Care of Mother, Child, and Adolescents (LAB)

❖ They are sturdy, graceful, agile, and

M8: Lesson 1: Preschooler: Nursing
posturally erect.
Assessment of Growth and Development
❖ Increase in muscle strength and refinement
GROWTH AND DEVELOPMENT of previously learned skills such as walking,
running, and jumping.
❖ Preschool
o Traditionally defined to include 3-6 years BODY SYSTEMS
of age. ❖ Nervous System
o Physical growth slows considerably o Handedness is beginning to be obvious.
during the period, but personality and o There is relative ease in learning
cognitive growth are substantial. language because of the increased
PHYSICAL GROWTH cognitive ability.
❖ Lymphatic System
❖ There is a definite change in the body o Lymphatic tissue begins to increase in
contour during the preschool years. size, particularly the tonsils; levels of
❖ The wide-legged gait, prominent lordosis, immune globulin (Ig)G and IgA antibodies
and protuberant abdomen of the toddler increase.
change into slimmer, taller, and much more o These changes tend to make preschool
childlike proportions. illnesses more localized (e.g., an upper
❖ Future body type becomes apparent: respiratory infection remains localized to
▪ ectomorphic/asthenic: slim body build the nose with little systemic fever).
▪ mesomorphic/sthenic: medium body ❖ Urinary System
build o Bladder remains to be palpable above
▪ endomorphic/hypersthenic: large body the symphysis pubis.
build o Voiding becomes frequent (9-10x a day).
❖ Muscular System
WEIGHT
o Muscles are noticeably stronger.
❖ Weight gain is slight during the preschool o Many children exhibit "genu valgus"
years; the average child gains only about 4.5 (knock-knees) which disappears with
lb (2 kg) a year. skeletal growth.
❖ During these years, appetite remains the ❖ Cardiovascular System
same as it was during the toddler years, a o Physiologic splitting of heart sounds and
level perhaps considerably less than some heart murmurs may be present for the
parents would like or expect. first time on auscultation.
o This murmur occurs because of the
HEIGHT
changing size of the heart in reference to
❖ Height gain is also minimal during this period: the thorax because the anteroposterior
only 2 to 3.5 in. (6 to 8 cm) a year on average. and transverse diameters of the chest
❖ Head circumference is not routinely have not yet reached adult proportions.
measured at physical assessments on o Pulse rate decreases to about 85
children over 2 years of age because it beats/min, and blood pressure holds at
changes little after this time. about 100/60 mmHg.

PHYSICAL PROPORTIONS TEETH

❖ No longer resemble those of the squat and ❖ Children generally have all 20 of their
potbellied toddler. deciduous teeth by 3 years of age;
Care of Mother, Child, and Adolescents (LAB)
permanent teeth don’t replace these until ❖ Preschoolers tend to imitate language
school age. exactly, so if they hear less-than-perfect
❖ Preserving these teeth is important because language, this is the language pattern they
they hold the position of the permanent teeth adopt.
as the child’s jaw grows larger. ❖ Egocentricity changes to awareness of
❖ If a deciduous tooth has to be removed, others; rules become important;
children need conscientious follow-up to be understands sharing.
certain a space for a permanent tooth ❖ Play Preschoolers do not need many toys
remains. because, with an imagination keener than it
will be at any other time in life, they enjoy
M8: Lesson 2: Preschooler: Nursing games that use imitation such as pretending
Assessment of Developmental Milestones they are a teacher, cowboy or cowgirl,
firefighter, or store clerk. Many preschoolers
DEVELOPMENTAL MILESTONE
have imaginary friends at this stage (Nielsen,
2012), which often exists until children
formally begin school.
❖ Four- and 5-year-olds divide their time
between roughhousing and imitative play.
Five-year-olds become interested in group
games or reciting songs they have learned in
kindergarten or preschool. Often exists until
children formally begin school.

