Developmental Psychology

Infant and Toddler

Learning Objectives

• At the end of this lesson, the student nurse will:• Discuss the growth and development of the infant and toddler• Discuss the developmental tasks of the infant and toddler• Discuss the Psychosocial development of the infant and toddler

Learning Objectives Con’t

• Discuss the Health Seeking behaviors of the infant and toddler• Discuss safety measures while caring for an infant and toddler• Discuss Nutrition for the infant and toddler• Discuss legislation that affects the infant and toddler

The Basics

• Infancy-First year of life• Toddlerhood-ages 1 to 3• It is a stage of rapid motor development (motor meaning muscle)• The motor activity of the neonate changes to specific muscle control

which leads to voluntary, coordinated muscular activity.• RECALL—Growth is sequential unless interfered with by abnormal

conditions

The Basics

• The ability to perform these new tasks is based on the maturational forces in the brain and the musculoskeletal system• RECALL-maturation is the development of organs so they can be used

by the body• READINESS-Once an organ is developed fully it is ready to learn

Personality Development

• RECALL-Freud’ theory of personality development and the interaction of the environment• ID-Basic drives 1st 8 months-pleasure principle-immediate satisfaction

of needs• EGO-separate self from environment. Socially acceptable behavior-

reality principle. This development continues during childhood and throughout the lifespan

Personality Development Con’t

• Superego-begins around 5 years old- conscience, morals, religion-becomes apparent in the pre-school and school aged years when the child learns socially acceptable behavior• Imitation• Temper tantrums• Displaying that he has a mind of his own• He is also ritualistic, egocentric(refers every event to himself),

ambivalent and negative

Developmental Tasks of the infant and Toddler• Tasks to be learned during this period are:• Upright postural control and locomotion-standing and walking-most

infants• Manipulability and prehension-ability to reach with the hand and

manipulate objects between the finger and thumb—allows learning to take solid foods• Learning to talk• Learning to control the elimination of body wastes-toddlerhood

Physical Growth and Development

• The average newborn weighs just over 7 pounds and is 20 inches at birth. During the first 2 years of life, infants grow at a very rapid pace.• An infant will grow approx. 1”/month until their first birthday• An infants weight doubles by 6 months and triples by 12 months.

Principles of Growth

• There are 4 major principles that govern the growth of an infant. These principles are:• 1.Cephalocaudal Principle• 2. Proximodistal Principle• 3. Principle of Hierarchial Integration• 4. Principle of Independence of Systems

Cephalocaudal Principle

• This principle states that growth follows a direction and pattern that begins with the head and upper body parts and then proceeds to the rest of the body. Therefore, we develop visual acuity well before we master the ability to walk

Proximodistal Principle

• This principle states that development proceeds from the center of the body outward. Therefore, the trunk of the body grows before the extremities of the arms and legs. Development of the ability to use various parts of the body also follows this principle. For example, the effective use of the legs precedes the ability to use the feet.

Principle of Hierarchical Integration

• This principle states that simple skills typically develop separately and independently, but these simple skills are integrated into more complex ones. For example, grasping an object cannot be mastered until the infant knows how to control the movements of individual fingers.

Principle of Independence of Systems• This principle suggests that different body systems grow at different

rates. For example, body growth, the nervous system and sexual maturation are quite different.

Head Growth

• During Infancy-rapid brain growth—• By the age of 12 months, the infants brain will be 2/3’s the size of an

adult brain.• During the first 6 months of life, head circumference will increase by

approx. 0.5 inches per month.• During the second 6 months of life, head circumference will slow to

approx. 0.25 inches per month

Fontanels

• Fontanel- a soft spot lying between the cranial bones of the skull of a fetus or infant• As the head grows, the fontanels gradually close.• Posterior fontanel-is triangle shaped and is located at the junction of

the parietal and occipital areas--- closes by 2 months of age• Anterior fontanel- is diamond shaped and is located at the junction of

the frontal and parietal bones--- closes by 12 -18 months of age

Physical Growth--TODDLER

• Physical growth slows during toddlerhood• However, the toddler should show a steady increase in growth, with

an average weight gain of about 5 lbs. per year and an increase in height by about 3 inches per year.• This slowed growth rate is evidenced by the toddler’s decline in

appetite and eating habits• The head gains a more proportional dimension to the rest of the body

reflecting slower brain growth. (Refer to figure 4-2 in text)

