps their
adorable little fingers around one of yours.
 DISSAPEARANCE: 2-3 MONTHS
5. SUCKING REFLEX
 Are involuntary movements that happen either
spontaneously or as responses to different actions.
The sucking reflex, for example, happens when the
roof of a baby’s mouth is touched. The baby will begin
to suck when this area is stimulated, which helps with
nursing or bottle feeding.
 DISSAPEARANCE: 2-3 MONTHS
6. BLINKING REFLEX
 Blink reflex is stimulated by momentarily
shining a bright light not directly into the
neonate’s eyes causing him or her to blink.
This reflex should not become inhibited. The
response occurs with the neonate’s trunk
curving toward the stimulated side.
7. TONIC-NECK REFLEX
 Is often called the fencing reflex. When your baby is
lying down and their head is turned to the right or left,
the corresponding arm extends while the other arm
bends next to their head. This makes them look like
they’re about to start fencing.
 DISSAPEARANCE: 5-7 MONTHS
8. STEPING REFLEX
 You’ll recognize this reflex when you hold
your baby upright and see those little legs
churn. If you hold your baby upright
immediately above a flat surface, your baby
may stretch their legs toward the surface.
Essentially, it looks like your baby is trying to
take steps.
 Cognitive Development
• The CD of newborn infant is difficult to
understand or to observe it

 Emotional Development
• The newborn infant expresses his emotion
just through cry for hunger, pain or
discomfort sensation
 Infancy
 Sitting Up
• Age 2 months
Age 8 months

• Ambulation
13 month old
Nine to 12-months

• Fine Motor Development in infancy

6-month-old
12-month-old
 Definition of normal infant

 It is the period which starts at the end of the first

month the end of the first year of age.

 Infant's growth and development during this

period are rapid.
 Physical growth of normal infant Weight
the infant gains
- Birth to 4 months - ¾ kg /month
- 5 to 8 months - ½ kg / month
- 9 to 12 months - ¼ kg /month

The infant will double his birth wt by 4-5

months and triple it by 10-12 months of age
Height
Length increases about 3 cm /month during
the 1st 3 months of age,
then it increases 2 cm /month at age of 4-6
months,
Then, at 7 12 months, it increases 1 ½ cm
per month
Head circumference
It increases about 2 cm /month during the
1st 3 months,
Then, ½ cm/month during the 2nd 9
months of age.
Posterior fontanel closes by 6-8 w of age.
Anterior fontanel closes by 12-18 months
of age.
Chest circumference
By the end of the 1st year, it will be equal to head
circumference.

Physiological growth of infants

 Pulse 110-150 b/min
 Resp 35 10 c/min
 Breath through nose.
 Blood pressure 80/50 20/10 mmHg
Dentition
Eruption of teeth starts by 56 months of
age.
It is called "Milky teeth" or
"Deciduous teeth" or "Temporary
teeth".
Average age for teeth eruptionLower
central incisors
 Erupt at 6 months
 Erupt at 7.5 months
 Erupt at 9 months
 Erupt at 11 months
 Erupt at 12 months
 Erupt at 14 months
 Erupt at 16 months
 Erupt at 18 months
 Erupt at 20months
 Erupt at 24 months
Motor Development At 2 months
 Hold head erects in mid-position.
 Turn from side back.
 At 3 months, the infant can
 Hold head erects and steady.
 Open or close hand loosely.
 Hold object put in hand
Head Control
Newborn
Age 6 months
At 4 months, the infant can sit with adequate
support.
 Roll over from front to back.
 Hold head erect and steady while in sitting
position.
 Bring hands together in midline and plays with
fingers.
 Grasp objects with both hands.
At 5 months, the infant can
 balance head well when sitting.
 Site with slight support.
 Pull feet up to mouth when supine.
 Grasp objects with whole hand (Rt. or Lt.).
 Hold one object while looking at another

At 6 months, the infant can

 sit alone briefly
 Turn completely over ( abdomen to abdomen ).
 Lift chest and upper abdomen when prone.
 Hold own bottle.
At 7 months, the infant can sit alone.
Hold cup.
Imitate simple acts of others.

At 8 months, the infant can sit alone steadily.

Drink from cup with assistance.
Eat finger food that can be held in one hand.
At 9 months, the infant can
rise to sitting position alone.
Crawl (i.e., pull body while in prone position).
Hold one bottle with good hand-mouth coordination

At 10 months, the infant

can creep well (use hands and legs).
Walk but with help.
Bring the hands together.