LANGUAGE
LANGUAGE DEVELOPMENT
❖ VOCABULARY increases markedly.
❖ The extent of a 3-year-old child’s vocabulary
❖ 900-word vocabulary by 3 years.
varies depending on how much the child has
❖ 2100-word vocabulary by 5 years
been encouraged to ask questions or
❖ Three to four sentences by 3 years
participate in conversations.
❖ From ages 4 to 5 years, preschoolers use
❖ A child typically, however, has a vocabulary
longer sentences of four or five words and
of about 900 words and uses it to ask
use more words to convey a message, such
questions constantly, up to 400 a day, such
as prepositions, adjectives, and a variety of
as “Why is snow cold?” “How do worms
verbs.
hear?” and “What does your tongue do?”
❖ Language continues to develop. Speech
❖ A child needs simple answers to such
remains primarily a vehicle of egocentric
questions to encourage curiosity, vocabulary
communication.
building, and questioning.
❖ Most enlightening and effective method is
❖ Egocentrism, or perceiving that one’s
play.
thoughts and needs are better or more
❖ Uses language without comprehending the
important than those of others, is also strong
meaning of words, particularly concepts of
during the preschool period. Preschoolers
right and left, causality, and time.
cannot believe that not everyone knows facts
❖ Thinking is often described as magical
they know; if asked, “What is your name?”
thinking.
they may reply, “Don’t you know it?”
❖ Define objects mainly in relation to TELEGRAPHIC
themselves, so a spoon is “what I eat with,”
❖ Children between the ages of 3- and 4 years
not a curved metal object; a crayon is “what I
form sentences of approximately three or
write with,” not an orange wax object.
Care of Mother, Child, and Adolescents (LAB)
four words and include only the words most ❖ Television, when supervised, can provide a
essential to convey meaning. quiet activity; some programs have
❖ Three-year-old children ask many questions educational content.
and use plurals, correct pronouns, and the
KINDS OF PLAY: ASSOCIATIVE PLAY
past tense of verbs.
❖ They name familiar objects (such as animals ❖ From solitary and parallel play, it shifts to
and parts of the body), relatives, and friends. simple forms of:
1. Cooperative play - when the child begins to
SOCIALIZATION AND PLAY
exchange ideas with other children and
❖ Play for the Preschooler gradually interact with them.
2. Loosely organized play - an activity that is
Importance:
continuous but membership changes.
o The child learns to express feelings. 3. Social play - child plays with other children.
o The child develops concern for his 4. Organized play - emerges at the latter part
playmates. of the preschool period.
o By play, the adult gains a view into the
EMOTIONAL DEVELOPMENT
child's world.
o They usually enjoy associative play ❖ Initiative The developmental task for the
which is group play in similar or identical preschool-age child is to achieve a sense of
activities but without rigid organization or initiative versus guilt (Erikson, 1993).
rules. Children with a well-developed sense of
o Manipulative constructive, creative, and initiative like to explore because they have
educational toys provide for quiet discovered that learning new things is fun.
activities, fine motor development, and ❖ Becomes independent.
self-expression. a. Feeds self completely.
o Most characteristic and pervasive activity b. Dresses self.
is imitative, imaginative, and dramatic c. Takes increased responsibility for
play. actions.
o Mutual play fosters development from ❖ They enjoy going with their family on
birth through the school years and vacation. These types of experiences lead to
provides enriched opportunities for increased vocabulary (e.g., at the zoo, words
learning. such as giraffe, elephant, and bear come
alive because they are transferred from
PLAY
abstract concepts to the actual animals).
❖ Predominantly associative play ❖ Imitation Imitating the actions of the people
❖ Enjoys imitative and dramatic play. around them peaks during preschool age.
▪ Imitates same-sex role functions in play. ❖ Role modeling this way should be fun and
▪ Enjoys dressing up, dollhouses, trucks, does not have to be accurate. Children
cars, telephones, doctor and nurse kits. generally imitate those activities best that
❖ Provide toys to help develop gross motor they see their parents performing at home.
skills: tricycles, wagons, outdoor gym; ❖ Fantasy Toddlers cannot differentiate
sandbox, and wading pool. between fantasy and reality; they believe
❖ Provide toys to encourage fine motor skills, cartoon characters they see on television are
self-expression, and cognitive development: real. Preschoolers, however, begin to make
construction sets, blocks, carpentry tools; this differentiation.
flashcards, illustrated books, puzzles; paints, ❖ Gender Roles Preschoolers begin to be
crayons, clay, and simple sewing sets. aware of the difference between sexes and
Care of Mother, Child, and Adolescents (LAB)
so need to be introduced to both gender simply wants to be his father; the little girl
roles. Gender-specific behavior has been wants to grow up like his mother.
evident by 5 years. ❖ The child becomes friends with both parents
❖ Socialization- capable of sharing, they play and the family becomes a meaningful love
with other children their age much more object.
agreeably than toddlers, which makes the
COGNITIVE DEVELOPMENT
preschool period a sensitive and critical time
for socialization. Preschoolers who are ❖ According to Piaget (1969), cognitive
exposed to other playmates have an easier development is still preoperational by 3 years
time learning to relate to people than those of age, although children during this period
raised in an environment where they rarely also enter a second phase called intuitional
see other children of the same age. thought. During this second phase of
❖ Aggressiveness and impatience peak at 4 development, children learn by asking
years then abate. questions such as “How come?” and “Why?”
❖ Oedipus and Electra Complexes: Oedipus ❖ Intuitive children show a style of thinking he
complex refers to the strong emotional called “centration.” Centration also means
attachment a preschool boy demonstrates that preschoolers cannot make mental
toward his mother; an Electra complex is substitutions and often feel they are always
the attachment of a preschool girl to her right. It’s important to remember this when
father. Parents can be assured this explaining procedures to preschoolers.
phenomenon of competition and romance in ❖ Preschoolers are not yet aware of the
1 preschooler is a normal part of maturing. property of conservation. This means that if
Some parents may need help in handling they have two balls of clay of equal size, but
feelings of jealousy and anger, however, one is squashed flatter and wider than the
particularly if a child is vocal in expressing other, they will insist the flatter one is bigger
feelings toward a parent. (because it is wider) or the intact one is
bigger (because it is taller). They cannot see
PSYCHOSEXUAL DEVELOPMENT
that only the form, not the amount, has
❖ Oedipal Stage or Phallic Stage (Sigmund changed.
Freud). ❖ One of the tasks of a preschool period is
❖ Strong attachment to the opposite sex parent readiness for school and scholastic learning.
while identifying with the same sex parent. ❖ Preoperational Phase (Piaget)
❖ Sex-typing, or the process by which the ❖ Comprises the age span from 2 to 7 years
individual develops the behavior, personality, and is divided into 2 stages:
attitudes, and beliefs appropriate for her ❖ Preconceptual phase, ages 2 to 4, and
culture and sex occur. ❖ the phase of intuitive thought, ages 4 to 7.
❖ Most powerful mechanisms are childrearing ❖ Shift from totally egocentric thought to social
practices and imitations. awareness and the ability to consider other
❖ The little girl becomes possessive of her viewpoints.
father and competes with her mother for her
MORAL AND SPIRITUAL DEVELOPMENT
father’s love (Electra Complex)
❖ The little boy may compete with the father for ❖ Children of preschool age determine right
the mother’s love (Oedipal complex). from wrong based on their parents’ rules.
❖ The parent of same-sex provides a model for ❖ Preschoolers begin to have an elemental
the child to imitate as he develops and concept of spirituality if they have been
matures. provided some form of religious training.
❖ By the end of the preschool, the boy no Belief in an outside force aid in the
longer wants to take his father’s place but
Care of Mother, Child, and Adolescents (LAB)
development of conscience; however,
preschoolers tend to do good out of self-
interest rather than because of strong
spiritual motivation (Kohlberg, 1984).
❖ Children at this age enjoy the security of
religious holidays and religious rituals such
as prayer before meals because these rituals
offer them the same reassurance and
security as a familiar nursery rhyme read
over and over. GROSS MOTOR DEVELOPMENT
MORAL DEVELOPMENT ❖ Walks upstairs using alternate feet by 3
❖ Preconventional or Premoral level years.
(Kohlberg) ❖ Walks downstairs using alternate feet by 4
o Punishment and obedience orientation (2 years.
to 4 y/o). ❖ Rides tricycle by 3 years.
o If children are punished for it, the action ❖ Stands on 1 foot by 3 years.
is bad. If they are not punished the action ❖ Hops on 1 foot by 4 years.
is good, regardless of the meaning of the ❖ Skips and hops on alternate feet by 5 years.
act. ❖ Balances on 1 foot with eyes closed by 5
o Naive instrumental orientation (4 to 7 years.
y/o). Actions are directed toward ❖ Throws and catches ball by 5 years.
satisfying their needs and less frequently ❖ Jumps off 1 step by 3 years.
the needs of others. ❖ Jumps rope by 5 years.
o Involves the philosophy of “You scratch ❖ Walking, running, climbing, and jumping are
my back, and I’ll scratch yours”. well established at age 36 months.

SPIRITUAL DEVELOPMENT FINE MOTOR DEVELOPMENT

❖ INTUITIVE- PROJECTIVE ❖ Hand dominance is established by 5 years.

o Children’s knowledge of faith and religion ❖ Build a tower of blocks by 3 years.
is learned from significant others in their ❖ Ties shoes by 5 years.
environment, usually from parents’ ❖ Ability to draw changes over this time.
religious practices. ▪ Copies circles, may add facial features
o Concrete concept of God with physical by 3 years.
characteristics, who is often like an ▪ Copies a square, and traces a diamond
imaginary friend. by 4 years.
o Understand simple bible stories and DEVELOPMENTAL MILESTONE
memorize short prayers, but their
understanding of the meaning of these ❖ 3 years old
rituals is limited.
o Learns right from wrong and behaves
correctly to avoid punishment.
Care of Mother, Child, and Adolescents (LAB)

TOY
❖ 4 years old 1. Imaginative
❖ imaginary friends are normal at this stage
❖ provide "real" playmates
❖ provide costumes (Superheroes)
❖ "dress-up" games
2. Creative
❖ sandbags
❖ cutting and pasting tools
❖ Watercolors/coloring books
❖ play clay
❖ simple jigsaw puzzles
3. Dramatic/Imitative
❖ play house
❖ dolls; puppets
❖ housekeeping toys,
❖ "doctor or nurse" sets
❖ playground equipment
❖ skates