NEURO

• Reflexes-are unlearned, organized, involuntary responses that occur automatically in the presence of certain stimuli. The basic reflexes include:• GRASP-will grasp an object placed in the hand• ROOTING-infant will turn toward touch with open mouth• SUCKING-will suck any object placed in mouth• GAGGING-occurs when the uvula touched, persists throughout life

Reflexes Con’t

• STEP-when holding infant upright and one foot touches a flat surface the infant will alternate feet as though walking• MORO(Startle)-with sudden, loud noise, the infant throws both arms

outward and then brings them together in an embracing movement.• TONIC NECK- Head turned to one side, arm on that side extended,

while the opposite arm flexed(fencing position). The baby assumes this position while lying on their back.

Reflexes Con’t

• BABINSKI- positive in newborns until age 6 + or – months. Upon stroking the sole of the foot, toes will flare.

• Neuro Growth for the Toddler-Increasing hand-eye coordination, manual dexterity, and walking/running skills contribute significantly to the toddlers locomotion and socialization.

Cardiac/ Vital Signs

• Normal Heart Rates in Children• Newborn-Awake at rest-100-180 bpm

• Asleep- 80-160 bpm• Exercise/Fever-up to 220

• 3 months to 2 years-Awake at rest-80-150 bpm• Asleep-70-120 bpm• Exercise/Fever- up to 200

• 2 years to 10 years-Awake at rest-70-110 bpm• Asleep-60-90 bpm• Exercise/Fever-up to 200

Normal Respiratory Rates and Blood Pressures in Children• Respiratory Rates----• Newborn-35 per minute• Ages 1-11 months-30 per minute• 2 years old-25 per minute• Blood Pressures-• Newborn to 1 year old-Average systolic 65-91 Average diastolic 50-55• 1-3 years old-Average systolic 90-93. Average diastolic 54-56

ELIMINATION

• Since the stomach enlarges during infancy, a greater volume of food can be accommodated and by the end of the first year of life, infants can have 1 to 2 bowel movements a day. However, the infant is vulnerable to vomiting, diarrhea, and dehydration if any type of gastric irritation is present. Breast fed babies have looser stools than bottle fed babies. Therefore, bottle fed babies are prone to constipation. A newborn will void 8-10 times a day.

Elimination Con’t

• Toddler-Sphincter muscle control begins at approximately 12-18 months of age and must be complete prior to the beginning of bowel and bladder training since the average toddler is not ready to begin toilet training until 18-24 months. Diapers remain drier for longer periods of time. Bladder control is usually more difficult to attain than bowel control.

TOILET TRAINING

• By age 2, the child is physically ready• The child is asked to give up doing what he wants to gain mother’s approval• Bowel training first---

• Number of stools is less• Observe time of day child goes• Place on seat at that time, with no toys or distractions• Wait 10-15 minutes and teach child desirable word• Praise when he succeeds• Don’t show disapproval when he doesn’t• Way to control environment• Release of inner tensions

Bladder Training

• Begin bladder training one month after bowel training is established• Some problems with bladder training-• Play• Teething• Too much fluid• Arrival of new baby

Toilet Training Con’t

• Fecal Smearing-• Pleasurable to child, upsetting to adults• Don’t show strong disapproval• Provide other methods to smear with such as clay or finger paints• Clean child promptly, secure diapers well

Toilet training begun too early can cause frustration and insecurityChild feels ambivalence toward mother-if she shows patience, love and

friendship will have no significant effect on child’s personalityA parent who pressures child may affect his development

HYGIENE

• Infants-do not need much bathing during the first year of life. When bathing an infant, only those areas being washed should be exposed to avoid chilling the infant. • The perineal area is always washed last.• It is important to clean all body creases thoroughly especially the

neckfolds and perineal area, and wash and dry each body part before moving on to the next area.