At 11 months , the infant can

Walk holding on furniture.
Stand erect with minimal support
At 12 months , the infant
canStand-alone for variable length of time.
Sit down from standing position alone.
Walk in few steps with help or alone (hands held at
shoulder height for balance).
Pick up small bits of food and transfers them to his
mouth
Ambulation (motor growth)
 9 month old crawl
 10 month old creep
 1 year stand independently from a crawl creep
position
 13 month old walk and toddle quickly
 15 month old can run
Emotional development
His emotions are instable, where it is rapidly changes from
crying to laughter.
His affection for or love family members appears.
By 10 months, he expresses several beginning recognizable
emotions, such as anger, sadness, pleasure, jealousy, anxiety
and affection.
By 12 months of age, these emotions are clearly
distinguishable.
Social development
He learns that crying brings attention.
The infant smiles in response to smile of others.
The infant shows fear of stranger (stranger
anxiety).
He responds socially to his name.
According to Erikson, the infant develops sense
of trust. Through the infant's interaction with
caregiver (mainly the mother), especially during
feeding, he learns to trust others through the
relief of basic needs
 As an infant's vision develops, he or she
may seem preoccupied with watching
surrounding objects and people.
Speech Milestones
 1-2 months coos
 2-6 months laughs and squeals
 8-9 months babbles mama/dada as sounds
 10-12 months mama/dada specific
 18-20 months 20 to 30 words 50 understood by
strangers
 22-24 months two word sentences, gt50 words, 75 understood by
strangers
 30-36 months almost all speech understood by strangers
Hearing
BAER hearing test done at birth
Ability to hear correlates with ability enunciate
words properly
Always ask about history of otitis media ear
aiding devices.
Early referral to MD to assess for possible fluid
in ears (effusion)
Repeat hearing screening test
Speech therapist as needed
 Red Flags in Infant Development

 Unable to sit alone by age 9 months

 Unable to transfer objects from hand to hand by
age 1 year
 Abnormal pincer grip or grasp by age 15 months
 Unable to walk alone by 18 months
 Failure to speak recognizable words by 2 years.
Toddlers
Normal toddler
Toddler stage is between 1 to 3 years of age.
-During this period, growth slows considerably.
Safety becomes a problem as the toddler becomes
more mobile.
Physical Growth
Weight
The toddler's average weight gain is 1.8 to 2.7 kg/year.
Formula to calculate normal weight of children over 1 year
of age is
Age in years X 28 .. kg.
e.g., The weight of a child aging 4 years
4 X 2 8 16 kg
Height
 During 12 years, the child's height increases by
1cm/month.
 The toddler's height increases about 10 to12.5cm/year.
Formula to calculate normal height
 Age in years X 5 80 cm.
 e.g., the length of 2 years old child
 2 X 5 80 90cm
Head and chest circumference
 The head increases 10 cm only from
the age of 1 year to adult age.
 During toddler years, chest
circumference continues to increase in
size and exceeds head circumference.
Teething
By 2 years of age, the toddler has 16
temporary teeth.
By the age of 30 months (2.5 years), the
toddler has 20 teeth
Physiological growth
 Pulse 80 to130 beats/min (average 110/min).
 Respiration 24-40 breaths/min
 Bowel and bladder control
 Daytime control of bladder and bowel
control by 2,430 months. (6 years).
Fine Motor – toddler
1 year old transfer objects from hand to hand
2 year old can hold a crayon and color vertical strokes
Turn the page of a book
Build a tower of six blocks
3 year old copy a circle and a cross build using small
blocks
Gross - Motor of toddler
At 15 months, the toddler can;
Walk alone.
Creep upstairs.
Assume standing position without falling.
Hold a cup with all fingers grasped around it.
At 18 months
Hold cup with both hands.
Transfer objects hand-to hand at will
At 24 months
Go up and down stairs alone with two feet on each
step.
Hold a cup with one hand.
Remove most of own clothes.
Drink well from a small glass held in one hand.
At 30 months (2-2.5 years) the toddler can;
Jump with both feet.
Jump from chair or step.
Walk up and downstairs, one foot on a step.
Drink without assistance.
Issues in parenting toddler (emotional
development)
Stranger anxiety should dissipate by age 2 ½ to
3 years
Temper tantrums occur weekly in 50 to 80 of
children peak incidence 18 months most
disappear by age 3.
Sibling rivalry aggressive behavior towards new
infant peak between 1 to 2 years but may be
prolonged indefinitely
Thumb sucking
Toilet Training
Cognitive Development
Up to 2 years, the toddler uses his senses and
motor development to different self from objects.
The toddler from 2 to 3 years will be in the pre-
conceptual phase of cognitive development (2-4
years), where he is still egocentric and can not take
the point of view of other people.
Social development
The toddler is very social being but still egocentric.
He imitates parents.
Notice sex differences and know own sex.
According to Erikson, The development of autonomy
during this period is centered around toddlers increasing
abilities to control their bodies, themselves and their
environment i.e., "I can do it myself".
Pre-School / Preschooler