M8: Lesson 3: Planning and Implementation

for the Health Promotion of Preschooler and
%
Family
❖ 5 years old
PROMOTING PRESCHOOLER SAFETY
Care of Mother, Child, and Adolescents (LAB)
▪ Protein requirements are 1.2g/kg for an
average daily consumption of 24g.
▪ Fat consumption should be decreased
with a substitute of soy-enriched foods.
o Approach:
▪ Serve meals using dishes; provide
comfortable chairs; and give small
feedings.
▪ Consider likes and dislikes
▪ Parents should be models
▪ The child should not be forced to eat-
distraction should be avoided
▪ The child should not be permitted to
nibble between meals
❖ Dressing
▪ Any 3-year-olds and most 4-year-olds
can dress themselves except for difficult
buttons, although conflict may occur over
❖ Preschoolers have more freedom than what the child will wear.
toddlers have. Playing outdoors alone, and ▪ Preschoolers prefer bright colors or prints
being away from a safe home environment and so may select items that are
are some factors that predispose the child to appealing in color rather than matching.
more accidents. As with other preschool activities,
❖ Causes of Accidents however, children need the experience of
▪ Increased initiative and desire to imitate choosing their own clothes. One way for
the behavior of the adult. parents to solve the problem of
▪ They may play with matches or turn on mismatching is to fold together matching
hot water. shirts and slacks so a child sees them as
▪ Increased freedom may result in playing a set rather than individual pieces. If
around motor vehicles or swimming. children insist on wearing mismatched
❖ Approach: clothing, urge parents to make no
▪ Emphasize safety measures apologies for their appearance.
▪ In nursery school, a safe environment ❖ Sleep
should be imposed ▪ Sleeps about 12hours a night and
▪ Avoid walking alone on streets infrequently takes day time naps.
▪ Know the local police ▪ Primetime for sleep disturbances
▪ Refuse gifts and automobile rides from ▪ Trouble going to sleep especially after so
strangers much activity and stimulation during the
▪ Give information about sex offenders day.
▪ To know own complete name, address, ▪ Others may develop bedtime fears, wake
and telephone number of home or during the night or have nightmares or
parents’ place of work sleep terrors.
❖ Nutrition • Approach:
▪ Calories: 1800 cal/day or 90kcal/kg/day ▪ Counseling parents about the importance
▪ Fluid requirements may also decrease of a consistent bedtime ritual
slightly to about 100ml/kg daily but ▪ Attention-seeking behavior is ignored
depends on the activity level, climatic and the child is not taken into the parents’
conditions, and state of health
Care of Mother, Child, and Adolescents (LAB)
bed or allowed to stay up past a stable it or any other electrical appliance near a
hour. basin of water.
▪ Keeping a light on in the room ▪ Encouraging children to eat apples,
▪ Providing transitional objects such as a carrots, chicken, or cheese for snacks
favorite toy, or leaving a drink of water. rather than candy or sweets is yet
▪ Establish limited rituals that signal another way to prevent tooth decay.
readiness for bed such as a bath or story. ▪ Dental services can be performed at 3
▪ Television viewing before bedtime may years of age. Because initial visits usually
cause resistance and delay sleep onset. reveal no cavities, this should be a pain-
❖ Exercise free experience and should help implant
▪ Exercise The preschool period is an the idea that dentists like to help rather
active phase, so preschool play tends to than hurt.
be vigorous. Roughhousing helps relieve ▪ Teeth grinding (bruxism) may begin at
tension and should be allowed as long as this age as a way of “letting go,” similar to
it does not become destructive. In body rocking, which children do for a
addition, preschoolers love time-honored short time each night before falling
games such as Ring around-the-rosy, asleep. Children who grind their teeth
London Bridge, or other more structured extensively may have greater than
games they were not ready for as average anxiety.
toddlers.
PROMOTING HEALTHY FAMILY FUNCTIONING
▪ Promoting these types of active games
and reducing television watching can be ❖ Common Fears of the Preschooler
steps toward helping children develop ▪ The greatest number and variety of real
motor skills as well as prevent childhood and imagined fears are present which
obesity include fear of the dark, being left alone,
❖ Hygiene animals (particularly large dogs and
▪ Preschoolers can wash and dry their snakes), ghosts, sexual matters
hands adequately if the faucet is (castration), and persons and objects
regulated for them (so they do not scald associated with pain.
themselves with hot water). 1. Greatest number of imagined and real fears
▪ When possible, parents should turn down of childhood during this period.
the temperature of the water heater in 2. Fears concerning body integrity are
their home to under 120°F to help common.
prevent scalds. a. Magical and animistic thinking allows
▪ Although preschoolers certainly sit well children to develop many illogical fears
in bathtubs, they should still not be left (fear of inanimate objects, the dark,
unsupervised at bath time in case they ghosts).
decide to add more hot water or to
practice swimming and then be unable to Fear of the Dark
get their head out of the water again. ▪ Due to vivid imagination and undue stress
❖ Care of teeth
▪ If independent toothbrushing was not ▪ A stuffed toy by day becomes a monster in
started as a daily practice during the the dark
toddler years, it should be started during Intervention:
preschool (G. A. Smith & Riedford, 2012).
▪ Electric or battery-operated toothbrushes 1. Monitor possible stimuli for such fear ( TV
are favorites of preschoolers and can be shows, adult discussions, frightening stories)
used safely if the child is taught not to use 2. Keeping a nightlight in the bedroom
Care of Mother, Child, and Adolescents (LAB)
3. Be sure the child is safe
4. No sleep medications, please!

Fear of Mutilation

▪ Fear of losing body parts with certain medical

procedures such as IV insertion or cast
application on a limb
▪ Child has an intense reaction to injury
▪ He cries not only from the pain but also from ❖ Special problems of a Preschooler
the sight of injury
▪ Avoid threatening the child with mutilations
▪ Postpone surgical procedures unless
emergency

Fear of Separations and Abandonment

▪ Sense of time distorted

▪ Sense of distance is limited
▪ Common causes: Hospitalization and going
to a new school
❖ Behavioral problems of Preschoolers
Care of Mother, Child, and Adolescents (LAB)
▪ It is considered best to tell the adopted child
the truth before his status has any meaning
to him

PREPARATION FOR SCHOOLING/NURSERY

SCHOOL

❖ Reasons why a child is sent to a nursery

school;
▪ When he needs educational experience
to supplement what he receives at home
▪ When he needs socializing experience
with other children
❖ Values of Nursery School
▪ Provides growth and development and
improves the general health of the child
▪ Increases capacity for independence,
self-confidence and feeling of security
▪ Broadens his appreciation of the
avenues of self-expression through art,
music and rhythm
❖ Criteria of selection of school
▪ Qualification of teachers
▪ Proportions of teachers to children
▪ Health facilities
▪ Physical set-up
▪ Educational method