Hygiene-Toddler

• Are usually bathed either every day or every other day depending on their activity level and state of cleanliness.• Their hair can be washed at the time of bathing.• Bath time for toddlers is often a playful fun time. Therefore, provide

plastic toys such as ducks, fish, boats etc. The time of the bath should be consistent from day to day. Don’t ever leave an infant or toddler unattended in the bath!!!!

Nutrition-Infant

• Newborn-liquid diet, either formula or breast feeding• Advantages of breast feeding include:• Some immunity in early life• Economical• Nutritionally best for baby• Easy to digest –no preparation, low in fat• Proper temperature• Fosters maternal-child bonding****Should not be pushed on a mother who is uncomfortable with the

method!!!****

Infant Nutrition Con’t.

• Infants in proportion to their weight requires more calories and protein• They will continue with the formula and breast feedings• Will begin whole milk at 15 lbs. or 6-12 months depending on the

pediatrician. Twelve months appears to be the standard of when whole milk should be introduced.

Infant Nutrition Con’t.

• Water can be offered in between feedings as an infant requires fluids to prevent dehydration• Vitamin C-30mg/day –add iron rich food after 5 months old-no citrus

until after 1 year• After the first 2 weeks, vitamin supplements may be required-poly-vi-

sol infant drops. Some formulas contain enough vitamins that a supplement may not be necessary

Infant Nutrition Con’t

• There is much controversy today over when to begin solids and when to stop formula feedings and transition to milk and solids• Sometime between 3-6 months, bland food is offered one at a time• Usually begin with rice cereal because it is easily digested• Begin with small feedings-one tsp. first• Put spoon onto back of tongue• Feeder must be calm, patient, gentle, and pleasant• Don’t show any evidence of dislike• Allow infant to touch his/her food

Infant Nutrition Con’t.

• Vegetables and fruits are the next things to start-one month later. Fruit juices can be introduced at the same time fruits are introduced. Fruit juice should be watered down.• Egg yolks and meats can be introduced by about 6-8 months• 8-10 months, finger foods begin and some table food-mashed

potatoes, macaroni, jello• Infant will try to hold a spoon at this time

Nutrition-Toddler

• By 12 months, they are able to drink from a cup; usually by 15-18 months, they will give up the bottle• They will attempt to eat with a spoon, but prefer fingers• Activity will have a great influence on appetite—sometimes will be

too busy to eat• Self-feeding will help to develop a sense of independence—expect a

mess• If the toddler learns to associate discomfort of any sort with taking

formula or food, feeding problems are likely to develop

Nutrition-Toddler Con’t

• Toddlers are ritualistic in their eating habits-esp. with dishes, utensils.• A toddler should eat 3 meals/QD with the family• At the end of the toddler period, toddlers will imitate the eating

habits of those around them• Toddlers should avoid pieces of hot dogs, popcorn, nuts, hard candy,

fats, sugar, chocolate, and seeds because they are hard to digest and may cause choking

Health Seeking Behaviors- Newborn Screening• There are common disorders in which the newborn is commonly

screened for. They include:• PHENYLKETONURIA-hereditary defect of metabolism that if left untreated

will lead to mental retardation• CONGENITAL HYPOTHYROIDISM• GALACTOSEMIA-the enzyme necessary for converting galactose into glucose

is missing. The infant will commonly experience difficulties after ingesting milk

Newborn Screening Con’t.

• MAPLE SYRUP URINE DISEASE-A disease involving defective metabolism of amino acids. Urine has a distinct sweet odor.• HOMOCYSTINURIA-An inherited disease caused by the absence of the

enzyme essential to the metabolism of homocystine which causes mental retardation and tend to have seizures.• BIOTINIDASE-the enzyme involved in fat synthesis is missing resulting in

delayed mental and physical development

Newborn Screening Con’t.

