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OB/Peds Blueprint for Exam 1 OB Measuring fundal height - determines uterine development & use to estimate gestation week (GW); measurement of height of uterus above symphysis pubis & indicator of fetal growth (p178) ● Starts at 20 weeks gestation (per ATI); uterus gradually rises to the level of the umbilicus; eaches xiphoid process by 36 wks ● Gestational weeks (GW) 18 to 30 fundal height in cm approx equals fetal age in weeks +/- 2 cm (3 cm variation on full bladder) ● Supine w/ head elevated &/or knees flexed; tape can be placed in the middle of a woman's abdomen & measurement made from upper border of symphysis pubis to upper border of fundus, w/ tape measure held in contact w/ skin for the entire length of uterus Process of conception (pg. 133) / Period of organogenesis One ovum per month is released from the ovary Viable for 12-24 hours; sperm viability: 48-72 hrs; conception period: 3-4 days Following intercourse, millions of sperms travel in search of an ova During travel the sperm undergo capacitation Only one sperm is able to penetrate the ovum Maturation of the ovum and sperm cells Pregnancy comes about from the union of a female germ cell, ovum with a male germ cell, the spermatozoon. Organogenesis is formation of organs; week 8 (Stage 2: embryonic): heart has 4 chambers, circulation through umbilical cord occurs, & all essential external & internal structures are present & will continue to grow (see PowerPoint: Conception, Pregnancy & Nutrition _ slide 5) Nutrition in pregnancy 25 – 35 lbs average expected weight gain for normal weight before pregnancy Increase calorie intake by 300 cal/day during pregnancy & energy intake increase of 400-500 kcal during lactation Iron – 30 mg; prevent anemia & maternal hemoglobin formation, fetal liver iron storage; SOURCES: liver, meats, whole grain or enriched breads and cereals, dark green leafy vegetables, legumes, dried fruits Folic acid – intake at least 400 mcg / 0.4 mg; prevention of neural tube defects, oral facial cleft (spinal bifida) & increased maternal RBC formation; SOURCES: fortified ready-to-eat cereals & other grain products, dark green leafy vegetables, oranges, broccoli, asparagus, artichokes, liver Calcium – fetal skeleton & tooth formation; maintenance of maternal bone & tooth mineralization; SOURCES: milk, cheese, yogurt, sardines or other fish eaten with bones left in, dark green leafy vegetables except spinach or Swiss chard, calcium-set tofu, baked beans, tortillas AVOID : shark, swordfish, king mackerel, or tilefish, tuna because of high mercury levels, caffeine, alcohol, & artificial sweeteners Determining GTPAL (p150) Gravity - # of positive test including current children
Term - # of born term; 37 to 40 weeks Preterm - # birth before 37 wks; 20 to 36 and 6/7 (6th day of a 7 week) Abortion - SAB or EAB; # of abortions or miscarriages before 20 wks of gestation Living Children - currently living children Naegele’s rule for determining EDC (p166) - Requires that the woman have a regular 28 day menstrual cycle Determining the first day of LMP, subtract 3 calendar months & add 7 days ; ie: December 10, 2016 is first day of LMP; EDB is September 17, 2017 Month Day Year LMP 12 10 2016 –3 + EDB 9 17 2017 Signs of pregnancy (probable, presumptive, and positive) (p152) Presumptive –changes felt by the woman; subjective changes reported (e.g., amenorrhea, fatigue, breast changes); can be caused by conditions other than pregnancy Probable – changes observed by an examiner; objective changes assessed by examiner (e.g., Hegar sign, ballottement, pregnancy tests); combined w/ presumptive S/S changes strongly suggest pregnancy Positive – signs attributed only to the presence of the fetus; objective signs assessed by examiner can be attributed only to the presence of the fetus (e.g., hearing fetal heart tones, visualizing the fetus, palpating fetal movements); definitive signs that confirm pregnancy Teratogens •Smoking during pregnancy: can lead to preterm labor, LBW, & intrauterine growth restriction. It also impairs milk production. The Five A’s: Ask, Advise, Assess, Assist, Arrange follow-up •Alcohol: can cause birth defects, impaired cognitive & psychomotor development, & emotional & behavioral problems. Fetal alcohol syndrome: involves growth restriction, central nervous system abnormalities, & facial dysmorphia. •Illicit drugs: deformities and neonatal abstinence syndrome •Caffeine: spontaneous abortion or preterm labor •Viruses: can cross the placenta. Ex. Rubella Hormone functions: ● Progesterone - maintains the endometrium, decreases contractility of the uterus, & stimulates maternal metabolism & development of breast alveoli. ● Estrogen - prepare endometrium for pregnancy. Stimulates uterine growth & uteroplacental blood flow. Causes proliferation of the breast glandular tissue & stimulates myometrial contractility ● FSH - stimulates growth of follicles ● LH - stimulates ovulation and development of corpus luteum ● HCG - can be detected in the maternal serum by 8-10 days after conception. hCG preserves the function of the ovarian corpus luteum. Stimulates meiosis & rupture of the follicle. Endometriosis - presence & growth of endometrial tissue outside of uterus; symptomatic or asymptomatic
