MCN - PEDIA Normal

Developmental Milestones
● Hold head up when on stomach (educate:
Infancy tummy time is important daily)
The period which starts at the end of the first 4 MONTHS
month up to the end of the first year of age. ● Starts to enjoy play and interaction
Infant’s growth and development during this period is ● Cooing turns into babbling and copies other
rapid. sounds
● Holds and reaches for toys
Infant Growth and Development Milestones ● Remembers faces and objects
● When studying these milestones you want to ● Rolls over
be familiar with certain categories, and to help 6 MONTHS
us remember these categories let’s remember ● Can sit up with support
the word “BABIES”. ● Stranger anxiety begins
● Babbles with early vowel sounds
“BABIES” ● Recognizes and responds to name
Body Changes ● Has fun looking at self in mirror
8-9 MONTHS
● Fontanelles close:
● Sits without support
❖ Anterior closed by 18 months
● Crawling
❖ Posterior closed by 2 months
● Stands with pulling and holds on to object
● Pincer grasp:uses the thumb and index finger
● Weight:
to pick up small objects
❖ 6 months doubles
● Easily moves objects from one hand to the
❖ 1 year triples
other
❖ Example: 8 lbs. at birth……16 lbs. at
● Object permanence: this means they now
6 months….24 lbs. at 1 year
know that once an object disappears it still
● Length:
exists.
❖ Grows ½-1 inch every month until 6
● Play: looking for hidden toys or playing
months
peek-a-boo
❖ Example: 21 inches at birth……24-27
10-12 MONTHS
inches at 6 months
● Begins walking
● Eruption of teeth: lower central incisors by 10
● Follows very simple commands
months…fall out by 6-7 years
● Puts objects in a container and bangs them
together
Achieving Developmental Milestones
● Says simple words like “mama” or “dada”
● The nurse will assess if the infant is meeting
● Separation anxiety starts
the following milestones at specific ages. It is
important to note if the baby is reaching these
Baby Safety
milestones because it tells us if the infant is
● SIDS (sudden infant death syndrome): an
developing properly.
infant under the age of 12 months dies for
unknown reasons and this tends to occur
2 MONTHS
during sleep.
● Moves head to each side and moves it in
Educational Pieces for Parents
response to sound
❖ Best sleep position: back
● Tracts faces with eyes
❖ Dress infant appropriately….don’t over dress
● Makes noises (early language) cooing
❖ Avoid exposing baby to tobacco smoke
● Smiles
❖ Remove extra items from sleep areas

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❖ Infant can sleep in the same room but not the life (no other foods or liquids
same bed needed)…..alternative iron-fortified formula.
● American Academy of Pediatrics (AAP)
● Shaken baby syndrome (never shake a baby): recommends exclusively breastfeeding for the
can cause brain injury and death first 6 months with the exception of vitamin D
❖ Teach the parent about this and supplementation (400 IU) for breastfed
importance of being calm and laying infants. Then can add solids over time while
infant down in a safe place and taking continuing breastfeeding or formula after 6
a break when things get intense months.
● Choking: there is a risk of choking starting ● None of the following during first 12 months:
after birth (babies can choke on milk or mucus cow’s milk or honey
in the respiratory tract
❖ Teach parent how to remove with Social Stimulation (PLAY)
bulb suction and suggest they take a ● Independent play: starts with observing to
CPR class interacting/grasping for objects and caregiver
❖ When foods are being introduced ● Observing: faces, high contrast objects, being
(usually around 6 months) AVOID talked or sung to….birth to 4 months
small, hard round food items like ● Interacting: toys to grasp like rattles,
grapes, uncooked vegetables etc. peek-a-boo, hiding objects, big toys to hold on
because these are a major choking to and push or stand
hazard
❖ Never leave unattended on surface Toddler
and stop swaddling once the baby can Toddler stage is between 1 to 3 years of age.
start rolling over (by 6 months) During this period, growth slows considerably.
● Car seat safety: back seat and rear-facing
device Toddler Growth and Development Milestones
● Burns: infants will start grabbing at items ● Toddlers are changing physically but their
around 4-6 months, adjust water growth rate slows down a bit compared to the
temperatures for the water heater, block off infant. However, they’re making huge leaps
electrical outlets and bounds in their mental development and
fine/gross motor development.
Interventions (considerations when providing care) ● They are becoming very aware of their
environment and want to explore and test it
Erik Stage: Trust vs. Mistrust out, which helps them understand their
● Meet needs promptly…..respond to crying environment. Furthermore, they start
● Young infants: swaddling, rocking, sucking, developing autonomy. This is where they
holding realize they’re individuals (separate from the
● Older infants: Keeping parents near if possible caregiver) and they are able to exert their own
(decreases separation anxiety), same will. Also, they realize their reactions influence
caregivers (decreases stranger anxiety), calm others around them.
environment, play: crib mobiles, objects from ● They will start to look less like a baby and
home older infants would be familiar with, more like a little child (as you can see in the
etc. example below). So, it is amazing the changes
Eating Plan a child undergoes within the first 3 years of
● Breastfeeding is considered the gold standard life.
in feeding an infant for the first 6 months of