SICKLE CELL DISEASE- A hereditary disease most common among African Americans characterized by the production of abnormal hemoglobin that causes the red blood cells to assume a sickle shape.CONGENITAL ADRENAL HYPOPLASIA-A rare disorder characterized by a deficiency of the enzyme essential for the synthesis of hormones made from cholesterol.CYSTIC FIBROSIS- A potentially fatal disease that affects the lungs, pancreas, urogenital system, the skeleton, and skin

IMMUNIZATION SCHEDULE

• First shot is Hep.B-up to 1 month in age• 2 months of age-DPT-Diptheria/whooping cough/Tetanus, IPV

(inactivated polio), pnemococcal (Pneumo), and HIB(Haemophilius Influenza) ****Polio vaccine used to be oral, now it is parental secondary to oral causing8-10 cases a year• 2 months of age- 2nd Hep.B• 4 months of age-2nd DPT/IPV/Pneumo• 6 months of age- 3rd DPT/IPV/Pneumo, 3rd Hep. B• 15 months of age-4th DPT/IPV/1st MMR(measles, mumps, and rubella)

and varicella(chicken pox vaccine)

Development of Deciduous Teeth

• Deciduous teeth- serves the digestive process and helps the development of the jaw• For most babies, the symptoms of teething appear about 3-4 months

before each tooth appears. Teeth appear for the first 2 and ½ years of life• Symptoms of teething-chewing on things, drooling, facial rash, pain,

irritability, gum swelling, refusing certain foods.• There are 20 deciduous teeth—

• 8 incisors for biting• 4 canine for tearing• 8 molars for chewing

Development of Teeth Con’t.

• Two lower central incisors erupt first(5-7 months)• Four upper incisors erupt at 6-8 months• Two lower lateral incisors and first four molars by 12-15 months• Four canine teeth by 16-20 months• The last set of teeth to come in are the second molars at 20-30

months.

Dental Care

• Brushing begins at about 2 years of age, encouragement is needed- with paste which they will swallow• Proper diet and milk• Fresh fruits/ raw vegetables encouraged- sweets discouraged• Fluoride treatments-which is also in our drinking water and vitamins.• The first visit to the dentist is usually around age 3.

Sleep and Rest-Infant

• Infants-have variable sleep patterns that are influenced by temperament, satisfaction with feedings, caregivers’ responses to periodic awakenings, and environmental conditions.• There is a transition from neonatal sleeping, which is shorter with

multiple sleep periods, to the more organized central nervous system maturation after the third month.• As the child matures, the sleep-wake cycle evolves into a pattern of

being awake during the day and asleep at night.• During the first months of life, infants experience more rapid eye

movement sleep than at any other time in life.

Sleep and Rest-Toddler

• Most toddlers require 12-14 hours of sleep each day with one or two naps a day. Bedtime protests can be reduced by beginning a winding down routine when toddlers are bathed, cuddled, and or read to prior to being put to bed.

Word Formation

• Psycholinguistics = study of language development• Man is superior to all other species in communication• Foundation of language development begins when the infant cries

and mom responds• Infants make their feelings known by:

• Body movements• Facial expressions• Vocalizations-whimpers, cries, coos

• Infants vocalize more if their mothers talk to them

Word Formation Con’t.

• Three theories of language acquisition• Skinner-reinforcement theory-A behavior followed by a reinforcing stimulus results in an

increased probability of that behavior occurring in the future.• Chomsky-Asserts that humans are born with the instinct or “innate facility” for acquiring

language. The left cerebral hemisphere of the brain is associated with language development.

• Social Learning Theory-An infant learns by observation and imitation.

Word Formation Con’t.

• **True language development is communication with understanding and begins about 2 years of age.• There are five developmental stages of language development• Stage 1-Reflexive Vocalization-First sound is a cry produced by

reflexive inhalation or exhalation of air.• Reflexive period involves undifferentiated crying• By the end of 2-3 weeks, the mother can detect differences in cries.

Word Formation Con’t.

• Stage 2-Cooing and Babbling• As the infant becomes aware of making sounds reflexive vocalization becomes cooing.