M9: Lesson 1: School-Age: Nursing

Assessment of Growth and Development

SCHOOL-AGE
Two aspects of masturbation that should be kept
❖ Refers to children between the ages of 6 to
in mind:
12 years.
▪ Masturbation focuses on a feeling in the ❖ This is usually the first time that children are
genital region. making truly independent judgments.
❖ The child of school age is more influenced by
▪ Shame and threats related to this activity can
the attitudes of his friends.
force children to repress their sexual
❖ This period begins with entrance into the
feelings. This might lead to impotence in
school environment.
males and frigidity in females.
❖ Physiologically the middle years begin with
The only child and adopted child the shedding of the first deciduous tooth and
end at puberty with the acquisition of the final
▪ The only child is the object of parental permanent teeth.
relations at home ❖ Time of gradual growth and development
▪ The adopted child maybe like the only child with even more progress in both physical and
emotional aspects.
Care of Mother, Child, and Adolescents (LAB)
PHYSICAL GROWTH ▪ The resulting abundance of tonsils and
adenoid tissue in the early school years
a. Weight
is often mistaken for disease during
❖ Annual average weight gain is
respiratory illness.
approximately 3-5 lbs. (1.3-2.2 kg).
▪ This tissue growth may also result in
❖ Major weight gains occur at 10-12 yr. for
temporary conductive deafness from
boys and 9-12 yr. for girls.
Eustachian tube obstruction.
❖ Girls are usually heavier.
▪ The appendix is also lined with lymphatic
❖ At 6 years old, both boys and girls are
tissue and the swelling of this.
about the same height.
❖ Cardiovascular and Respiratory System
❖ Before puberty, children of both sexes
▪ Left ventricle of the heart enlarges so as
have a “growth spurt”.
to be strong enough to pump blood to the
▪ Girls-between 10-12 yr.
growing body.
▪ Boys - between 12-14 yr.
▪ Innocent heart murmurs may become
❖ Girls may well be taller than boys.
apparent owing to the extra blood
❖ Posture becomes erect.
crossing heart valves.
PROPORTIONAL CHANGES ▪ Pulse rate decreases to 70-80 bpm.
▪ BP increases to about 112/60 mmHg.
❖ Posture is erect with a steady gait. ▪ Maturation of the respiratory system
❖ Slimmer look with longer legs, varying body leads to increased O2 -C02 exchange
proportions, and a lower center of gravity. which increases exertion ability and
❖ Skeletal lengthening and fat diminution are stamina.
increased represented by muscle tissue. ❖ G.I System
❖ Decrease in head circumference in relation ▪ Fewer stomach upsets, better
to standing height, a decrease in waist maintenance of blood glucose levels, and
circumference in relation to height, and an increased stomach capacity.
increase in leg length. ▪ Caloric needs are less than they were in
FACIAL CHANGES the preschool years.
❖ Bones
❖ Face grows faster in relation to the remainder ▪ Continue to ossify throughout childhood.
of the cranium. ▪ Associated characteristics of height and
❖ Skull and brain grow very slowly weight relationships, rapid or slow
❖ “Age of the loose tooth” and “Ugly duckling growth, and other important features of
stage” development should be explained to
MATURATION OF THE SYSTEMS children and their families.
▪ 7 y/o child who look like 10-year-old child
❖ Nervous System will in fact think and act like 7 y/o.
▪ Brain growth is complete. ❖ Sexual Maturation
▪ Fine motor coordination becomes ▪ At a set point in brain maturity, the
refined. hypothalamus transmits an enzyme to
▪ Eye globe reaches its final shape at this the anterior pituitary gland to begin
time. production of gonadotropic hormones
▪ The adult vision (20/20) level is achieved. which activate changes in the testes and
❖ Lymphatic System ovaries.
▪ IgG and IgA reach adult levels ▪ Timing of this maturity varies widely,
▪ Lymphatic tissue continues to grow in between 10-14 years of age.
size up until about age 9
Care of Mother, Child, and Adolescents (LAB)
Sexual concerns: ▪ The boy grows taller, and his shoulders
widen.
a. Concerns of Girls
▪ Axillary sweating begins.
▪ Females are usually conscious of breast
b. Girls
development.
▪ The pelvis and hips broaden.
▪ A girl who is developing ahead of her
▪ The breast tissues develop and may be
peers may tend to slouch or wear loose
tender. At first, the nipple is slightly
clothing to hide the fact.
elevated, at 7 ½ -8 years of age. The
▪ Other, girls study themselves and wonder
areola becomes somewhat protuberant
whether their breasts are going to
and enlarged between the ages of 9 and
develop enough.
11 years.
▪ Breast development is usually NOT
▪ Axillary sweating begins.
symmetric.
▪ The initial growth of pubic hair occurs at
▪ Hips become broader.
8- 14 years.
▪ As part of preparation for menstruation,
▪ Vaginal secretions become milky and
girls should be told that vaginal
change from an alkaline to an acid pH,
secretions will appear.
and vaginal flora change from mixed to
▪ Some girls already menstruate
Doderlein's lactic acid-producing bacilli.
(MENARCHE).
b. Concerns of Boys PSYCHOSEXUAL DEVELOPMENT
▪ Boys become concerned of increasing
❖ Latency period (Sigmund Freud)
genital size.
▪ During this time children experience
▪ Testicular development precedes penis
relationships with same-sex peers
growth.
following the indifference of the earlier
▪ Males measure their 'manliness" by
years and preceding the heterosexual
penis size, which can make a male who
fascination that occurs for most boys and
develops late feel inferior.
girls in puberty.
▪ Hypertrophy of breast tissue
❖ Industry vs. Inferiority (Erikson)
(GYNECOMASTIA) occurs more often in
▪ Stage of accomplishment is achieved
stocky or heavy boys.
somewhere between 6 and adolescence.
▪ They have to be reassured that pubic hair
▪ Eager to develop skills and participate in
growth comes first before the
meaningful and socially useful work.
appearance of chest hair and beard.
▪ Mastering new skills and assuming new
▪ As seminal fluid is produced, boys may
responsibilities.
begin to notice ejaculation during sleep
▪ Growing sense of independence. Tasks
called NOCTURNAL EMISSIONS ("Wet
that can be carried out through to
dreams").
completion.
PREPUBERTAL CHANGES ▪ Grades, material rewards, additional
privileges, and recognition provide
a. Boys
encouragement and stimulation.
▪ Testes and scrotum increase in size.
▪ Ability to cooperate with others.
▪ The skin over the scrotum changes color;
▪ Ability to compete with others.
it becomes reddened and stippled.
▪ Ability to cope effectively with people.
▪ The breasts may enlarge slightly this
▪ Sense of inferiority: failure to develop a
growth disappears in.
sense of accomplishment.
▪ The penis gradually becomes wider and
▪ Previous stages have not been
longer.
successfully mastered.
Care of Mother, Child, and Adolescents (LAB)
▪ Social environment places a negative 4. Conservation: can recognize matter even if
value on any failure. the form has changed; related to the
▪ Repeated failures permanence of mass and volume; knows
▪ Comparison with others that quantity remains the same even though
appearance differs.
PSYCHOSOCIAL SKILLS
5. Reversibility: recognizes events even in their
❖ School occupies half of his waking hours reverse for he can imagine a process in
▪ friends/classmates, more important than reverse.
family 6. With concrete, logical thinking
▪ teacher becomes parent-substitute 7. Acquires use of reason and understanding of
▪ school phobia - difficulty coping with rules - allows greater use of language.
school demands 8. Names months and years, right and left, can
❖ Increasing social sensitivity tell time.