▪ protective mechanical barrier ▪ rewetting drops or oil- or water-based lubricants may be used to help decrease the distracting noise that is produced upon thrusting ▪ intended for single use, and is sold OTC ▪ male condoms should not be used concurrently o Diaphragm (pg. 111) ▪ shallow, dome-shaped, latex or silicone device with flexible rim that covers the cervix ▪ mechanical barrier to meeting of sperm with ovum ▪ also provides a chemical barrier to pregnancy- by holding spermicide in place against the cervix for the 6 hours it takes to destroy sperm ▪ should be largest size woman can wear ▪ General Information: ● you must use diaphragm every time intercourse takes place ● must be left in place for at least 6 hours after last intercourse o if you remove it before the 6 hours it increases your chances of becoming pregnant ● if you have repeated acts of intercourse, you must add more spermicide for each act ● Disadvantages: o reluctance to insert and remove it o cold gel may reduce vaginal response to stimulation o failure to insert device before foreplay o Cervical Cap (pg. 112) ▪ fits snugly around the base of the cervix close to the junction of the cervix and vaginal fornices ▪ remain in place no less than 6 hours and no more than 48 hours at a time ▪ should be left for at least 6 hours after last intercourse ▪ seal provides a physical barrier to sperm; spermicide inside the cap provide a chemical barrier ▪ can be inserted hours before sex without later need for additional spermicide ▪ Toxic Shock Syndrome (TSS) can occur o Contraceptive Sponge (pg 113) ▪ vaginal sponge is a small, round polyurethane sponge that contains N-9 spermicide designed to fit over the cervix ▪ sponge must be moistened with water before it is inserted into the vagina to cover the cervix ▪ provides protected for up to 24 hours and for repeated instances of sex ▪ should be left in place for at least 6 hours after last sex and no more than 24-30 hours ● wearing it longer may put women at risk for TSS ● Chemical - o Spermicides- such as nonoxynol-9 (N-9) ▪ work by reducing the mobility of the sperm
▪ chemicals attach the sperm flagella and body, thereby preventing the sperm from reaching the cervical os ▪ surfactant that destroys the sperm cell membrane o Intravaginal Spermicides ▪ sold without prescriptions ▪ aerosols, foams, tablets, suppositories, creams, films, and gels ▪ Not more than 1 hour before intercourse, the spermicide should be inserted high into the vagina so that it makes contact with the cervix ● Ovum viability - o 12 to 24 hours Fertility assessments · Endometriosis (pg. 67) o Presence and growth of endometrial tissue outside the uterus o During or immediately after menstruation the tissue bleeds, resulting in an inflammatory response with subsequent fibrosis and adhesions to organs o Decreases chances of getting pregnant · Normal- Female o Favorable cervical mucus (thin & watery) o Clear Passage between cervix and tubes o Patent tubes with normal mobility · Normal- Male o Normal Semen o Unobstructed genital tract o Normal genital function o Normal hormones · Females- Diagnostic Testing o H&P o Assessment of Ovulatory Function § Basal Body Temperature Monitoring (BBP) · Have to be consistent, same way everyday · Sharp drop = ovulation § Hormonal Assessment § Transvaginal Ultrasound § Endometrial Biopsy o Assessment of Cervical Factors § Spinnbarkheit § Ferning Test (cervical mucus) o Hysterosalpinography o Laparoscopy · Males- Diagnostic Testing
● Stage 1: Pre-Embryonic Development o Morula (fertilized egg) eventually forms a fluid filled cavity w/in cell mass ● Blastocyst ○ Inner solid cell mass ○ Develops into fetus and amnion ● Trophoblast ○ Out cell mass that surrounds cavity ○ Develops into the placenta and Chorion o Cluster of Cells o Woman may never know she was pregnant o 7-14 days ● Stage 2: Embryonic (Weeks 3-8) o Week 8: Period of Organogenesis ● Heart has 4 chambers ● Circulation through umbilical cord occurs ● All essential external/internal structures are present and grow ● Stage 3: Fetal (Weeks 9-40) o Weeks 21- ● Surfactant production begins around week 24 ○ Betamethasone- steroid given to speed up surfactant production in case baby is early ● Respiratory movement noted ● Fetus reacts to sudden movements o Weeks 29- ● Subcutaneous fat forms ● Testes start to descend o Weeks 33- ● Body begins to store fat ● Muscle tone is developed ● Maternal antibodies transfer to fetus ● Exhibits sleep and awake patterns ● Fetal Assessment Tests? ○ NonStress Test ○ Amniocentesis ○ Chorionic Villi Sampling ○ Ultrasound ○ Biophysical Profile