• Begins at about 6-8 weeks• Cooing only involves vowel sounds

• All babies everywhere make the same sounds at this stage—even hearing impaired babies• By age 3-6 months, the infant learns to manipulate their tongue and lips along with throat

and voice and babbling begins• Babies may babble for their own pleasure• Both cooing and babbling can be increased by environmental stimulation• Babies laugh aloud at this time and there is less crying.

Word Formation Con’t

• Stage 3-Lallation or imperfect imitation• Babbling diminishes as syllabic babbling and lalling begins• Lalling-baby repeats sounds that they have picked up from their

environment. (lalling is infantile speech stammering)• Baby begins making squeals or shouts of delight at the approach of a

familiar person• By 7-8 months babies join vocalized syllables into repetitive

sequences, ie-ma-ma; ba-ba; da-da• Baby starts to talk along with others

Word Formation Con’t

• Stage 4- Echolalia and Imitation of Sound• By 9-10 months, the infant begins to repeat by imitation sounds they

have heard around them• They are definitely aware of sounds made by others• Parents repeat baby’s sounds, baby will repeat parent’s sounds• There is no comprehension, but they are developing repertoire of

sounds of the language they are to learn

Word Formation Con’t.

• Stage 5-True Speech• 10-12 months-they begin to pay attention to a few familiar words• They begin to follow simple directions, ie.-”no” by one year of age• They begin to recognize their name and names of family members• True speech begins as the child intentionally and correctly uses a

word and anticipates a response to the word they have uttered-verbal understanding has developed

Stage 5 Con’t.

• By 15 months-child can speak four intelligible words, and they understand many more words• ***By 2 years of age the child has a 50 word vocabulary and can make

2-word sentences- speech and language usage merge and true language development has occurred. Communication with understanding occurs.

Language Comprehension

• A 3-4 week old infant responds to a speaking voice• A 5 month old infant can discriminate between friendly and angry

talking• A 9-10 months old baby understands gestures and responds to “bye-

bye”• A 10-12 month old infant responds to simple commands• At 18 months old, a child responds to simple requests• At 20 months old, a child can name animals in a book• At 3 years old, grammatically correct sentences are used

The Five Senses and Infants

• Sight-Infants can track objects at birth• Infants prefer bright lights and yellow, green and pink objects as well

as large geometric shapes• Vision is 10 to 30 times less acute than normal adult vision of 20/20.• By the time the infant is 6 months old, vision should be 20/100 or

better.• Eye movement is unequal due to weak eye muscles

Senses Con’t

• Hearing-The top of the ear is about level with the eyes• The infant hears and responds to loud low- frequency sounds• A sudden loud sound will produce a startle response• By age 6 to 8 weeks, infants recognize their mother’s voice and turn

their heads in response to it.• A 1 year old can discriminate between different sounds and often

recognize the source.

Senses Con’t

• Taste-Infants can discriminate between different tastes.• If given a sweet solution, they will begin to make sucking movements• If given something sour, they will respond with a grimace or pout• A 1 year old has developed a capacity to taste and has preferences for

certain flavors• Sweet taste is universally pleasing

Senses Con’t.

• Touch-An infants face is most sensitive to touch-especially around the mouth• The hands and soles of the feet are also sensitive• Infants like to be touched and rocked because of the calming effect• Infants feel pain as witnessed after an injection is given• A typical reaction to pain is loud crying and thrusting the whole body

and extremities• A 1 year old demonstrates withdrawal from pain but may not be able

to recognize the source of the pain. Example-hot pot

Senses Con’t

• Smell-studies indicate that an infant has a sense of smell• Newborns react to strong odors by turning away• Newborns can recognize the smell of breast milk

Motor Development

• Motor development is related to physical, cognitive and social development.• Motor growth includes gross and fine motor development, which

provides the infant with the means and freedom to explore the environment• Gross Motor Development-is the ability to use large muscle groups to

maintain balance and postural control or locomotion. The following is a summary of gross motor skills in the infant and toddler

Gross Motor Development Con’t.