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● Some fine and gross motor skills a toddler can ❖ Normal part of childhood
perform: Throw and kick a ball, run, climb, development (unfortunately)….it will
hold a pencil and scribble, build with blocks, pass as the child becomes older
say their name, use 100s of words, talk in up ❖ Stay calm and don’t give in to the
to 3 word sentences etc. child (teaches them tantrums work) or
try to reason with them
Body Changes ❖ Ignore the behavior but stay close so
● Weight (by 24 months): they know you’re there
❖ Gains about 4-6 lbs. per year (this is ❖ Be consistent with your approach
decreased compared to the infant’s ● Prevention:
rate) ❖ Divert their attention to something
❖ At 24 months, weight should be 4 x else
the birth weight: ❖ Be aware of the triggers: hunger,
❖ Example: 7 lbs. at birth…what would sickness, tiredness, etc.
the weight be at 2 years? Around 28 ❖ Let them have some autonomy with
lbs. choices (give simple options…..It’s
❖ Average weight of 24 month old is time for bed….we can read this book
26.5 lbs (girls) -27.5 lbs (boys) or that book?”)
● Height (by 24 months): ❖ Praise their good behavior
❖ Increases by 2-3 inches per year ❖ Prepare them for a change in event:
❖ Height at 24 months is ½ their adult ❖ Example: leaving the park…..say “you
height can go down the slide 3 more times
❖ Average height for 24 month old is: and then we are going home” rather
33-34 inches than suddenly telling them it’s time to
● Head to chest circumference: equal around leave.
12-24 months (newborn head circumference
was about 1-2 cm bigger than the chest On the move (SAFETY)
circumference) ● Toddlers are at a major risk for hurting
themselves due to increased mobility,
“TODDLER” curiosity, not able to perceive the danger or
Temper Tantrums consequences. Therefore, it’s a dangerous age
for death.
● Why do they have them? It goes along with
● Educate parent about: “DANGERS”
the common saying “terrible twos”. At this
Drowning
time in life, the toddler is developing a sense
Automobile accident (stay in rear-facing until
of autonomy and they want to be
2 years in the back and then switches to
independent but struggle with this new found
forward-facing in the back after 2 years)
development. They easily become stressed or
Nose-dives (falls)
agitated when they can’t accomplish
Getting burned
something. For example, opening a container
Eating toxic substances
to access toys or being told “no” can cause a
Revolvers/rifles…unsecured firearms
tantrum. Toddlers are immature in how they
Suffocate/chokes
process their emotions.
● How do they respond? Scream, cry loudly,
throw items on the ground, hit etc. Diaper to potty training
● Education for parents? ● Child must be ready physically and mentally or
it won’t be successful