Preschool stage
Definition:
It is the stage where child is 3 to 6 years of
age. The growth during this period is
relatively slow.
Physical growth
Weight
 The preschooler gains approximately
1.8kg/year.
Height
 He doubles birth length by 45 years of
age.

Physiological growth
Pulse 80120 beat/min. (average 100/min).
Respiration 24-40 br./min.
Blood Pressure (ranges from 90-109 mmHg)
Fine Motor
Older Toddler
3 year old
 copy a circle and a cross build using small
blocks
4 year old
 use scissors, color within the borders
5 year old
 write some letters and draw a person with
body parts
Fine motor and cognitive abilitiespre-school
Buttoning clothing
Holding a pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself
Cognitive development
Preschooler up to 4 years of age is in
the pre-conceptual phase. He begins to
be able to give reasons for his belief
and actions, but not true cause-effect
relationship.
Emotional Development of Preschooler
Fears the dark
Tends to be impatient and selfish
Expresses agression through physical and verbal
behaviours.
Shows signs of jealousy of siblings
Social development in preschoolers
Egocentric
Tolerates short separation
Less dependant on parents
May have dreams night-mares
Attachment to opposite sex parent
More cooperative in play
 The Oedipus complex, also known as the Oedipal complex,
describes a child's feelings of desire for their opposite-sex
parent and jealousy and anger toward their same-sex parent.
The concept was first introduced by Sigmund Freud in his
theory of psychosexual stages of development.

 In simple terms, a boy feels that he is competing with his

father for possession of his mother, while a girl feels that
she is competing with her mother for her father's affection.
According to Freud, children view their same-sex
parents as a rival for the opposite-sex parent's attention
and affection.
 The Electra complex is a psychoanalytic term used to
describe a girl's sense of competition with her mother for
the affection of her father.
 According to Freud, during female psychosexual
development, a young girl is initially attached to her
mother. When she discovers that she does not have a
penis, she becomes attached to her father and begins to
resent her mother, who she blames for her "castration."

As a result, Freud believed that the girl then begins to identify

with and emulate her mother out of fear of losing her love.
Resolving the Electra complex ultimately leads to
identification with the same-sex parent.
Social development
According to Erikson theory, The
preschooler is in the stage where he
develops a sense of initiative, Where he
wants to learn what to do for himself, learn
about the world and other people.
Red flags preschool
Inability to perform self-care tasks, hand
washing simple dressing, daytime toileting
Lack of socialization
Unable to play with other children
Unable to follow directions during exam
 School-Age
Normal school-age child
School-age period is between the age of 6 to 12
years. The child's growth and development is
characterized by gradual growth.
Physical growth
Weight
Schoolage child gains about 3.8kg/year.
Boys tend to gain slightly more weight through 12
years.
Weight Formula for 7 - 12 yrs (age in yrs x 7 ) 52
Height
The child gains about 5cm/year.
Body proportion during this period Both boys and
girls are long-legged.

