Developmental Influences on Child Health Promotion

1. Developmental Influences on Child Health Promotion Part 2: Psychosocial, Cognitive, Moral Development Ricci, chapters 25-29

2. G&D Theories • Piaget—cognitive—learning to think, reason, make judgments • Erikson—psychosocial—personality development • Kohlberg—moral—development of a sense of right and wrong

3. Piaget • Sensorimotor phase—learning thru senses and motor skills. Object permanence is major task. • Preoperational phase—egocentrism—inability to see others’ point of view. Concrete thinking based on what is observed. • Concrete operations—mostly concrete thinking with beginnings of abstract thought. Conservation and reversibility are major concepts • Formal operations—abstract thinking. Develops a workable philosophy of life.

4. Erikson • Trust vs. mistrust (0-1). Relationship to primary caregiver is essential to establishing trust. • Autonomy vs. shame & doubt (1-3). Need to do things for self. When stopped or made to feel wrong about it, feel shame and doubt. • Initiative vs. guilt (3-6). Creating and starting things on one’s own. Egocentrism causes guilt. • Industry vs. inferiority (6-12). Need to feel worthwhile and important is crucial. Comparison to peers creates feelings of inferiority. • Identity vs. role confusion (12-18). Striving for a sense of self and belonging and finding a direction are important. Demands on self and from others can create confusion.

5. Kohlberg • Preconventional level—doing what is right to avoid punishment or because it is in his own best interests and is fair • Conventional level—tries to live up to others expectations; what is right is whatever is society’s rules • Postconventional level—doing good acc’d to what is best for greatest #; universal moral principles of justice, equal rights, and respect for human dignity

6. Developmental Tasks—Infant • Trust • Begins separateness • Develops and desires affection • Preverbal communication of needs • Learns language • Fine and gross motor skills • Explores environment • Develops object permanence

7. Toddler • Egocentric • Begins socially acceptable behavior • Separateness • Increased verbal communication skills • Tolerates delayed gratification • Controls body functions • Begins self-care

8. Preschooler • Sense of initiative • Increased language skills • Behaves in socially acceptable ways • Develops conscience • Identifies sex roles • Develops readiness for school

9. School Age • Active and cooperative member of group • Learns rules/norms of society; adapts to moral standards • Increased psychomotor and cognitive skills • Masters time, conservation, and reversibility • Masters oral and written communication • Wins approval from adults and peers • Builds a sense of industry and + self-concept • Gives affection without expecting anything

10. Adolescence • Develops group and self identity • Gains independence from parents • Develops value system • Develops academic & vocational skills • Develops analytical skills • Adjusts to rapid physical & sexual changes • Develops sexual identity • Develops multicultural skills • Considers and chooses career

11. Role of Play in Development • Universal language of children • Provides socialization • Stimulates development—physical, emotional, and cognitive, moral • Develops creativity • Provides outlet for fears • Helps develop self-awareness

12. Social Character of Play • Solitary or onlooker play—plays by self or enjoys watching others (infancy) • Parallel play—plays with same toy, but with no interaction (toddler) • Associative—plays same thing as others in group, but no group plan or goal (preschool) • Cooperative—together with others, play is organized with group goal (school-age)

13. Developmental Assessment • To identify children whose developmental level is below normal for chronologic age and who therefore require further investigation • Remember, most are only screening tools, not diagnostic.

14. Risk Factors p. 1055 • LBW, prematurity • CNS problems or neuromuscular issues • Hyperbilirubinemia/kernicterus • Congenital malformations (syndromes) • Chronic OM • Inborn error of metabolism (PKU) • Perinatal infections • Parental issues—drugs, ETOH, low income, mental illness, etc

15. Warning Signs (p. 1056) • No response to stimuli, does not interact with others • No babbling • Persistent primitive reflexes • Abnormal posturing—head lag, fisting, arching, tiptoeing • Failure to achieve gross and fine motor milestones • Failure to achieve language milestones; echolalia • Extreme aggressiveness, fearfulness, sadness • Easily distracted, can’t concentrate • Rarely engages in fantasy play • Failure to achieve personal-social skills or self-help activities

16. Denver Developmental Screening Test II • AKA “Denver II” or DDST • Widely used, standardized measures • Tests personal-social, language, fine, gross motor skills • Examiners must be specifically trained and certified in use of the tools • Have to have a “kit” with specific items to administer the test and follow instructions in the manual to ensure validity of the test.

17. Interpretation of Denver • Don’t use the word “test” with a parent, but tell them it is a guide • If child “fails” skill, reevaluate in 1-4 weeks • If still problems, do not freak parents out; remind them this is screening only • Refer to pediatrician or developmental testing center for further evaluation