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EARNING
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UTCOME
1
Describe usual physical development from infancy through adolescence.
Concepts for Lecture
1. Neonates and infants (0 to 1 year):
•
Weight:
The infant weighs 2.7 to 3.8 kg (6.0 to 8.5 lb) at birth;
13.75 cm (5.5 in.) by 6 months and gains another 7.5 cm (3 in.) by
12 months.
•
Head and chest circumference:
Average head circumference is
35 cm (14 in.); chest circumference is usually about 2.5 cm (1 in.)
less than head circumference. By about 9 to 10 months, the head
the infant reaches for objects. By 6 to 10 months, the infant can fix
on an object and follow it in all directions. By 12 months, depth
perception is fully developed and the child is able to recognize a
change in levels (such as the edge of a bed).
•
Hearing:
Newborns with intact hearing will react with a startle to
•
Smell and taste:
These senses are functional shortly after birth.
The newborn prefers sweet tastes, is able to recognize the smell of
the mother’s milk, and responds by turning toward the mother.
•
Touch:
The sense of touch is well developed at birth. The new-
born responds positively when touched, held, and cuddled.
C
HAPTER
21
PROMOTING HEALTH FROM CONCEPTION THROUGH
ADOLESCENCE
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UGGESTIONS FOR
C
LASSROOM
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CTIVITIES
• Show Tanner’s sexual maturity rating tables.
•
If possible, ask students to obtain their physi-
cal development records from their parents
and compare their developmental milestones
to those in the text.
21–2). These reflexes disappear during the first year in an orderly
sequence to permit development of voluntary movements. The
newborn can also yawn, stretch, sneeze, burp, and hiccup at birth.
2. Toddlers (1 to 3 years):
•
Appearance:
The toddler appears chubby, with relatively short
legs and a large head. The face appears small when compared to
the skull. As the child grows, the face becomes better propor-
tioned. Toddlers have pronounced lumbar lordosis and a protrud-
2
2
•
Head circumference:
Head circumference increases about 2.5 cm
(1 in.) on average each year. By 24 months the head is 80% of
average adult size and the brain is 70% of adult size.
•
Vision:
Acuity is fairly well established at 1 year, 20/70 at
raisins or cereal pieces and place them into a receptacle, hold a
spoon and cup, walk up stairs with assistance, and probably crawl
down stairs. The 2-year–old can hold a spoon and put it into the
3. Preschoolers (4 to 5 years):
•
Appearance:
The child appears taller and thinner; the brain is
almost adult size at 5 years. The extremities grow more quickly
than the body, making the body appear out of proportion. The
child appears slender with an erect posture.
112 CHAPTER 21 / Promoting Health From Conception Through Adolescence
•
Height:
The child grows about 5 to 6.25 cm (2 to 2.5 in.) each
year, doubling birth length by 4 years, and measures about 102 cm
(41 in.).
4. School-age children (6 to 12 years):
•
Weight:
Average weight gain is about 3.2 kg (7 lb) per year
14. The extremities grow more quickly than the trunk. By age 6,
thoracic curvature develops and lordosis disappears.
•
Vision:
By 6 to 8 years, depth and distance perception is accurate.
By age 6, the child has full binocular vision, eye muscles are well
5. Adolescents (12 to 18 years):
•
Appearance:
Growth is accelerated, with sudden, dramatic physi-
cal changes (adolescent growth spurt). The head, hands, and feet
are first to grow to adult status, next the extremities. The adoles-
cent looks leggy, awkward, and uncoordinated until the trunk
CHAPTER 21 / Promoting Health From Conception Through Adolescence 113
L
EARNING
O
UTCOME
2
Identify tasks characteristic of different stages of development from infancy
through adolescence.