Dentition
Permanent teeth erupt during school-age period, starting from 6
years, usually in the same order in which primary teeth are lost.
The child acquires permanent molars, medial and lateral
incisors.
Physiological growth
Pulse 9,015 beats/min (75 to 105 b/min).
Respiration 213C/min(18-24 br./min).
Blood Pressure – systolic: 96-131
diastolic: 55-62
School Years fine motor
Writing skills improve
Fine motor is refined
Fine motor with more focus
Building models logos
Sewing
Musical instrument
Painting
Typing skills
Technology computers
Motor Development
At 68 years, the schoolage child
Rides a bicycle.
Runs Jumps, climbs and hops.
Has improved eye-hand coordination.
Prints word and learn cursive writing.
Can brush and comb hair.
 At 810 years (295 days), the schoolage child;
 Throws balls skillfully.
 Uses to participate in organized sports.
 Uses both hands independently.
 Handles eating utensils (spoon, fork, knife) skillfully.
 At 1012 years, the schoolage child
 Enjoy all physical activities.
 Continues to improve his motor coordination.
School Age gross motor
8 to 10 years team sports
Age ten match sport to the physical and
emotional development
School performance
Ask about favorite subject
How they are doing in school
Do they like school
By parent report any learning difficulties,
attention problems, homework
Parental expectations
School Age cognitive development
At 7-11 years, the child now is in the concrete
operational stage of cognitive development. He is
able to function on a higher level in his mental
ability.
Greater ability to concentrate and participate in
self-initiating quiet activities that challenge
cognitive skills, such as reading, playing computer
and board games.
Emotional development
The school age child
Fears injury to body and fear of dark.
Jealous of siblings (especially 68 years old child).
Curious about everything.
Has short bursts of anger by age of 10 years but able to
control anger by 12 years.
Social development
The schoolage child is;
 Continues to be egocentric.
 Wants other children to play with him.
 Insists on being first in every thing
 Becomes peer oriented.
 Improves relationship with siblings.
 Has greater selfcontrol, confident, sincere.
 Respects parents and their role.
 Joints group (formal and informal).
 Engage in tasks in the real world.
Red flags school age
School failure
Lack of friends
Social isolation
Aggressive behavior fights, fire setting,
animal abuse
Adolescent age
(13 to 18 Year Old)
Adolescent age
Physical growth
Physiological growth
Secondary sex characteristics
Cognitive development
Emotional development
Social development
Definition of adolescent
Adolescence is a transition period from childhood
to adulthood. Its is based on childhood
experiences and accomplishments.
It begins with the appearance of secondary sex
characteristics and ends when somatic growth is
completed and the individual is psychological
mature.
Physical growth
Weight
Growth spurt begins earlier in girls (1014 years, while it is 1216 in boys).
Males gains 7 to 30kg, while female gains 7 to 25kg.
Height
By the age of 13, the adolescent triples his birth length.
Males gains 10 to 30cm in height.
Females gains less height than males as they gain
5 to 20cm.
Growth in height ceases at 16 or 17 years in females and 18 to 20in males
Physiological growth
Pulse Reaches adult value 6080 beats/min.
Respiration 1620C/minute.
NB The sebaceous glands of face, neck and chest
become more active. When their secretion
accumulates under the skin in face, acne will
appear.
Appearance of secondary sex characteristics
1- Secondary sex characteristics in girls
Increase in transverse diameter of the pelvis.
Development of the breasts.
Change in the vaginal secretions.
Growth of pubic and axillary hair.
Menstruation (first menstruation is called
menarche, which occurs between 12 to 13 years).

Body image
2- Secondary sex characteristics in boys
Increase in size of genitalia.
Swelling of the breast.
Growth of pubic, axillary, facial and chest hair.
Change in voice.
Rapid growth of shoulder breadth.
Production of spermatozoa (which is sign of
puberty).
Adolescent
As teenagers gain independence they begin to
challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early adolescents
Cognitive development
Through formal operational thinking, adolescent
can deal with a problem.
Emotional development
This period is accompanied usually by changes in
emotional control. Adolescent exhibits
alternating and recurrent episodes of disturbed
behavior with periods of quite one. He may become
hostile or ready to fight, complain or resist
every thing.
Social development
He needs to know "who he is" in relation to
family and society, i.e., he develops a sense of
identity. If the adolescent is unable to
formulate a satisfactory identity from the
multi-identifications, sense of self-confusion
will be developed according to Erikson-
Adolescent shows interest in other sex.
He looks for close friendships.
Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide
Adolescent Teaching
Relationships
Sexuality STDs / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons
TYPES OF THEORIES OF
GROWTH & DEVELOPMENT
 Intellectual development or Jean piaget theory or
cognitive development.
 Moral development or Jean piaget & Lawrence
Kohlberg theory.
 Emotional development or Erik. H Erikson theory or
psychosocial development.
 Development of sexuality or Sigmund Freud’s theory
or psycho-sexual theory or development.
 Spiritual development or James. W Fowler’s theory.
Theoretical foundations of personality development:
Psycho-sexual development (freud)
Psycho-social development (Erickson)
Theoretic foundations of mental development:
Cognitive development (piaget)
Language development
Moral development (Kohlberg)
Spiritual development (Fowler’s)
Sigmund Freud (1856-1939) – Austrian neurologist; founder of
psyhoanalysis
Offered the first real theory of personality development.
FREUD’S PSYCHOSEXUAL
THEORY