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● The anal and urethral sphincter can be with sounds or hidden doors….like to mimic
voluntarily controlled around 18-24 months. parents activities
Bowel control comes before the bladder Erikson’s Psychosocial Theory: Autonomy vs. Shame
(reason: bowel movement is easier to detect). and Doubt
● Most children potty trained by 3 years ● Developing independence….able to reach this
(day-time) . stage because they’ve developed trust with
● Night-time potty training takes more caregiver (needs being met in previous
time….still needs a diaper at night (4-5 years). stage)…discovered they’re individuals
● Know the signs that a child is ready to potty separate from others…their actions affect
train: “TOILET” others and objects in their environment
❖ Two or more hours with dry diaper ● Result of stage: develop confidence to develop
❖ On and off (potty by self and their skills (toilet training, feeding self, dressing self)
pants) ● Interventions to help with this stage: provide
❖ Interested in potty opportunities for independence and give
❖ Likes sitting on toilet (5-10 minutes) positive feedback, don’t punish for doing skills
❖ Experiencing regular BM (same time) wrong
❖ Tells you they have to go ❖ Choices with food, drinks, books to
read, activities
Developmental Stage Theory Separation Anxiety: know the stages
Piaget’s Cognitive Theory: Sensorimotor (birth to 2 ● Protest: crying and doesn’t want
years) to Preoperational phase (2 to 7 years). parent to leave
● A person develops through various stages by ● Despair: depressed no longer crying
interacting and exploring their environment but withdrawn/quiet….but will cry
and this helps them learn about it. Based on once parent comes back
the toddler’s age they may be in either ● Detachment: rare to get to this
sensorimotor (birth to 2 years) or stage….to cope they detach
preoperational phase (2 to 7 years). themselves from parent…seems
● What to remember about preoperational? happy and that they have coped but
❖ Toddlers don’t see things from they haven’t…affects the child parent
another person’s point of view….very relationship…won’t cry when parent
egocentric returns
❖ They’re symbolic in thinking and Interventions for separation anxiety:
play….plays pretend (ex: pretends a ● Remind the child that the parent is
stick is a sword and fighting monsters) coming back (if this is true), maintain
● Type of Play by Toddlers: parallel play routines, encourage the child to talk
● This means they observe others play and play about the parent.
beside them but don’t actually play with
others. Loves to Say NO!
● Toys Toddlers like: blocks and ones with ● Negativism: doing the opposite of what is
containers (love putting objects inside things), being asked
push and pull toys (wagon, cars, strollers ❖ Why? The toddler wants to be
etc.)…remember they’re walking, stuffed independent so when you ask them to
toys, pretend sets (cooking, shopping, do something they don’t desire or
building), coloring, painting, balls (like aren't going to do they will say no ...
throwing objects), books that are interactive .it's all about their autonomy.

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❖ Education on how to deal: avoid ❖ Why? It’s comfortable and predictable for
getting no response ... .give options them. It actually creates an environment
and let them pick (helps with where they can start learning new skills.
autonomy) example: “You can take
your medicine in a blue cup or green Rivalry (sibling): this is the age where many toddlers
cup.” rather than “Are you ready to become a brother or sister
take your medicine?”
❖ Why does it cause problems? It breaks the
Eating Plan routine, attention is diverted suddenly and
● Well balanced diet (tend to be grazers) they will start to act out (tantrums or
● Toddlers like to have small easy to grab regression).
nutritious snacks rather than sit down and eat ❖ Interventions: include them so the focus of
3 meals a day (fruits, veggies, meats, milk, attention is not too hard to cope with like with
water…limit juices, processed, sweets, and feeding and care, consider their comfort for
fatty foods) routines and try to maintain important ones,
● Don’t let toddler fall asleep with bottle in watch out for jealousy because toddler may
mouth…dental caries physically harm the new sibling
● When should they go to a dentist? When the
first set of teeth have broken through….lower Regression: toddlers can start to revert back to infancy
central incisors…around 8-10 months so by skills or temporarily lose developmental skills they
12 months (assist w/ brushing teeth and ask if have obtained…like they can start using the bathroom
water has fluoride in it at home….if not may on self if previously potty trained, refusing to eat and
need fluoride application) want a bottle, lose speaking abilities, not sleeping at
● Becomes picky about food (eats based on how night etc.
it looks…avoid foods that are mixed together ❖ Why? Toddlers learn and grow differently in
like a stir-fry with rice, mixed meats and the development of skills and if overwhelmed
veggies…separate them…use fun plates) or stressed they can regress. Toddlers have
● Ritualistic (more about this later) about how specific bursts of learning based on age
their meals are presented….certain foods at (milestones ages) compared to adults who
for certain mealtimes, particular plate, or cup build upon their skills and can more easily
● Doesn’t like trying new foods at this deal with failures and stress than the toddler.
time…will have a limited diet of what they ❖ Causes: Stress (feel like they can’t cope or be
like successful at new skill or situation), disruption
● Choking risk….avoid foods that are hard to to their routine (new sibling, new caregiver,
chew: big chunky meats, foods with strings being in the hospital)
like celery, seeds, hard candy, popcorn ❖ Result: Regresses back in their stage of
etc.)….still fine-tuning their chewing abilities development because they’re more
(large pieces can become lodged in the comfortable and it’s more predictable.
throat)…educate about how to relieve from ❖ Interventions: don’t punish due to the
choking. regression, identify the cause of stress (try to
remove or alleviate it if possible) or when a
Rrr (rituals, rivalry, regression) regression episode is likely to occur (going to a
Ritualism: the child wants things done the same way new daycare…not the best time to be
each time….has certain routines and items they use learning a new skill that requires
for specific tasks (ex: needs a specific plate to eat, independence until comfortable with new
needs a bedtime story before going to bed etc.)