Concepts for Lecture
1. Neonates and infants (birth to 1 year): A neonate’s basic task is
2. Toddlers (1 to 3 years): Toddlers develop from having no voluntary
3. Preschoolers (4 to 5 years): During the preschool period, physical
4. School-age children (6 to 12 years): The school-age period starts
when the deciduous teeth are shed. This period includes the preado-
5. Adolescents (12 to 18 years):
This is the period in which the person
becomes physically and psychologically mature and acquires a personal
L
EARNING
O
UTCOME
3
Trace psychosocial development according to Erikson from infancy through
adolescence.
Concepts for Lecture
1. According to Erikson, the central crisis at this stage is trust versus
mistrust. Resolution determines how the individual approaches sub-
sequent developmental stages. Fulfillment of needs is required to
develop a basic sense of trust.
Erikson sees the period from 18 months to 3 years as the time
milestone as determining the individual’s self–concept. Preschoolers
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Discuss nursing interventions to assist
children and parents to meet the central tasks
of each age.
S
UGGESTIONS FOR
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LINICAL
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CTIVITIES
• Arrange for an observational experience at a
day-care center or school. Have students keep
observations of the children’s activities and
114 CHAPTER 21 / Promoting Health From Conception Through Adolescence
must learn what they can do; as a result, they imitate behavior, and
their imaginations and creativity become lively.
L
EARNING
O
UTCOME
4
Explain cognitive development according to Piaget from infancy through
adolescence.
Concepts for Lecture
1. Piaget refers to the initial period of cognitive development as the
sensorimotor phase. This phase has six stages, three of which take
2. According to Piaget, the toddler completes the fifth and sixth stages
of the sensorimotor phase and starts the preconceptual phase at about
3. The preschooler’s cognitive development, according to Piaget, is the
phase of intuitive thought. Children are still egocentric, but this sub-
sides as they experience their expanding world. They learn through
4. According to Piaget, the ages 7 to 11 years mark the phase of cogni-
tive operations. The child changes from egocentric interactions to
cooperative interactions, develops increased understanding of con-
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UGGESTIONS FOR
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•
Discuss nursing interventions to assist chil-
dren and parents to develop the cognitive abil-
ities of each age.
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age 6. Reading skills are usually well developed in later childhood.
By age 9 most are self-motivated, compete with themselves, and like
5.
Cognitive abilities mature during adolescence. Between the ages of 11
and 15 begins Piaget’s formal operations stage. The main feature of this
stage is that children think beyond the present and beyond the world of
L
EARNING
O
UTCOME
5
Describe moral development according to Kohlberg from childhood through
adolescence.
Concepts for Lecture
1. Infants associate right and wrong with pleasure and pain; what gives
them pleasure is right. When they receive abundant positive
2. According to Kohlberg, the first level of moral development is the
preconventional level when children respond to punishment and
3. Preschoolers are capable of prosocial behavior—that is, any action
that an individual takes to benefit someone else. Preschoolers do not
4. Some school–age children are at Kohlberg’s stage 1 of the precon-
ventional level, punishment and obedience, and act to avoid being
punished; however, some are at stage 2, instrumental-relativist
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UGGESTIONS FOR
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•
Discuss nursing interventions to assist
children and parents to morally develop
(e.g., development of family “rules”).
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5.
According to Kohlberg, the young adolescent is usually at the conven-
tional level of moral development. Most still accept the Golden Rule;
want to abide by social order and existing laws; examine their own val-
L
EARNING
O
UTCOME
6
Describe spiritual development according to Fowler throughout childhood
and adolescence.
Concepts for Lecture
1. According to Fowler, the toddler’s stage of spiritual development is
undifferentiated. Toddlers may be aware of some religious practice.
They are primarily involved in learning knowledge and emotional
don’t understand the meaning of the behavior. They require simple
explanations of spiritual matters and use their imagination to envi-
sion such ideas as angels or the devil.
According to Fowler, the school-age child is in stage 2 of spir-
itual development (mythic-literal). The child learns to distinguish
Some will reject religion, and others will continue to accept it; the
decision is largely influenced by the parents. If the child continues
religious training, the child is ready to apply reason rather than blind
belief in most situations.