According to the famous psychoanalyst SIGMUND FREUD,

children go through a series of psychosexual stages that lead to the
development of adult personality. His theory described how
personality developed over the course of childhood.
Freud believe that personality developed through a series of
childhood stages in which the pleasure-seeking energies of the id
become focused on certain erogenous areas. An erogenous zone is
characterized as an area of the body that is particularly sensitive to
stimulation.
Freud’s Theory of Personality
Freud’s Theory of Personality
The five psychosexual stages by Sigmund Freud;
•ORAL
ANAL
PHALLIC
LATENT
GENITAL
 Erogenous zone (serves as source of pleasure)
 Psychosexual energy (libido) – driving force behind behavior
 Each stages of development marked by conflicts that can help
build growth, depending on how they are resolved
 If completed successfully – a healthy personality is the result.
 If certain issues are not resolved, fixations can occur
 FIXATION – is a persistent focus on an earlier psychosexual
stage.
 Stereotyped behavior in response to frustration
 An obsessive or unhealthy preoccupation or attachment
Oral Stage
0-18 months
Mouth is the site of gratification or the
primary source of interaction
Activity – biting, sucking, crying
Sucking – enjoyment; relief of tension;
nourishment
Nursing Implications:
Provide oral stimulation – pacifier
Do not discourage thumbsucking – the infant derives
pleasure from oral stimulation through gratifying
activities
Weaning process- primary conflict for this stage
If fixation occurs – results to dependency or aggresion
Oral fixation results to drinking, smoking or nail-
biting.
Anal Stage
18 months - 3 years
Site of gratification – anal region
Activity – elimination, retention or defecation of feces
Principle of holding on and letting go
Mother wins – obedient, kind, perfectionist, meticulous
Child wins – stubborn, hardheaded, anti-social
Help child achieve bowel and bladder control even if child is
hospitalized
Signs of Readiness for Toilet Training
Can stand, squat and walk
Can communicate toilet need
Can maintain self dry for 2 hours
 Inappropriate parental response can result in negative outcomes,
Parents approach
 (lenient) – messy, wasteful or destructive personality
 (strict) – stringent, orderly, rigid and obsessive
 NEVER punish, ridicule, or shame a child for accidents.
 In this stage, parents are highly advised to provide support and
encourage their children because the success of this stage is
dependent upon in which the parents approaches toilet training.
Phallic Stage
4-6 years
Site of gratification – genitals
Activity – may show exhibitionism
Increase knowledge of sexes
Masturbation – accept child fondling as normal
exploration
Answer child questions directly
Right age to introduce sexuality
Latent Stage
7-12 years
Period of suppression – no obvious development
Child libido or energy is diverted to more concrete type of thinking
Helps child achieve positive experience so ready to face conflict of
adolescence
Genital Stage
Puberty to death
Site of gratification – genitals
Achieve sexual maturity
Learns to establish relationships with opposite sex
Give an opportunity to relate to opposite sex
Allow child to verbalize feelings about new
relationships
 The goal of this stage is to establish a balance between the
various life areas.
 If the other stages have been completed successfully, the
individual should now be well-balanced , warm and caring.
Psychosocial Theory
Erik Erikson (1902-1996)
Former student of Freud
Person’s social view of himself or herself is more
important than instinctual drives in determining behavior
Stresses importance of culture and society to the
development of one’s personality
Resolution of conflict – allows an individual to go on to
the next phase of development
Erikson’s Stages of Psychosocial Development
Trust vs. Mistrust
Autonomy vs. Shame
Initiative vs. Guilt
Industry vs. Inferiority
Identity vs. Role Confusion
Intimacy vs. Isolation
Generativity vs. Stagnation
Integrity vs. Despair
Infant
Trust vs. Mistrust – 0-18 months
Foundations of all psychosocial tasks
Child learns to love and be loved
Satisfy needs on time – breastfeed
Care must be consistent and adequate – both parents at
1st year of life
Give an experience that will add to security – soft
sounds, touch, eye contact
Toddler
Autonomy vs. Shame & Doubt – 18 months-3 years
Self-government or independence
Give opportunity of decision-making like offer choices
Encourage to make decision rather than judge
Set limits
Preschooler
Initiative vs. Guilt – 4-6 years
Learns how to do things
Let them explore places and events
Activity recommended – modeling clay, finger-
painting will enhance imagination and creativity
and facilitate fine motor development
Negative resolution – limited brainstorming and
problem-solving skills
School-age
Industry vs. Inferiority – 7-12 years
Learn how to do things well
Give short assignments or projects
Positive reinforcement – praise, reward
Adolescent
Identity vs. role diffusion or confusion – 12-18 years (20)
Learns who he/she is or what kind of person he/she will become by
adjusting to new body image and seeking emancipation from parents
Freedom from parents
Other Stages
Young adult – intimacy vs. isolation (18-25 or 30
years); looking for a lifetime partner and career
focus
Middle-aged adult – generativity versus
stagnation (30-45 years); extend their concern from
just themselves and their families to the community
and world
Older adult – integrity vs. despair (45-65 or
above); feels good about the life choices
Cognitive Development
Jean Piaget (1896-1980)
Swiss psychologist
The way children learn and think
SENSORIMOTOR
(0-2 YEARS)
PIAGET’S THEORY OF COGNITIVE
Development proceeds from reflex activity to representation and sensorimotor solutions to problems.
GOAL: OBJECT PERMANENCE