MORAL DEVELOPMENT (Kohlberg)

COGNITIVE DEVELOPMENT ❖ STAGE VI "LAW AND ORDER"

▪ Development of conscience and moral
❖ Concrete operations (Piaget) standards.
▪ Use thought processes to experience ▪ Rules are established and set down by
events and actions. others.
▪ Understanding about relationships ▪ Adopt and internalize the moral values of
between things and ideas. their parents.
▪ Make judgments based on what they see ▪ Rewards and punishments guide their
(perceptual thinking) to make judgments judgment, a bad act is the one who break
based on what they reason (conceptual rules or does harm.
thinking).
▪ Master symbols and use their memories
of past experiences to evaluate and
interpret the present.
▪ Mastering the concept of conservation
▪ Develops classification skills

COGNITIVE SKILLS

1. Period of industry: likes to explore, produce,

accomplish to have adventure.
2. Develops confidence.
3. Decentering: can consider more than one
thing at a time which leads to an ability to
empathize, sympathize.
Care of Mother, Child, and Adolescents (LAB)
MORALITY ▪ Dramatic stories and myths used to
communicate spiritual meanings.
❖ Morality develops in the school before age 9:
▪ Some children drop or modify certain
▪ with a strict superego
religious practices (e.g., praying for
▪ rule dominance - things are black or
tangible benefits).
white; right or wrong
▪ Others continue to follow religious
▪ After 9 years old: autonomous morality
practices because of their dependence
develops; recognizes differing points of
on their parents.
view; may see "gray areas.'

CONCEPT ON DEATH M9: Lesson 2: School-Age: Nursing

Assessment of Developmental Milestones
❖ Early school-age period:
▪ Believes own death can be avoided SCHOOL-AGE CHILD (6-12 years old)
▪ Associates death with aggression or
violence ❖ This period begins with entrance into the
▪ Believes wishes or unrelated actions can school environment, which has a significant
be responsible for death impact on development and relationships.
❖ 9-12 years ❖ This is usually the first time that children are
▪ Understands death as the inevitable end making a truly independent judgment.
of life
BIOLOGIC DEVELOPMENT
▪ Begins to understand own mortality;
expressed as interest in the afterlife or as ❖ Height and weight growth assumes a slower
fear of death but steady pace as compared with earlier
▪ Expresses ideas about death gathered years. Their annual average weight gain is
from parents and other adults approximately 3 to 5 lbs; the increase in
height is 1 to 2 inches.
SPIRITUAL DEVELOPMENT (Fowler)
❖ By age 10 years, brain growth is complete,
❖ Mythic-literal (7 to 12 years ) so fine motor coordination becomes more
▪ They picture God as human and use refined. At about this same time, adult vision
adjectives such as “loving and helping”. level is achieved.
▪ Fascinated by the concepts of heaven ❖ Innocent heart murmurs may become
and hell. apparent due to the extra blood crossing
▪ They view illness or injury as a heart valves.
punishment for a real and imagined ❖ Since all of the primary teeth are lost during
misdeed. this age span, middle childhood is
▪ Private world of fantasy and wonder sometimes known as the age of the loose
▪ Symbols refer to something specific tooth, and the early years of middle
▪ Young school-age children expect that childhood is the ugly duckling stage, when
their prayers will be answered, good the new secondary teeth appear to be much
rewarded, and bad punished. too large for the face.
▪ During the prepuberty stage, children ❖ Maturation of the respiratory system leads to
become aware of spiritual increased oxygen-carbon dioxide exchange,
disappointments. which increases exertion ability and stamina.
▪ They realize that their prayers are not ❖ Maturity of the GI system is reflected in fewer
always answered on their own terms, and stomach upsets, better maintenance of blood
they begin to reason rather than accept glucose levels, and an increased stomach
faith blindly. capacity.
Care of Mother, Child, and Adolescents (LAB)
GROWTH AND DEVELOPMENT MILESTONES allow children to see things from another’s
point of view.
❖ They progress from making judgments
based on what they see (perceptual thinking)
to making judgments based on what they
reason (conceptual thinking).

Children can use concrete operational thought

because they learn several new concepts, such as:

1. Decentering – the ability to project the self

into other people’s situations.
2. Accommodation – the ability to adapt
Prepubescence (2-year period that precedes thought processes to fit what is perceived
puberty) (understanding that there can be more than
one reason for other people’s situations).
❖ The period that begins toward the end of 3. Conservation – the ability to appreciate that
middle childhood and ends with the thirteenth a change in shape does not necessarily
birthday. mean a change in size.
4. Class inclusion – the ability to understand
that objects can belong to more than one
classification.