● Placenta (ch. 6, pg. 137) ○ forms at implantation ○ maternal-placental-embryonic circulation is in place by day 17 ○ functions as a means of metabolic exchange ● Fetal Circulatory System (pg. 139) ○ cardiovascular system is the first organ system to function in developing human ○ blood vessel and blood cell formation begins in 3rd week and supplies embryo with oxygen ○ Lungs do not function for respiratory gas exchange ■ Special pathway called ductus arteriosus bypasses the lungs ● Hematopoietic System (pg. 140) ○ formation of blood, occurs in yolk sac- beginning of 3rd week ○ 5th week- stem cells seed fetal liver ○ 6th week- hematopoiesis begins ○ 7th & 9th week- large liver size ○ 8th- 11th week: bone marrow, spleen, thymus, lymph nodes ● Respiratory System (pg. 141) ○ develops during embryonic life ○ week 4-17: development of respiratory tract (larynx, trachea, bronchi, lung buds) ○ 16-24 weeks: bronchi and terminal bronchioles ○ Week 24: Surfactant ● Gastrointestinal System (pg. 141) ○ 5th/6th Week: pharynx, lower respiratory, esophagus, stomach, duodenum, liver, pancreas, and gallbladder ● Hepatic System (pg. 141) ○ 4th Week: Liver and Biliary tract ○ 12th Week: Bile a constituent of meconium ● Renal System (pg. 142) ○ Kidneys form during 4th week ○ begin to function in 5th week ● Neurologic System (pg. 142) ○ 3rd week: nervous system originates from ectoderm ○ 4th Week: Open neural tube forms ○ 8th Week: Nerve fibers transverse throughout body ○ 11th/12th week: fetus makes respiratory movements, moves all extremities, and changes position in utero ○ 24 weeks: responds to sound ● Endocrine System (pg. 142) ○ 3rd/4th Week: thyroid gland develops with structures along head/neck ○ 8th Week: secretions of thyroxine ○ 6th Week: adrenal cortex is formed ○ 5th-8th Week: Pancrase forms ○ 20th week: Insulin is produced
Accident Prevention/Anticipatory Guidance
● Anticipatory Guidance ensures that parents are aware of the specific developmental needs of each developmental stage (pg. 689) ● Focused on providing families information on normal growth and development and nurturing child rearing practices; deal with it before it becomes a problem (pg. 743) ○ prenatally- parents need specific instructions on home safety ○ parents must implement home safety changes early to minimize risks to child ● AP- should extend beyond giving general information to empowering families to use the information as a means of building competence in their abilities ○ base interventions on needs identified by the family, not the professional ○ view family as competent or as having ability to be competent ○ provide opportunities for the family to achieve competence ● Suicide, poisoning, falls, head injuries, drowning, burns, firearm injuries ○ implementing programs of injury prevention and health promotion (pg. 691) ● As children develop, their innate curiosity compels them to investigate the environment ● Prevention Strategies (pg. 691) ○ use of car restraints ○ bicycle helmets ○ smoke detectors ● RN plays a role in preventing injuries by using developmental approach to safety counseling for parents and children ○ RN discusses appropriate injury prevention tips to parents and children (pg. 696)
Communicating with family on topics of concern
● Be direct, empathetic
Communication techniques with children (pg. 744)
● pay attention to infants/younger children through play or by directing questions or remarks at them ● include other children as active participants ● nonverbal components convey the most significant messages ● continue to talk to the child, but go about activities that do not involve the child ○ allows child to observe from safe position ● If a child has a toy/doll, “talk” to the doll first to ease child into conversation ● allow children time to feel comfortable ● avoid sudden or rapid advances, broad smiles, extended eye contact ● talk to parents if child is initially shy ● communicate through transition objects before questioning child directly ● give older children opportunity to talk without parents present ● assume a position that is eye level with child ● speak in quiet, unhurried, and confident voice ● speak clearly, be specific, and use simple words and short sentences ● state directions and suggestions positively
● offer a choice only when one exists ● be honest ● allow children to express concerns/fears ● use a variety of communication techniques