• 2-3 months old-Some head lag when pulled to a sitting position • Holds head up and supports weight on forearms when prone• Some head bobbing while supported in a sitting position• Rolls from abdomen and back• Tonic neck and moro reflexes disappearing

Gross Motor Development Con’t

• 4-6 months-Good head control with no head lag• Holds chest and abdomen up with weight supported by hands while

prone• Sits with support• Rolls from back to abdomen• Bears weight in standing position with support

Gross Motor Development Con’t.

• 7-8 months-Sits alone without support. • Bears weight with some support• 9-12 months-Moves from prone to sitting to standing position without

assistance • Stands alone without support• Goes from crawling to creeping to cruising• Attempts to walk alone

Gross Motor Development Con’t

• 13-18 months-Walks a few steps without support• Walks upstairs with help• Creeps downstairs• Turns book pages• Walks and pulls toys• Able to remove shoes and socks• Tries to put shoes on• Unzips zippers

Gross Motor Development Con’t.

• 19-30 months-Goes up and down steps alone (places both feet on one step before going to the next)• Kicks ball forward without losing balance• Turns doorknobs• Brushes teeth• Dresses self with supervision but cannot tie shoes• Inserts square into square holes

Fine Motor Development

• Fine motor development-as the infant progresses, the infant begins to utilize the hands and eyes to explore and manipulate the environment. Fine motor development is the ability to coordinate hand-eye movement in an orderly and progressive manner. The following is a summary of fine motor skills in infants and toddlers.

Fine Motor Skills

• 2-3 months-Follows object past midline. Holds hand open. Regards own hands and fingers when held in front of face. Places hand in mouth. Briefly reaches at a dangling object.• 4-5 months-Reaches for an object beyond grasp. Looks from object to

hand and back again. Places object in mouth. Uses whole hand to grasp object. Plays actively with hands and feet.• 6-7 months-Holds objects securely and bangs them together. Actively

drops objects. Transfers object between hands.

Fine Motor Skills Con’t

• 8-9 months-Pincer grasp beginning. Releases object at will. Dominant hand preference emerging.• 10-12 months-True pincer grasp present. Can self-feed finger foods.

Can place small objects into a container. Can remove small objects from a container. Can hold and mark with a crayon with a fist. Can turn multiple pages in a book at one year. At 1 year, pincer movement is well established and the infant is able to grip objects between the thumb and the end of the fingers-this allows him to feed himself.

Socialization

• Socialization is the process whereby an individual learns how to adapt and adjust to a given social environment.• The first social group is the family-specifically the mother-food, comfort

and attention• At birth the neonate lacks interest in people• By 4 weeks, he stares at faces• At 2 months, the infant is actively aware of adults who cares for him

and smiles• At 3 months, the infant turns his head and eyes in response to a voice,

follows mom’s movements

Socialization Con’t.

• At 4 months, the child cries when people leave, smiles in reply to another’s smile and has an interest in father and siblings• At 5 months, there is an increased demand for sociability, he is happy

when played with• At 7 months, the child enjoys peek-a-boo and is becoming doubtful of

strangers.****Stranger anxiety develops between 6-8 months****• At 8-10 months, behavior is aggressive as he pulls hair and grabs

faces. The child is also aware of another child’s presence

Socialization Con’t.

• At 10 months, the child has a short attention span and likes to be with family• At 12 months, the child loves attention, throws things out of the

playpen, loves being chased, enjoys pat-a-cake• At 15 months, the child is more interested in attending to their own

business, exploring, walking• At 18 months, the child is getting into everything, never stays in one

place, is more responsive to adults and is conscious of social approval.

Cognition

• Intelligence-deals with thinking, perceiving and understanding. It is the ability to learn and deal with new situations• Intellectual growth has to do with:

• Certain innate features the infant is born with, such as the number of neurons and chemical transmitters one has

• Intellect will develop only to the extent which these innate elements have the potential to develop

• Intellectual growth can be influenced by factors outside the child• Intellect starts as a meager reflexive beginning and grows to a mental computer

Jean Piaget

• Swiss Psychologist-Theory of Cognitive Development• Intellectual growth hinges on two important principles of organization

and adaptation• To get from organization to adaptation, the infant goes through the

process of assimilation and accomodation

Concepts of Piaget’s Theory

• ORGANIZATION-the ability to order and classify new experiences in the mind-like putting information in a file cabinet or creating a new file on a computer.• Once organized, the patterns of thought are known as SCHEMA which

people use to interpret or make sense of their experiences.