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daycare situation), concentrate on what the ● The despair and detachment stage of
toddler is doing well separation anxiety is the same as the toddler.
● Magically thinker: may think the parent may
be hurt or never coming back when separated
Preschool from the parent….they don’t understand time
The preschooler includes the ages 3-5 years (so don’t give a time for when coming
where their growth during this period is relatively back….just reassure them frequently the
slow. parent is coming back)

“PRESCHOOL”
Physical Changes Erikson and Piaget’s Theories
● The preschooler is going through the process Initiative vs. guilt: third stage and it’s from ages 3 to 5
of stretching and filling out. Their face is ● The child gained a sense of trust and
becoming more defined (less round) and developed autonomy in the previous two
they’re losing the protruding belly. In addition, stages. Now they need independence to try
their limbs are elongating. By the end of new things, learn how to accomplish tasks,
preschool, at the age of 5, the child will be make decisions, and how to deal with
social, talkative, and very active with a situations that challenge them ex: failure,
blossoming personality. making right choices (conscience is
❖ Gaining only about 5 lbs/yr and grows developed…choosing right or wrong…will
about 3 inches per year they choose to obey?).
❖ Height average: 44 inches (by 5 years) ❖ If not given opportunities to try new
❖ Weight average: 42 lbs. (by 5 years) things or make choices by self the
❖ Fine and gross motor skill child will develop guilt and struggle
development is rapidly becoming with trying new things and struggle
fine-tuned from the age of 3 to 5. with being independent will have
● Gross motor skill examples: ride a tricycle, issues with developing a sense of
catch and bounce a ball, run, hop, skip, climb purpose.
etc. and all of these skills are becoming very ❖ If this stage is failed, they will
well established as he or she approaches 5. experience guilt.
● Fine motor skill examples (by the age of 5): ❖ If this stage is accomplished, the child
copy and write first name, zip-up jacket, will have a sense of purpose.
button-up shirt, use scissors, copy shapes like ❖ Interventions to help the child in this
triangle, circles…all of these skills are getting stage:
the child ready for school. ❖ Encouraging play, especially imaginary
play, giving the child within reason
Reduced Separation Anxiety (but still there until freedom to try new things and
around 4 to 5 years): encouraging them when they fail,
● The young preschooler (age 3) does not like avoid criticizing or trying to control all
being away from the parent, especially during aspects of choices and try to accept
a stressful situation, sickness, etc. their choices
● The young preschooler tolerates it better than Preoperational: 2-7 years and overlaps with the
the toddler during the protest stage in that he toddler
or she will not scream and cry loudly, but ● The preschooler is egocentric still like the
instead they will cry quietly and may act out. toddler but is changing to eventually be able