MORAL DEVELOPMENT

❖ Although children of 6 or 7 years of age know

the rules and behaviors expected of them,
they do not understand the reasons behind
them.
❖ Rewards and punishments guide their
behavior; a “bad act” is one that breaks a rule
PSYCHOSOCIAL DEVELOPMENT Developing a or does harm.
Sense of Industry (vs Inferiority) ❖ Older school-age children are able to judge
an act by the intentions that prompted it
❖ It has been suggested that the individual’s rather than just by the consequences.
fundamental attitude toward work is
established during middle childhood. SPIRITUAL DEVELOPMENT
❖ School-age children are eager to develop
❖ Children at this age think in very concrete
skills and participate in meaningful and
terms but are avid learners and have a great
socially useful work.
desire to learn about God.
❖ A sense of accomplishment also involves the
❖ School-age children begin to learn the
ability to cooperate, to compete with others,
difference between the natural and the
and to cope effectively with people.
supernatural but have difficulty
❖ Children need and want real achievement.
understanding symbols.
COGNITIVE DEVELOPMENT Concrete ❖ Although younger children expect their
Operational Stage prayers to be answered, they begin to
recognize that this does not always occur
❖ The rigid, egocentric outlook of the preschool and become less concerned when prayers
years is replaced by thought processes that are not answered.
Care of Mother, Child, and Adolescents (LAB)
PSYCHOSEXUAL DEVELOPMENT Latency M9: Lesson 3: Planning and Implementation
Period for the Health Promotion of School-Age and
❖ During this period, children elaborate on Family
previously acquired traits and skills. PROMOTING SCHOOL-AGE SAFETY
❖ Physical and psychic energy are channeled
into acquisition of knowledge and vigorous ❖ School-age children are ready for time on
play. their own without direct adult supervision.
This means that they need good education
SOCIAL DEVELOPMENT on safety practices.
❖ One of the most important socializing agents ❖ School age is not too early for parents to look
in the life of the school-age child is the peer at the effect of carrying heavy backpacks on
group. children’s posture.
❖ Valuable lessons are learned from daily ❖ Sexual maltreatment is an unfortunate and
interaction with age-mates. all-too-common hazard for children.
▪ They learn to appreciate the numerous 1. Safety education is essential; accepts
and varied points of view that are increasing responsibility for own safety.
represented in the peer group. 2. Motor vehicle accidents -leading cause of
▪ They become increasingly sensitive to injuries/accidents
the social norms and pressures of the ▪ Be role model as safe driver
peer group. ▪ Use of safety belts
▪ The interaction among peers leads to the ▪ Teach rules of pedestrians
formation of intimate friendship between ▪ No playing in streets or alleys
same-sex peers. ▪ Practice bike safety
❖ One of the outstanding characteristics of 3. Provide supervision during sports activities.
middle childhood is the formation of 4. Provide adult supervision during swimming
formalized groups or clubs. and boating activities; provide teachings.
▪ (Supervision and education are key
PLAY elements in the prevention of accidents
in. this stage.)
❖ Not only does play involve increased
5. Teach respect for fire and its dangers.
physical skill, intellectual ability, and fantasy,
6. Teach on prevention of - sexual abuse.
but as children form groups and cliques, they
"Private parts" are those parts of the body
begin to develop a sense of belonging to a
covered by a bathing suit
team or club.
❖ School-age play is characterized by rules PROMOTING NUTRITIONAL HEALTH
and rituals, team play, quiet games and
activities, and ego mastery. ❖ Calories : needs 2100 - 2400 calories per day
❖ Breakfast is the most important meal.
LANGUAGE DEVELOPMENT ❖ More likely to eat junk foods and take zero-
caloric foods (softdrinks).
❖ Six-year-olds talk in full sentences, using
❖ To make the child take the needed calories :
language easily and with meaning. By 9
WELL-PLANNED
years of age, they use “swear” words to
❖ Displays good table manners
express anger or just show other children
❖ Fostering industry by preparing simple meals
they are growing up. By 12, a sense of humor
with healthy ingredients
is apparent.
Care of Mother, Child, and Adolescents (LAB)
PROMOTING DEVELOPMENT (Daily Activities) ▪ Dental caries are largely preventable with
proper brushing and use of fluoridated
❖ Dress
water or fluoride application.
▪ the right age to teach children the
❖ Malocclusion
importance of caring for their own
▪ A deviation of tooth position from the
belongings.
normal.
▪ have definite opinions about style or
▪ A malocclusion should be evaluated by
clothing, often based on the likes of their
an orthodontist to see if orthodontic
friends rather than the preferences of
braces or other therapy is necessary.
their parents.
▪ A child who wears different clothing may CONCERNS AND PROBLEMS
become the object of exclusion from a
❖ Problems Associated With Language
school club or group.
Development
❖ Sleep
▪ The common speech problem of the
▪ 10-12 hours of sleep a night
preschool years is broken fluency; the
▪ "Telebabad" ensues which may deprive
most common problem of a school-age
them of adequate sleep at night.
child is articulation.
▪ Children with television sets, electronic
❖ Anxiety Related to Beginning School
games, or smartphones in their
▪ The biggest task of the 1st year of formal
bedrooms not only have shorter sleep
school is learning to family and does not
times at night but also are more likely to
feel pushed out by being sent to school;
be obese
or else, counseling may be done.
❖ Exercise
❖ School Refusal or Phobia
▪ School-age children need daily exercise.
▪ Refers to fear of attending school
▪ Need not involve organized sports.
▪ Child may develop physical signs of
❖ Hygiene
illness.
▪ Both boys and girls become interested in
▪ Causes:
showering as they approach their teen
o anxiety of separation from home
years.
o teacher factor
▪ This can be encouraged because
o particular school-related activities
perspiration increases with puberty,
▪ Interventions:
along with sebaceous gland activity.
o Parents should treat the situation
M9: Lesson 4: School Age: Common Health matter-of-factly.
Problems and Concerns o This requires coordination among the
school, school nurse, and health care
COMMON HEALTH PROBLEMS provider who diagnose the problem.
❖ Children Who Spend Time Independently
❖ Dental Carries ▪ Latchkey Children: refers to school
▪ Caries (cavities) are progressive, children who are without adult
destructive lesions or decalcifications of supervision for a part of each weekday.
the tooth enamel and dentin. ▪ They generally carry a key so they can let
▪ Neglected caries result in poor chewing themselves into their homes after school.
and therefore poor digestion, abscesses, ▪ Major concern: these children feel lonely
and pain, and sometimes osteomyelitis and have an increased tendency to have
(bone infection) if the jaw bone is accidents, delinquent behavior and
involved. decreased school performance from lack
of homework supervision.
Care of Mother, Child, and Adolescents (LAB)
▪ For those children who feel safe, a short much of their own security and respect is
period of independence may actually be lost when they are not believed.
beneficial, because it encourages ❖ Dishonest Behavior-Cheating
problem-solving in self-care. ▪ Most common in young children, ages 5
❖ Sex Education to 6 years.
▪ It is important that school-age children be ▪ Find it difficult to lose at a game or
educated about pubertal changes and contest, and they cheat to win.
responsible sexual practices. ▪ They have not yet acquired the full
▪ Also, preteens should have adults they realization of the wrongfulness of this
can turn to for answers to questions behavior and do it almost automatically.
about sex. ▪ usually disappears as they mature is lost
▪ Ideally, these should be their parents, but when they are not believed.
because sex is an emotionally charged ▪ Parents need to be aware of the types of
topic, some parents may be extremely behaviors they model for their children.
uncomfortable discussing it with their ▪ When they set examples of honesty,
children. children are more likely to conform to
▪ As a result, healthcare personnel often these standards.
become resource persons. ❖ Stealing
▪ Lesbian, gay, bisexual, and transgender ▪ Happens at around 7 years of age when
(LGBT) youth may not obtain the same they discover the importance of money.
levels of care due to fear of ▪ If stealing persists beyond 9 years of age
discrimination. – counseling may be required.
▪ They may choose not to disclose their ▪ Interventions:
sexual orientation or gender identity to o Explore the cause of stealing.
healthcare providers or they may avoid o Handle the situation without a great
care completely. deal of emotion.
▪ Nurses can take steps to improve health o Importance of property rights must be
outcomes for LGBT youth by providing emphasized.
care that is affirming and inclusive. o Parents must set good examples.
❖ Dishonest Behavior-Lying ❖ Violence or Terrorism
▪ Have difficulty distinguishing between ▪ Children basically view their world as
fact and fantasy. safe, so it is a shock when violence such
▪ They do not have the cognitive capacity as a school shooting or reports of
to deliberately mislead. terrorists enter their lives
▪ Sometimes they misperceive or fail to
Common recommendations for parents to
remember an event.
help children feel safe:
▪ They may lie because of low self-esteem
or as a means of getting ahead or ▪ Assure children they are safe; even if the
acquiring something with little effort violence is in their community, their
▪ Reassure parents that all children lie parents are actively involved in being
sometimes and that they often have certain they are not in danger.
difficulty separating fantasy from reality. ▪ Do not allow children or adolescents to
▪ Help parents to understand the view footage of traumatic events over
importance of their own behavior as role and over because this decreases their
models and of being truthful in their ability to feel safe.
relationships with children. ▪ Explain that there are bad people in the
▪ The issue can be discussed with the world, and bad people do bad things, but
children directly to impress on them how
Care of Mother, Child, and Adolescents (LAB)
not all people in a particular group or who
M10: Lesson 1: Adolescent: Nursing
look a particular way are bad. Assessment of Growth and Development
❖ Bullying

Traits commonly associated with school-age ADOLESCENCE

bullies include: ❖ The period between 13-20 years old which
▪ Advanced physical size and strength for serves as a transition period between
their age childhood, and adulthood.
▪ Aggressive temperament (both male and ❖ Period of "storm and stress.“
female) ❖ Second "rapid growth period."
▪ Parents who are indifferent to the 1. Pubescence - the time span during which
problem or are permissive to an reproductive functions begin to mature; ends
aggressive child with the attainment of full maturity or
▪ Parents who typically resort to physical reproductive capacity and is characterized
punishment by:
▪ There is the presence of a child who is a ▪ rapid growth of the body
“natural victim” ▪ full genital development
▪ sexual awareness
Suggestions for school personnel to deal with 2. Puberty - period of full reproductive maturity.
bullies include: ▪ Girls: Before, this period was believed to
be heralded by the first menses
▪ Supervise recreation periods closely.
(Menarche). Studies, however, have
▪ Intervene immediately to stop bullying.
shown that most young girls are NOT
▪ Insist if such behavior does not stop, both
FERTILE for about 1-2 yrs after
the school and parents will become
menarche.
involved.
▪ Boys: Puberty approaches at or near the
▪ Advise parents to discuss bullying with
first ejaculation. True reproductive
their school-age child and help them
maturity is attained when viable sperms
understand that it should be reported to
appear in the semen.
allow adults to intervene.
3. Adolescence - social and behavioral
▪ Parents should monitor their child’s
maturation from the beginning of
social media and texting interactions.
pubescence to beyond the time of
❖ Recreational substance use
reproductive maturity.
▪ Illegal substances are available
nowadays to children even during PHYSICAL GROWTH
Grades V to VI.
▪ Commonly abused-substances: ❖ The major milestones of development in the
o rugby (toluene)/solvents adolescent period are the onset of puberty
o cigarettes (8-12 y/o) and the cessation of body growth
o alcohol (16-18 y/o).
o marijuana ❖ Physiologic growth is rapid and the
development of adult coordination
❖ Growth stops with closure of epiphyses lines
of long bones (16-18 yr. in females; 18-21 in
males
Care of Mother, Child, and Adolescents (LAB)
HEIGHT AND WEIGHT DENTITION