DEVELOPMENT
PRE-OPERATIONAL Problems solved through REPRESENTATION; language development; (2-4 years); thoughts and language
(2-7 YEARS) both EGOCENTRIC; cannot solve conservation problems.
GOAL: SYMBOLIC THOUGHT

CONCRETE OPERATION REVERSIBILITY attained; can solve conservation problems; LOGICAL OPERATION developed and
(7-11 YEARS) applied to CONCRETE problems; cannot solve complex verbal problems.
GOAL: LOGICAL THOUGHT

FORMAL OPERATION LOGICALLY SOLVES all types of problems, thinks SCIENTIFICALLY; solves COMPLEX problems;
(11 YEARS- ADULTHOOD) COGNITIVE structures mature.
GOAL: SCIENTIFIC REASONING
Cognitive Development Theory

Children "construct" their understanding of the

world through their active involvement and
interactions.
Studied his 3 children to focus not on what they
knew but how they knew it.
Described children's understanding as their
"schemas” and how they use:
assimilation
accommodation
Cognitive Development Theory
 How we think, learn to reason, exercise judgment, have
intellectual organization
 Observed children
 Defined 4 periods that children move through:
 *Sensorimotor (Birth-2 yrs)
 *Preoperational (2-7 yrs.)
 *Concrete (7-11 yrs)
 *Formal (11 yrs-adult)
 Stages of moral development influenced by environment
 Observed boys, ages 5-13 yrs.
 Moral Development Theories
 How we acquire moral values, are guided by morals,
how we treat others based on morals
 Jean Piaget-Environmental influences
 Lawrence Kohlberg-Cognitive and moral linked,
expanded Piaget’s work, defined 3 levels with 6
stages of moral development
 Is a continual process that occurs throughout the
lifespan.
Sensorimotor Stage

0-2 years
“Practical intelligence” – words and symbols not
yet available; baby communicates through senses
and reflexed
Subdivision:
1. Neonatal reflex – 1 month; all reflexes
2. Primary circular reaction – 1-4 months;
activity related to body
Repetition of behavior – thumbsucking
Toy – rattle or tape of parent’s voice
3. Secondary circular reaction – 4-8 months; pleasurable
experiences from environment
Memory traces are present
Anticipate familiar events
Toy – mirror, peek-a-boo
4. Coordination of secondary reaction – 8-12 months;
exhibit goal oriented behavior
Discover object and person permanence
Increased sense of separateness
Recognizes shapes and sizes of familiar objects
Toy – nesting toys (colored boxes)- hidden inside the blanket
5. Tertiary circular reaction – 12-18 months; capable
of space and time perception
Game – throw and retrieve
6. Invention of new means through mental
combinations – 18-24 months; transitional phase to the
pre-operational thought period
Toys – blocks, colored plastic rings
Children use trial and error to discover new
characteristics of objects and events.
Exploring permanence and different actions(toys)
Preoperational Thought