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to see things from other people’s point of control), avoid giving a specific time
view (currently they see things from their but in relation to an event or in stages
point of view only). as it’s about to happen….example:
● They’re magical thinkers and love pretend play “Your friend will visit after your
(having imaginary playmates etc.) afternoon nap.”….don’t say “At 1
● Animism: the preschooler thinks inanimate o’clock your friend will be here.”
objects (ex: toys) are living things and have
feelings like they do Child’s Safety
❖ example: my son had a stuffed ● Not as rambunctious and unaware of danger
monkey and when he would eat, he compared to the toddler because the
would have to feed the monkey preschooler has now developed more intellect
because it was hungry too. and can follow the rules, but still have to
● Literal thinkers watch with other things like: unsecured guns,
Scared “Fear” swimming, bike safety, stranger danger etc.
Preschoolers fear many things due to their Healthy Eating
inability to distinguish fact from fiction and their ● not as picky as the toddler, especially by
creative imaginations fuel this fear. five…more willing to try new foods and be
● Animism (discussed above) can cause fear. better at sitting down to eat as they approach
Toys that are scary looking or make loud 5 (younger children will still not be able to sit
noises can cause this. The YouTube lecture for long periods)
contains a real life example of a preschooler ● “Baby teeth” completely in by 3 (dental care
experiencing fear due to animism. very important)…start losing them around 5
● Hospitalizations: feel like they are sick because to 6 (varies from child to child)….avoid fatty,
of something they did and the sugary foods
hospitalization/sickness is ● Always watch for choking risk. Don’t run with
punishment…reassure them this is not the suckers in mouth or talk with food in mouth
case but they have a sickness and be honest etc.
with them about it…explain in very simple
terms. Others are starting to become important for playtime
● Procedures: the preschooler fears mutilation Finally starting to transition where they want
of their body and that they may lose to play with others…starts out with associative
something on their body. This is especially play…then cooperative play
true since they are very creative thinkers and
make the procedure worse than it really is. Play style: associate play (starting around 3
They most definitely fear invasive procedures years…progressed from parallel play by the toddler)
like shots, IVs, etc. to cooperative play (around 4-5 years).
❖ Interventions and education to help ● Associative play: children are playing/talking
them cope:simple explanations, together in the sense they are doing the same
medical play: dolls (demonstrate how activity together like using the same toys
to give a shot and let them do it, read (where they begin to understand sharing or
a book about it), listen to the child borrowing) or using the same equipment
and answer their questions, keep ❖ example: playing in a sandbox by
parent with them if possible, give using shoves and sand molds but they
choices, allow to be independent aren’t working together to accomplish
(regression can still happen when something but rather focusing on
stressed or experience loss of their own activity…..this type of play
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Developmental Milestones
is building the framework for social School Age
interaction and how to get along with A period between the ages of 6 to 12 years
others…hence cooperate where the child’s growth and development is
● Cooperative play: children play together characterized by gradual growth.
doing the same activity by cooperating and
collaborating together and have the same “SCHOOL”
focus and goals doing so. Social Skills
❖ example: working together to build a ● Less egocentric and more concerned about
sand castle…they must communicate others and their perspective (cares about
with peers, follow the rules, be kind, what others think and how they can help out),
share, leader and follower easily seen. loves peer activities and forms special
friendships with the same gender (changes
Outline behavior expectations for the parent during when they become teens), parents influence
this age range: still a big part but they start to question it
● Can experience loss of control due to being toward the end of this stage, competitive play
hospitalized or sick. This occurs because they (teams) and joining clubs where rules are
can’t do the things they normally did like important to follow
dress, eat, play. ● Play style with others includes cooperative,
● Due to this loss of control, the child can competitive, physical, constructive play with
regress. challenges. Also, they like doing things by
● Aggression in behavior: can be influenced by themselves like reading, video games,
parents “modeling” or other aggressive collecting items, and board games.
people in the child’s life, media ● Games you may see a school-age child
● Negativism and ritualism like during the playing: Simon Says, Charades, Hide and Seek,
toddler years is decreasing Tag, Basketball, board games, Hopscotch,
● Can experience nightmares (reassure them jump rope, kick the can etc.
that you’re there, listen, help go back to own
bed) Changes (BODY)
● Height: Grows about 2.5 inches per year
Language explosion (major growth spurts will happen in teen
Major development in language during this years when puberty starts) average height is
time is vocabulary exploding by age of 5 in that they 45 inches for a 6-year-old and 59 inches for a
know about 2400 words and speak in 5 word 12-year-old
sentences that are complex with descriptive words ● Weight: Gain about 4 ½ to 7 lbs. a year
and use conjunctions like and or but to join words (average: 45 lbs. at 6 years to 90 lbs. by 12
together. years…depends on the child’s genetics and
● May experience stuttering during this time but other factors could be more or less)
should resolve after the age of 5. ● Teeth: started losing baby teeth usually
● If a child does this: take time to listen, don’t around 5 to 6 years (central incisors) and now
rush them or finish their words or sentences permanent teeth start coming in (usually the
or scold or make fun of the child for this issue central incisors) . Teething technically doesn’t
or make a big deal about it…. referral for end until adulthood with wisdom teeth
speech therapy may be needed to prevent coming in around age 21 (makes for 32
problems as he or she becomes older and still permanent teeth), but most of the 28
stutters. permanent teeth are done erupting by 12 to