❖ Boys typically grow about 4 to 12 in. (10 to ❖ 2nd Molars : 13 yrs

30 cm) in height and gain about 15 to 65 lb ❖ 3rd Molars (Wisdom Teeth) : 18-21 yr., but
(7 to 30 kg) may erupt as early as 14-15 yr.
❖ Girls grow 2 to 8 in. (5 to 20 cm) in height and ❖ Jaw reaches adult size toward the end of
gain 15 to 55 lb (7 to 25 kg) adolescence. As a result, adolescents whose
❖ Growth stops with the closure of the 3rd molars erupt before the lengthening of the
epiphyseal lines of the long bones, which jaw is complete may experience pain and
occurs at about 16 or 17 years of age in may need these molars extracted because
females and about 18 to 20 years of age in they do not fit the jawline.
males.
PUBERTY
BODY SYSTEMS
❖ Puberty is the time at which an individual
❖ Skeletal System first becomes capable of sexual
▪ First, gain is mostly in weight, leading to reproduction.
stocky, slightly obese appearance, then ❖ A girl has entered puberty when she begins
the thin appearance of late adolescence. to menstruate; a boy enters puberty when he
▪ Skeletal system grows faster than the begins to produce spermatozoa.
muscles. ❖ These events usually occur between ages 11
▪ These differences lead to: and 14 years.
o lack of coordination
SECONDARY SEX CHANGES
o poor posture.
▪ They appear long-legged and awkward ❖ Secondary sex characteristics, such as body
because extremities elongate first hair configuration and breast growth, are
followed by trunk growth. those characteristics that distinguish the
❖ Cardiovascular and Respiratory System sexes from each other but that play no direct
▪ Heart and lungs increase in size more part in reproduction.
slowly than the rest of the body ❖ The secondary sex characteristics that
→insufficient energy left for activity → began in the late school-age period continue
CONSTANT FATIGUE to develop during adolescence.
▪ Fatigue is also due to protein depletion,
with protein being used up for body
growth.
▪ PR = 70 bpm
▪ RR = 20 cpm
▪ BP =120/70 mmHg (late adolescence)
▪ BP in males > BP in females (due to large
body mass in males)
❖ Endocrine System
▪ Androgen stimulates sebaceous glands
to extreme activity (ACNE).
▪ The formation of apocrine sweat glands
(glands present in the axilla and genital
area) occurs shortly after puberty for
strong body odor.
Care of Mother, Child, and Adolescents (LAB)