2-7 years
1.Preconceptual – 2-4 years;
egocentric – unable to see others’ view point;
Can arrive at answers mentally
Thinking is concrete and literal
Static thinking – inability to remember what he or she started to talk
about
 Concept of time – now
 Concept of distance – as far as he/she can see
 Not aware of reversibility – every action there is an
opposite reaction
 Unable to state cause-effect relationships
 Concept of animism
 Toy – modeling clay (require imagination)
 Initiative – 4-7 years; beginning of causation
Concrete Operational Thought

7-12 years
Able to find solution to everyday problems with systematic
reasoning
Have concept of reversibility – cause and effect
Have concept of conservation – constancy despite transformation
Classification
Activity – collecting and classifying objects
Formal Operational Thought
12 years and up
Cognition achieve its final form
Can deal with past, present or future
Have abstract and mature thoughts
Can solve hypothetical problems with scientific reasoning
Activity – talk-time to sort through attitudes and opinions
Moral Development
 Lawrence Kohlberg (1929-1987)
 Psychologist
 Moral reasoning
 Help identify how a child may feel about an
illness
 Help determine whether a child can be depended
on to carry out self-care activities
 Approximate cognitive stages of development
LEVEL I PRECONVENTIONAL LEVEL

STAGE 1 - Punishment and Obedience Orientation

- Reflexes causes actions
- “I MUST FOLLOW THE RULES OTHERWISE I WILL BE PUNISHED”

STAGE 2 - Instrumental Relativist Orientation

- Conforms to obtain rewards or favors
- “ I MUST FOLLOW THE RULES FOR THE REWARD AND FAVOR IT GIVES”

LEVEL II CONVENTIONAL LEVEL

STAGE 3 - Good-Boy-Nice Girl Orientation

- Seeks good relations and approval of family group; Orientation to interpersonal relations of mutuality
- “I MUST FOLLOW THE RULES SO I WILL BE ACCEPTED”

STAGE 4 - Society-Maintaining Orientation

- Obedience to Law and Order in society; maintenance of social order shows respect for authority
- “ I MUST FOLLOW RULES SO THERE IS ORDER IN THE SOCIETY”

LEVEL III

STAGE 5 - Social Contract reorientation

- Concerned with individual rights and legal contract, social contract; utilitarian lawmaking perspective
- “ I MUST FOLLOW RULES AS THERE ARE REASONABLE LAWS FOR IT”

STAGE 6 - Universal Ethical Principle Orientation

- Higher Law and Conscience Orientation
- Orientation to internal decisions of conscience but without clear rationale or universal principles
- “ I MUST FOLLOW RULES BECAUSE MY CONSCIENCE TELLS ME”
Lawrence Kohlberg
Moral Development Theory
Level 1- Preconventional
Stage 1- Punish and Obey
Stage 2- Instrumental Relativist
Level 2- Conventional
Stage 3- Good boy/Nice girl
Stage 4- Society Maintenance
Level 3- Post-Conventional
Stage 5-Social Contract
Stage 6- Universal Ethics
Preconventional-Level I
Infancy – premoral, prereligious, amoral stage (little
concepts of any motivating force)
Stage 1: 2-3 years; Punishment/obedience orientation
(“heteronomous morality”)
Child does right because a parent tells him or her and to avoid
punishment
Give clear instructions to avoid confusion
Stage 2: 4-7 years
Individualism
 Carries out actions to satisfy own needs rather than society’s
Will do something for another if that person does something for the
child
Unable to take responsibility for self-care (because meeting own
needs interferes with this)
Conventional-Level II
Stage 3: 7-10 years
Orientation to interpersonal relations of
mutuality
Child follows rules because of a need to be a
“good” person in own eyes and eyes of others
Child enjoys helping others
Allow child to help with bed making and other
like activities
Praise behavior
Stage 4: 10-12 years
Maintenance of social order, fixed rules and authority
Child finds following rules satisfying
Follow rules of authority figures to keep the system working
Follows self-care measures ONLY if someone is there to enforce
them
Postconventional-Level III

Stage 5: older than 12

Social contract, utilitarian law-making perspectives
Follow standards of society for the good of all people
Responsible for self-care – standard of an adult
Stage 6: Universal ethical principle orientation
Follows internalized standards
Many adults do not reach this level of moral development
Analysis

 Theories give nurses some answers on why and how people react,
respond as they do
 Human behavior is complex
 No one theory answers all questions
 All theories are multi-dimensional, not linear, they are guidelines