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13 years (therefore, at the end of this stage to (accepted by others) and teachers (grades and
beginning of the next). feedback they get smart enough etc.). A poor
❖ Educate: Dental care VERY important self-concept leads to self-doubt, depression, and low
to prevent cavities, learning to self-worth.
develop habits of good oral hygiene ● Tips for helping a child develop a good
(brush twice a day and floss daily), self-concept: be positive and highlight child’s
visiting dentist every 6 months (twice strengths, guide with setting attainable goals
a year), orthodontics if needed (and praise when completed), care about their
● Onset of puberty varies…girls tend to enter interests and help them grow in them, let
puberty earlier than boys. The onset of them grow and when they mess up help them
puberty for girls is between the ages of 8-13 reflect back on what happened and how to
years, while boys enter puberty around 9-14 improve next time
years. Therefore, the child should be educated ● Bullying: harming or intimidating a person
about puberty and body changes that will ❖ Most common setting is at school but
occur. can be outside of school or via social
media “cyberbullying”.
Harmful Risks ❖ Boys tend to be more physical while
The school-age child is very active with other girls will tease, mock, or spread
peers (some school-age children may want to show off rumors.
or compete). Therefore, they need education about ❖ Signs child is bullied: see physical
taking steps to stay safe during play. Educational topics injuries that child can’t explain very
include: well, school items are missing, doesn’t
● Safe usage of bikes/scooters/skates (helmets want to go to school (fakes sickness),
and other protective gear) grades are poor, behavior changes
● Swimming safety: avoid diving or deep water (withdrawing, agitated, depressed),
dangers like undercurrents…always wearing a suicidal behavior
life jacket (consider swimming lessons) ❖ Get your child to open up about it
● Strangers: kidnapping tactics, not trusting a (takes time), report it, don’t ignore it,
stranger, inappropriate touch (teach child but take an active part as a parent in
what is okay vs. what is not) getting it stopped (contact school,
● Avoid dangerous objects: fire and guns (keep report to authorities etc.) and let your
out of reach and locked up) child know you care
● Car and Traffic safety: wear a seat belt while
riding in a vehicle. Most school-age children Heavy
will be riding in a booster seat (state laws ● Weight: nutrition and exercise are very
vary) important in helping prevent childhood
❖ Example: some states say if the child obesity… obesity leads to health problems
is older than 8 years and at least 4’9 like type 2 diabetes, hypertension, joint pain
they no longer need a booster seat and much more.
Remember the risk factors for obesity:
Obstacle at this Age High caloric diet (limit junk food, fast food,
The school-age child is forming self-concept sugary drinks)
during this time. They are asking themselves, “Who Exercise lacking (limit electronic activities and
am I?” and “How do I fit in?” The parents play a role encourage to get outside and exercise)
with this developing as well as the school setting, ➢ “US Department of Health and Human
which is majorly influenced with peer approval Services, recommends that children