M10: Lesson 2: Adolescent: Nursing the changing body image that comes with
Assessment of Developmental Milestones adolescence.
❖ Self-Esteem- Like body image, self-esteem
PLAY OR RECREATION may undergo major changes during the
adolescent years and can be challenged by
❖ Thirteen-year-old children change from all the changes that occur during
school-age activities of active games to more adolescence.
adult forms of recreation such as listening to ❖ Value System- Adolescents develop their
music, texting or chatting, or following a values throughout their childhood as they
sports team’s wins and losses. interact with their family. As they increase the
❖ Most adolescents spend a great deal of time amount of time they spend with their peer
just talking with peers as social interaction, group, they may question these values and
either face-to-face or through electronic participate in experiences that may put them
media. at risk for physical and/or psychological
❖ Beginning at the age of 16 years, most harm. Identifying risk-taking behaviors and
adolescents want part-time jobs to earn offering guidance and support is important in
money. Such jobs can teach young people promoting the health of the adolescent.
how to work with others, accept ❖ During adolescence, individuals begin to
responsibility, and how to save and spend explore their sexual preferences and may
money wisely. question their gender identity. Encourage an
❖ Many adolescents engage in charitable open dialogue with adolescents to assist
endeavors during middle to late adolescence them to process their feelings and establish
as a form of recreation. their own identity.
EMOTIONAL DEVELOPMENT ❖ Career Decisions- The adolescent may
identify an educational and career trajectory
❖ Early Adolescent Developmental Task: during self-discovery of personal positive
Identity Versus Role Confusion attributes. It is common for adolescents to
The task of forming a sense of identity is for seek and experiment with multiple roles
adolescents to decide who they are and what before reaching a decision that is rewarding.
kind of person they will be. The four main ❖ Emancipation From Parents
areas in which they must make gains to Emancipation from parents can become a
achieve a sense of identity include: major issue during the middle and late
▪ Accepting their changed body image. adolescent years for two reasons.
▪ Establishing a value system or what kind ❖ Encourage parents to give adolescents more
of person they want to be. freedom in areas such as choosing their own
▪ Making a career decision clothes or after-school activities; at the same
▪ Becoming emancipated from parents time, help parents continue to place some
❖ If young people do not achieve a sense of restrictions on adolescent behavior
identity, they can have little idea what kind of ❖ Both parents and adolescents may need help
person they are or may develop a sense of to understand that emancipation does not
role confusion. mean severance of a relationship but rather
a change in a relationship because people
IDENTITY VS. ROLE CONFUSION
who are independent of one another can
❖ Body Image- Adolescents who were able to have even better relationships than those
develop a strong sense of industry during who are dependent on one another.
their school-age years learned to solve
problems and are best equipped to adjust to
Care of Mother, Child, and Adolescents (LAB)
INTIMACY VS. ISOLATION ❖ Site of gratification: Genitals
❖ Preadolescent and early adolescent:
❖ Developing a sense of intimacy means a late
relationships with same-sex peers.
adolescent is able to form long-term,
❖ Late adolescence: opposite-sex peer
meaningful relationships with persons of the
relationship
opposite as well as their same sex.
❖ Intimate relationships: emotional
❖ Those who do not develop a sense of
attachments between two people
intimacy are left feeling isolated; in a crisis
characterized by concern for each other's
situation, they have no one to whom they feel
well-being; a willingness to disclose private,
they can turn for help or support.
possibly sensitive topics; and a sharing of
SENSE OF INTIMACY common interests and activities.
❖ Distinct from sexual relationships.
❖ Starts toward the end of adolescence and ❖ Possible for individuals to have close
continues into early adulthood. relationships without becoming sexually
❖ The ability to form intimate relationships is involved.
strongly correlated with a sense of trust. ❖ At the same time, people can be involved in
❖ Infants who are unable to front a sense of sexual relationships that are not particularly
trust may be unable to relate to others on a intimate.
deep enough level to form lasting and close ❖ Close friendships include a strong emotional
relationships as adults. foundation in which individuals understand
❖ Need to be helped to differentiate between and care about each other.
sound relationships and those that are based ❖ Development of intimacy during adolescence
only on sexual attraction. involves changes in the adolescent's needs
❖ Intimacy involves: for intimacy and in the capacity and
▪ developing sense of compassion or opportunities to have intimate friendships.
concern for other persons ❖ Over the course of the adolescent years,
▪ discerning when words will hurt individuals become more capable of and
▪ determining when companion us interested in emotional closeness with other
unhappy and needs encouragement d. people.
knowing when a friend needs support ❖ The greater degree of behavioral
(EMPATHY) independence provides more opportunities
❖ Important for parents to keep the lines of for teenagers to be alone with friends and to
communication open on the subject of come into meaningful contact with adults
sexuality. outside their families.
❖ They should be taught to have a ❖ Although research on intimacy during
monogamous relationship and use adolescence has focused on peer
contraceptives (e.g. condoms, pills) to friendships, intimate relationships are by no
prevent that "first love hurts.“ means limited to peers.
❖ The yearning sensation may make them feel, ❖ Teenagers may also develop intimate
that it can be alleviated only by a sexual act. relationships with parents, siblings, and
PSYCHOSEXUAL DEVELOPMENT adults who are not part of their immediate
families.
❖ Genital Stage
❖ 12 – 19 years COGNITIVE DEVELOPMENT
❖ Final major stage in Freud’s theory ❖ The final stage of cognitive development, the
❖ Focuses on sexual maturation with energy stage of formal operational thought,
also spent on friendships and readying for begins at age 12 or 13 years and grows in
marriage. depth over the adolescent years, although it
Care of Mother, Child, and Adolescents (LAB)
may not be complete until about age 25
years.
❖ This step involves the ability to think in
abstract terms and use the scientific method
(i.e., deductive reasoning) to arrive at
conclusions.
❖ The problems that adolescents are asked to
solve in school
depend on this type of thought.
❖ Problem solving in any situation depends on
the ability to think abstractly and logically.
❖ With the ability to use scientific reasoning,
adolescents can plan their future. They can
create a hypothesis and think through the
probable consequences.
❖ Is capable of:
▪ abstract thinking (able to describe self
abstractly)
▪ scientific reasoning and formal logic
▪ views problems comprehensively
▪ increasing intellectual abilities
▪ learning through intuition, inference and
surmise rather than imitation and
repetition M10: Lesson 3: Planning and
Implementation for the Health Promotion of
▪ making a hypothesis
Adolescent and Family
MORAL DEVELOPMENT
PROMOTING ADOLESCENT SAFETY
❖ STAGE VII ("FIRST STAGE OF TRUE
❖ Unintentional injuries, most commonly those
MORALITY”, 12-18 YRS)
involving motor vehicles, are the leading
▪ Morality is based on contractual
cause of death among adolescents.
agreements, both personal or social.
❖ Drowning occur in adolescents when good
▪ There is clear awareness of relativism of
swimmers go beyond their capabilities on
values and impermanence of regulations.
dares or in hopes of impressing friends.
▪ The Constitution and the “situation
❖ Other common causes of death in
ethics" are examples.
adolescents are homicide and self-harm (i.e.,
▪ "Let's decide what's best for us."
suicide).
SOCIALIZATION
Care of Mother, Child, and Adolescents (LAB)
❖ Sleep
▪ Need an average of 8 hours sleep
▪ "Growth spurts" happen during sleep
protein synthesis and release of
somatotropic hormone happen when a
person sleeps.
❖ Exercise
▪ Needed to maintain muscle tone and to
provide an outlet for tension.
▪ Adolescents who are involved in
structured athletic activities do receive
daily exercise. If they have not
participated in competitive sports before,
however, they may need advice on
increasing exercise gradually so they do
not overdo it and consequently develop
muscle sprains or other overuse injuries.
PROMOTING NUTRITIONAL HEALTH
PROMOTING HEALTHY FAMILY FUNCTIONING
❖ Appetite increases with rapid growth.
❖ Early adolescents may have many
❖ Inadequate diet results to retarded growth
disagreements with parents that stem partly
and delay in sexual maturity.
from wanting more independence and partly
❖ Increased need for protein, Calcium for rapid
from being so disappointed in their bodies. It
skeletal growth, Iron for girls during
may be helpful to counsel parents to
menstruation, Zinc for sexual maturation.
appreciate that although it is not easy to live
❖ WATER is the most important element in his
with a teenager, it is equally difficult to be the
diet and in the diet of all age groups.
teenager.
❖ Sports activities increase nutritional
❖ By the time they are 16 years old,
requirements.
adolescents generally become more willing
❖ Eating habits are influenced by peer group:
to listen and talk about problems.
e.g. Junk foods
❖ Unfortunately, as another way to prove they
PROMOTING DEVELOPMENT (Daily activities) are old enough to leave high school and
enter into a more mature college or work
❖ Dress and Hygiene
world, older adolescents may begin to
▪ Capable of “total self-care"
experiment with drugs or alcohol, interpreting
▪ Overly conscientious about appearance
the use of these as the mark of being an
and personal hygiene
adult.
▪ Money is usually spent for clothing.
❖ Care of the Teeth M10: Lesson 4: Adolescent: Common Health
▪ Adolescents are generally very Problems and Concerns
conscientious about tooth brushing
because of a fear of developing bad COMMON HEALTH PROBLEMS
breath. ❖ Hypertension
▪ Individuals with braces must be ▪ Causative factors:
extremely conscientious in tooth o obesity
brushing to prevent plaque buildup on o black race
tooth surfaces. o diet high in salt and fat
o family history of HPN
Care of Mother, Child, and Adolescents (LAB)
▪ BP should be taken routinely in children “normal” weight and standard food
over 3 yr. of age. portions.
❖ Poor Posture
▪ Due to imbalance of growth that arises
from skeletal system growing a little more
rapidly than the muscles attached to it.
▪ Detect difference between normal
posture and the beginning scoliosis.
❖ Body piercing and tattoos
▪ Body piercing and tattoos are a strong
mark of adolescence.
▪ Body piercings and tattoos have become
a way for adolescents to make a
statement of who they are and that they
are different from their parents.
▪ Be certain they know the symptoms of
infection at a piercing or tattoo site.
❖ Fatigue
▪ Diet, sleep patterns and activity
schedules must be assessed.
▪ Be aware that if the fatigue began as a
short period of extreme tiredness, it
suggests disease more so than a long, ill-
defined report of always feeling tired.
❖ Menstrual Irreguralities
▪ Check ups with an OB-Gynecologist
should be done if irregularities persist.
❖ Acne (Pimples)
▪ A common skin disorder which is a self-
limiting inflammatory disease that
▪ involves the sebaceous glands that
empty into hair shafts (pilosebaceous
unit).
▪ More common in boys than girls.
▪ Peak ages:
o 14-17 years (females)
o 16-19 years (males)
❖ Obesity
▪ Obesity can interfere with developing a
sense of identity if it is difficult for
adolescents to like their reflection in a
mirror or if they are always excluded from
groups because of their weight.
▪ Some adolescents may be unaware that
their food intake is excessive.
▪ Health teaching with these adolescents
may need to begin with a discussion of