According to Fowler, the adolescent or young adult reaches the
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UGGESTIONS FOR
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•
Have the students debate whether children
who are not exposed to religion or faith-based
teaching, as Fowler suggests, are able to
develop this in adulthood. Have the students
provide their rationale for opinions.
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L
EARNING
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UTCOME
7
Identify assessment activities and expected characteristics from birth through
late childhood.
Concepts for Lecture
1. Neonates and infants:
• Health assessment occurs immediately at birth and continues for
the promotion of wellness; newborns can be assessed immediately
manifests vital signs in the normal range, and displays the ability
to habituate to stimuli and to calm self.
• Motor development: The infant performs gross and fine motor skills
in the normal range, exhibits reflexes appropriate for age, displays
2. Toddlers:
• It is essential that nurses do accurate and timely assessments to
promote health and detect problems early, thus allowing for early
interventions.
• Assessment activities for toddlers are similar to those for infants in
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Demonstrate physical assessment of growth in
the nursing laboratory (e.g., height and weight,
head circumference).
•
Show an audiovisual presentation of the per-
formance of the Denver Developmental
Screening Test (DDST).
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UGGESTIONS FOR
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CTIVITIES
conference and compare findings with mile-
stones in the text.
3. Preschoolers:
• During assessment, the preschooler can often participate in an-
swering questions with assistance from parents or caregivers.
Preschoolers can describe the types of activities they enjoy.
4. School-age children:
• During assessment, the nurse responds to questions from the par-
ent or other caregiver, gives appropriate feedback, and lends sup-
port. The nurse also demonstrates interest in the child and
enthusiasm for the child’s strengths.
5.
Adolescents:
• Adolescents are usually self–directed in meeting their health needs.
Because of maturation changes, however, they need teaching and
guidance in a number of health care areas.
• Physical development: The adolescent should exhibit physical
•
Development in activities of daily living: The adolescent demon-
strates knowledge of physical development, menstruation, repro-
CHAPTER 21 / Promoting Health From Conception Through Adolescence 119
L
EARNING
O
UTCOME
8
Identify essential activities of health promotion and protection to meet the
needs of infants, toddlers, preschoolers, school-age children, and adolescents.
Concepts for Lecture
1. Health promotion guidelines for infants:
• Health examinations are at 2 weeks, 2 months, 4 months, 5 months,
and 12 months.
measures; and providing toys without small parts or sharp edges.
• Nutrition: Review breast–feeding and bottle-feeding techniques,
formula preparation, feeding schedule, introduction of solid foods,
and the need for iron supplementation at 4 to 6 months.
• Elimination: Topics include characteristics and frequency of stool
2. Health promotion guidelines for toddlers:
• Health examinations should occur at 15 and 18 months, then as
recommended by the primary care provider. Dental visits should
start at age 3, hearing tests by 18 months or earlier.
• Protective measures should include immunizations, screening for
3. Health promotion guidelines for preschoolers:
• Health examinations should take place every 1 to 2 years.
• Protective measures include immunizations, screening for tubercu-
losis, vision and hearing screening, regular dental screenings, and
fluoride treatment.
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Divide the students into five groups. Assign
each an age group. Have each group develop
safety measures for the assigned age group
and share these with the class.
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UGGESTIONS FOR
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CTIVITIES
4. Health promotion guidelines for school–age children:
• Health examinations include annual physical examinations or as
recommended.
• Protective measures include immunizations; screening for tubercu-
losis; periodic vision, speech, and hearing screenings; regular den-
5. Health promotion guidelines for adolescents:
• Health examinations should occur as recommended by the primary
care provider.
• Protective measures include immunizations, screening for tubercu-
losis, periodic vision and hearing screenings, regular dental
6.
Adolescents face many health risks, including the consequences of risky
behavior, such as injury related to accidents, sexually transmitted dis-