Pain assessment in children (pg. 793)
● purpose of pediatric pain assessment is to determine how much pain the child is feeling ● Behavioral/Observational Pain Measures ○ infancy to 4 years old ○ trained observer to watch a child's behaviors that suggest discomfort (vocalization, facial expressions, body movements) ● Self-Report Pain Rating Scales ○ children older than 4 years old ○ simple, concrete anchor words, such as “no hurt” to “biggest hurt” ○ Faces Scales- children can simply point to the face that represents how they feel ● Multidimensional Measures ○ cognitive skills (measurement, classification, seriation) become apparent b/w 7-10 years old ○ Older children are able to use 0- ○ Pain charts and pain drawings are used to obtain information on the location of pain ○ Pediatric Pain Questionnaire- asses patient and parental perceptions of the pain Normal development in the infant and toddler, developmental assessments(p723) · Directional Trends
- First pattern : cephalocaudal or head-to-tail direction – head end develops first & is large & complex, whereas lower end is small & simple & takes shape at later period; most apparent during period before birth, but also applies to postnatal behavior development. Infants achieve control of heads before they have control of their trunks & extremities, hold their backs erect before they stand, use their eyes before their hands, & gain control of their hands before they have control of their feet.
- Second trend : proximodistal , or near-to-far – midline-to-peripheral concept; early embryonic development of limb buds followed by rudimentary fingers & toes. In infants, shoulder control precedes mastery of the hands, whole hand is used as a unit before fingers can be manipulated, & CNS develops more rapidly than PNS. Trends or patterns are bilateral & appear symmetric; each side develops in same direction & at same rate as other.
- Third trend : differentiation – describes development from simple operations to more complex activities & functions, from broad, global patterns of behavior to more specific, refined patterns. All areas of development (physical, cognitive, social, & emotional) proceed this direction; process of development & differentiation, early embryonal cells w/ vague, undifferentiated functions progress to an immensely complex organism composed of highly specialized & diversified cells, tissues, & organs. Generalized development precedes specific or specialized development; gross, random muscle movements take place before fine muscle control. · Sequential Trends – In all dimensions of growth & development, there is a definite, predictable sequence, w/ each child passing through every stage. For example, children crawl before they creep, creep before they stand, & stand before they walk. Later facets of the personality are built on the early
Focus assessment on airway, breathing, and circulation; weigh child whenever possible for calculation of drug dosages. Unless an emergency is life-threatening, children need to participate in their care to maintain a sense of control. Focus on essential components of admission counseling, including the following:
- Appropriate introduction to the family
- Use of child's name, not terms such as “honey” or “dear”
- Determination of child's age and some judgment about developmental age (If the child is of school age, asking about the grade level will offer some evidence of intellectual ability.)
- Information about child's general state of health, any problems that may interfere with medical treatment (e.g., allergies), and previous experience with hospital facilities
- Information about the chief complaint from both the parents and the child Admission to ICU Prepare child and parents for elective intensive care unit (ICU) admission, such as for postoperative care after cardiac surgery. Prepare child and parents for unanticipated ICU admission by focusing primarily on the sensory aspects of the experience and on usual family concerns (e.g., people in charge of child's care, schedule for visiting, area where family can stay). Prepare parents regarding child's appearance and behavior when they first visit child in ICU. Accompany family to bedside to provide emotional support and answer questions. Prepare siblings for their visit; plan length of time for sibling visitation; monitor siblings' reactions during visit to prevent them from becoming overwhelmed. Encourage parents to stay with their child:
- If visiting hours are limited, allow flexibility in schedule to accommodate parental needs.
- Give family members a written schedule of visiting times.
- If visiting hours are liberal, be aware of family members' needs and suggest periodic respites.