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Developmental Milestones
and adolescents ages 6 through 17 Nurse’s Role with the Hospitalized School-age Child:
years do 60 minutes (1 hour) or more 7 T’s
of moderate-to-vigorous physical
activity daily”(“Physical Activity Take time to let them to express fears
Guidelines for School-Aged Children Talk about those fears and coping techniques to help
and Adolescents”, 2019). maintain control
Accessibility limited to healthy foods Truthful about procedures and tests
View food as a way to deal with stress Teach with pictures, outlines, age appropriate videos,
Your genetics and family dynamics (how equipment and lay how it will happen
family members eat, what’s prepared, exercise Tactful with privacy (especially during procedures that
habits, and genetics affect how a person puts expose privates) (modesty)
on weight) Time given for activities that helps keep them
distracted from sickness or upcoming procedures
Education on Managing or Preventing Obesity in a Their friends…keeping in communication with school
School-age Child: friends is important
● Make it a family effort (set obtainable goals Learn Developmental Theories for School Age Child
and start slow) Erikson’s: Industry vs. Inferiority
● Replace junk food that child likes with creative ● The school-age child is very industrious and is
healthy foods yearning to accomplish things through
● Example: instead of candy serve vibrant tangy developed skills they have acquired and
fruits, or baked sweet potatoes fries instead of mastered. Accomplishments give them a
French fries, pizza with low fat or plant based sense of satisfaction, and this causes them to
cheese, turkey pepperoni, avoid sugary drinks feel confident, which makes them feel like a
(set limit), avoid rewarding with food, make competent person in the world they live in.
exercise fun (bike trails, team sports) Therefore, the goal from this stage is
competency.
Exposure to drugs, violence, and sexual content ● The main drivers in helping them develop this
through media and school: are through competing (play/sports), school
● Listen to your child and pay attention to what work, their parents, and peers.
they are exposed to (via online, from friends ● However, the child must know that not
etc.), have an honest open line of everyone can accomplish or master every skill
communication with the child and talk about or task and this is okay. They just need to keep
these issues when they come up and how to trying and focus on their other
deal with them. accomplishments.
● Will test the limits by telling lies, stealing, ● Inferiority develops when the child feels like
cheating they aren’t good at something or have
limitations that prevent them from
Outcome of Hospitalizations (Nurse’s Role) accomplishing. This can lead to the lack of
Hospitalized school-age child can experience the trying to accomplish and affect self-esteem.
following FEARS:
● Fear of pain, injury (losing a body part or Piaget’s: Preoperational stage & concrete operations
becoming deformed), death, losing ● Preoperational stage until 7 years and then
independence/control (interruption to school concrete operations starts at 7 years until 12.
routine, separation from family and friends), ● The school-age child is starting to think about
modesty: doesn’t like showing private parts how others view things and egocentric

|Jas
MCN - PEDIA Normal
Developmental Milestones
thought is decreasing (they know that other
people have different thoughts).
● They are concrete thinkers. They take a
statement for exactly how it was said and
don't think beyond it. They can’t think
abstractly yet.
● They now have the ability to understand
conservation. An example of this would be:
there are two plates that are the same size
with the same amount of food on them, but
when food from one plate is moved to a
smaller plate a child without conservation
thinking would think that the smaller plate
had more food on it than the larger plate.
However, a school-age child understands that
the smaller plate has the same amount of
food on it as the larger one and that the plate
was just switched.
● In addition, they develop classification skills
(can place items in a group based on
similarities or like characteristics- color, size,
what it’s used for etc.)

Moral Development by Kohlberg

Why do children conform to rules?
● Early until 7 years: the child know there are
rules but doesn’t really understand the
purpose or why of the rules….they behave
because of consequences or praises…and
conforms for rewards or praise
● Later on until 10 years: “good boy or nice girl
orientation”…follow rules and conforms
because they’re liked and this helps maintain
a good standing with people…they want to be
liked or seen as “good”.
● Older school age children over 10 years:
conform due to “law and order orientation”
and want to keep social order by obeying law
and rules so they conform.

|Jas