- Assure family they can call the unit at any time. Prepare parents for expected role changes, and identify ways for parents to participate in child's care without overwhelming them with responsibilities:
- Help with bath or feeding.
- Touch and talk to child.
- Help with procedures. Provide information about child's condition in understandable language:
- Repeat information often.
- Seek clarification of understanding.
- During bedside conferences, interpret information for family members and child or, if appropriate, conduct report outside room. Prepare child for procedures even if it involves explanation while procedure is performed. Assess and manage pain; recognize that a child who cannot talk, such as an infant or child in a coma or on mechanical ventilation, can be in pain. Establish a routine that maintains some similarity to daily events in child's life whenever possible:
- Organize care during normal waking hours.
- Keep regular bedtime schedules, including quiet times when television or radio is lowered or turned off.
- Provide uninterrupted sleep cycles (60 minutes for infants; 90 minutes for older children).
- Close and open drapes and dim lights to allow for day and night.
- Place curtain around bed for privacy.
- Orient child to day and time; have clocks or calendars in easy view for older children. Schedule a time when child is left undisturbed (e.g., during naps, visit with family, playtime, or favorite program). Provide opportunities for play. Reduce stimulation in the environment:
- Refrain from loud talking or laughing.
- Keep equipment noise to a minimum.
- Turn alarms as low as safely possible.
- Perform treatments requiring equipment at one time.
- Turn off bedside equipment that is not in use, such as suction and oxygen.
- Avoid loud, abrupt noises.
Normal growth and changes for infant and toddler (pg. 725)
● External Proportions ○ fetal development- head is the fastest growing body part; at 2 months gestation, head is 50% of total body length ○ Infancy- trunk predominates; ○ Childhood- legs are the most rapidly growing part ○ Adolescence- trunk again elongates ● Skeletal Growth and Maturation ○ most accurate measure of general development is skeletal or bone age- osseous maturation ○ Bone formation begins during the second month of fetal life ○ assessment of bone age: 5-6 months ○ RN’s must understand that growing bones of children possess many unique characteristics ■ bone fractures occurring at growth plate may be difficult to discover and may significantly affect subsequent growth and development ■ Factors that influence skeletal muscle injury rates and types in children and adolescents: ● less protective sports equipment ● less emphasis on conditioning, especially flexibility ● adolescents- fractures are more common than ligamentous ruptures because of the rapid growth rate ● Neurological Maturation ○ grows proportionately more rapidly before birth ○ rapid growth of infancy continues during early childhood then slows to a more gradual rate during childhood and adolescence ○ Two periods of rapid brain cell growth ■ A: dramatic increase in the number of neurons between 15-20 weeks of gestation ■ B: increase at 30 weeks which extends to 1 year of life ● Metabolism ○ energy requirement to build tissue steadily decreases with age following the general growth curve
- Genitourinary
- Gynecologic
- Musculoskeletal
- Neurologic
- Genitourinary
- Gynecologic
- Musculoskeletal
- Neurologic
- Endocrine Family medical history: To identify genetic traits or diseases that have familial tendencies and to assess exposure to a communicable disease in a family member and family habits that may affect the child's health, such as smoking and chemical use Psychosocial history: To elicit information about the child's self-concept Sexual history: To elicit information concerning the child's sexual concerns or activities and any pertinent data regarding adults' sexual activity that influences the child Family history: To develop an understanding of the child as an individual and as a member of a family and a community
- Family composition
- Home and community environment
- Occupation and education of family members
- Cultural and religious traditions
- Family function and relationships Nutritional assessment: To elicit information on the adequacy of the child's nutritional intake and needs
- Dietary intake
- Clinical examination Performing Pediatric Physical Examination (pg. 756) Perform the examination in an appropriate, nonthreatening area:
- Have room well-lit and decorated with neutral colors.
- Have room temperature comfortably warm.
- Place all strange and potentially frightening equipment out of sight.
- Have some toys, dolls, stuffed animals, and games available for the child.
- If possible, have rooms decorated and equipped for different-age children.
- Provide privacy, especially for school-age children and adolescents.
- Provide time for play and becoming acquainted. Observe behaviors that signal the child's readiness to cooperate:
- Talking to the nurse
- Making eye contact
- Accepting the offered equipment
- Allowing physical touching
- Choosing to sit on the examining table rather than the parent's lap If signs of readiness are not observed, use the following techniques:
- Talk to the parent while essentially “ignoring” the child; gradually focus on the child or a favorite object, such as a doll.
- Make complimentary remarks about the child, such as about his or her appearance, dress, or a favorite object.
- Tell a funny story, or play a simple magic trick.
- Have a nonthreatening “friend” available, such as a hand puppet, to “talk” to the child for the nurse (see Fig. 4.26, A ). If the child refuses to cooperate, use the following techniques:
- Assess reason for uncooperative behavior; consider that a child who is unduly afraid may have had a traumatic experience.
- Try to involve the child and parent in the process.
- Avoid prolonged explanations about the examining procedure.
- Use a firm, direct approach regarding expected behavior.
- Perform the examination as quickly as possible.
- Have an attendant gently restrain the child.
- Minimize any disruptions or stimulation.
- Limit the number of people in the room.
- Use an isolated room.
- Use a quiet, calm, confident voice. Begin the examination in a nonthreatening manner for young children or children who are fearful:
- Use activities that can be presented as games, such as test for cranial nerves (see Table 29.11 or parts of developmental screening tests (see Chapter 28).
- Use approaches such as Simon Says to encourage the child to make a face, squeeze a hand, stand on one foot, and so on.
- Use the paper-doll technique:
- Lay the child supine on an examining table or floor that is covered with a large sheet of paper.
- Trace around the child's body outline.
- Use the body outline to demonstrate what will be examined, such as drawing a heart and listening with a stethoscope before performing activity on the child. If several children in the family will be examined, begin with the most cooperative child to model desired behavior. Involve the child in the examination process:
- Provide choices, such as sitting on a table or in a parent's lap.
- Allow the child to handle or hold equipment.
- Encourage the child to use equipment on a doll, family member, or examiner.
- Explain each step of the procedure in simple language.
- Examine the child in a comfortable and secure position:
- Sitting in parent's lap
- Sitting upright if in respiratory distress Proceed to examine the body in an organized sequence (usually head to toe) with the following exceptions:
- Alter sequence to accommodate the needs of different-age children (see Table 29.2).
- Examine painful areas last.
- In an emergency situation, examine vital functions (airway, breathing, and circulation) and injured area first. Reassure the child throughout the examination, especially about bodily concerns that arise during puberty. Discuss findings with the family at the end of the examination. Praise the child for cooperation during the examination; give a reward such as a small toy or sticker.
Developmental Theories and Applying the Concepts
Freud Psychosexual development: Oral stage ( birth to 1 year of age ) – During infancy, the major source of pleasure seeking is centered on oral activities, such as sucking, biting, chewing, and vocalizing. Children may prefer one of these over the others, and the preferred method of oral gratification can provide some indication of the personality they develop. Anal stage ( 1 to 3 years of age ) – Interest during the second year of life centers in the anal region as sphincter muscles develop and children are able to withhold or expel fecal material at will. At this stage, the climate surrounding toilet training can have lasting effects on children's personalities. Phallic stage ( 3 to 6 years of age ) – During the phallic stage, the genitalia become an interesting and sensitive area of the body. Children recognize differences between the sexes and become curious about the dissimilarities. This is the period around which the controversial issues of the Oedipus and Electra complexes, penis envy, and castration anxiety are centered.
_- Become aware that objects have permanence—that an object exists even though it is no longer visible
- Toward the end of the sensorimotor period, children begin to use language & representational thought
- Preoperational (2 to 7 years of age) – predominant characteristic of egocentrism (sense does not mean selfishness or self-centeredness but inability to put oneself in place of another)
- Children interpret objects & events in terms of their relationships or their use to them; unable to see things from any perspective other than their own; cannot see another's point of view, nor see any reason to do so.
- Preoperational thinking is concrete & tangible.
- Children cannot reason beyond observable & lack ability to make deductions or generalizations; thought dominated by what they see, hear, or otherwise experience; increasingly able to use language & symbols to represent objects in their environment
- Through imaginative play, questioning, & other interactions, they begin to elaborate concepts & to make simple associations between ideas
- Concrete operations (7 to 11 years of age) – thought becomes increasingly logical & coherent
- Children able to classify, sort, order, & organize facts about world to use in problem solving
- Develop new concept of permanence: conservation - realize that physical factors (volume, weight, & number) remain the same even though outward appearances are changed
- Able to deal w/ number of different aspects of situation simultaneously
- Do not have the capacity to deal in abstraction; solve problems in concrete, systematic fashion based on what they can perceive; reasoning is inductive
- Thought becomes less self-centered; can consider points of view other than their own; thinking has become socialized
- Formal operations (11 to 15 years of age) – characterized by adaptability & flexibility
- Adolescents think in abstract terms, use abstract symbols, & draw logical conclusions from set of observation
- Can make hypotheses & test them; they can consider abstract, theoretic, & philosophic matters; may confuse ideal w/ practical, most contradictions can be dealt w/ & resolved_ Language Development · Born w/ mechanism & capacity to develop speech & language skills but do not speak spontaneously; environment provide means to acquire skills · Intact physiologic structure & function (respiratory, auditory, & cerebral) plus intelligence, need to communicate, & stimulation · Intelligence – rate of speech development varies from child to child & directly related to neurologic competence & cognitive development · Need to communicate – gesture precedes speech; gesture recedes but never disappears entirely as speech develops; infants can learn sign language before vocal language & that it may enhance development of vocal language · Stimulation – all stages of language development, children's comprehension vocabulary (what they understand) is greater than their expressed vocabulary (what they can say), & development reflects continuing process of modification involves both acquisition of new words & expanding & refining of word meanings previously learned Moral Development (Kohlberg) - Preconventional level – moral development parallels preoperational level of cognitive development & intuitive thought; culturally oriented to labels of good/bad & right/wrong, children integrate these in terms of physical or pleasurable consequences of their actions
_- At first, children determine goodness or badness of an action in terms of its consequences; avoid punishment & obey w/out question those who have authority to determine & enforce rules; have no concept of basic moral order that supports consequences
- Later, children determine that right behavior consists of w/c satisfies their own needs (sometimes needs of others); elements of fairness, give & take, & equal sharing are evident; interpreted in practical, concrete manner without loyalty, gratitude, or justice
- Conventional level – children concerned w/ conformity & loyalty; value maintenance of family, group, or national expectations regardless of consequences
- Behavior meets w/ approval & pleases or helps others is considered good; earns approval by being “nice”
- Obeying rules, doing one's duty, showing respect for authority, & maintaining social order are correct behaviors
- Correlated w/ stage of concrete operations in cognitive development
- Postconventional, autonomous, or principled level – individual has reached cognitive stage of formal operations
- Correct behavior tends to be defined in terms of general individual rights & standards that have been examined & agreed on by the entire society
- Emphasis on possibility for changing law in terms of societal needs & rational considerations_ Role of Play in Development · Social-affective play – begins w/ social-affective play; infants take pleasure in relationships w/ people; adults talk, touch, nuzzle, & elicit responses from infant, the infant soon learns to elicit parental emotions & responses w/ behaviors as smiling, cooing, or initiating games & activities · Sense-pleasure play – nonsocial stimulating experience that originates from w/out; objects in environment (light & color, tastes & odors, textures & consistencies) attract children's attention, stimulate their senses, & give pleasure · Skill play – after infants have developed ability to grasp & manipulate, they persistently demonstrate & exercise their newly acquired abilities through skill play, repeating action over & over again · Unoccupied behavior – children are not playful but focus their attention momentarily on anything that strikes their interest; onlookers who actively observe activity of others · Dramatic, or pretend, play – One of vital elements in children's process of identification is dramatic play (symbolic or pretend play); begins in late infancy (11 to 13 months of age) & predominant form of play in preschool children; can pretend & fantasize almost anything by acting out events of daily life, children learn & practice roles & identities modeled by members of their family & society.
- Children's toys provide medium for learning about adult roles & activities that may be puzzling & frustrating to them
- Simple, imitative, dramatic play of toddlers, like using telephone, driving car, or rocking doll, evolves into more complex, sustained dramas of preschoolers, w/c extend beyond common domestic matters to wider aspects of the world & society, such as playing police officer, storekeeper, teacher, or nurse
- Older children work out elaborate themes, act out stories, & compose plays · Games – children in all cultures engage in games alone & w/ others
- Very young children participate in simple, imitative games such as pat-a-cake & peek-a-boo
- Preschool children learn & enjoy formal games, beginning w/ ritualistic, self-sustaining games (ring around the rosy & London Bridge); exception of some simple board games, preschool children do not engage in competitive games; preschoolers hate to lose & try to cheat, want to change rules, or demand exceptions & opportunities to change their moves
- School-age children & adolescents enjoy competitive games, including cards, checkers, & chess, & physically active games Social Character of Play