Piaget’s Concepts Con’t

• ASSIMILATION-material is taken in and molded to fit within the child’s existing frame of reference. The child perceives and interprets new information in terms of existing knowledge and understanding—like life science-1st cells, then systems• Example-the child calls everything on the road a car because it is the

only word he knows, or all four-legged animals are dogs.

Piaget’s Concepts Con’t

• ACCOMODATION-Process of change through which the child becomes able to take in new information; the knowledge mixes with the old and new experiences are added to his/her schema.• At this point because of the new material assimilated, the infant has

matured to the point that it can now solve more difficult tasks

Piaget’s Concepts Con’t.

• ADAPTATION-Occurs when the child has the ability to change old ways of thinking to solve new problems.• The child is said to have coping behavior• Adaptation is a yard stick to measure intelligence• Intelligence according to Piaget, is a process of adaptation by which

higher cognitive levels are reached.

Piaget’s Theory

• LET’S REVIEW• Piaget’s theory divides the intellectual development into four main

stages, which are orderly and sequential.• A. Sensorimotor stage-0-2 yeares• B. Preoperational stage-3-7 years• C. Concrete operational stage-7-12 years• D. Formal operational stage-12-16 years• ***Succession of these stages is constant, the ages at which they occur can vary.

Piaget’s Sensorimotor Stage

• Occurs during the first 2 years of life• Most learning activities is directed toward simple motor actions and

incoming perceptions.• By the end of this period, the child should be able to use simple tools

to obtain what they want by anticipating the consequences of their actions.• There are SIX phases in the sensorimotor period

STAGE 1

• Use of Reflexes (0 to 1 month)• A child uses reflexes they are born with---what are some of the reflexes that

we already discussed?• There is an absence of intelligence• Reflexes are building blocks because as brain cells develop and become

chemically active, reflexes become more proficient

STAGE 2

• Primary Circular Reactions (1 to 4 months)• Reflexes undergo changes due to the child’s interaction with the environment.

This results in a an adjustment in his schema• Simple reflexes are replaced by systematic combinations of reflexes and some

become voluntary- ie: pleasurable experiences may be repeated-sucking is a reflex, but thumb sucking is voluntary• As vision becomes more developed, the infant becomes more interested in

himself

STAGE 2 Con’t.

• By the end of this stage, the child is beginning to investigate---plays with hands and feet• Cooing begins during this stage

STAGE 3

• Secondary Circular Reaction (4 to 8 months)• The child becomes concerned with the external environment• Purpose is associated with movement as he tries to reproduce

interesting events-ie. Kicking legs to shake the crib to make the mobile move---Study-tie a string to one foot and attach to a mobile- the infant will have increased movement of the leg• This power of association is the beginning of understanding cause and

effect relationships• The infant at this time begins to recognize objects and people familiar

to them.

STAGE 4

• Coordination of Secondary Shema (8 to 12 months)• New behaviors formed that are intentional as a result of better vision

and coordination of the pincer grasp• Object permanency begins-an object exists even if they can’t be seen• Uses signals to anticipate coming events- ie.-removing a lid from a box

to find a ball, if a bottle is given upside down, the infant will reverse it to the correct position

STAGE 5

• Tertiary Circular Reactions( 12 -18 months)• There is an increased interest in the environment and repetitive

behavior.(primitive reasoning skills)• Beginning of trial and error experimentation and problem solving—

ie.-a toy is on the rug, he will note that if he pulls the rug, the toy will come to him• Interested in new experiences, tries new responses to reach the same

goal-ie.- drops things differently• Interested in putting things together

STAGE 6

• Intervention of New Means (18-24 months)• Start to create mental images that enables them to devise new ways

of dealing with the environment• *Child can problem solve without trial and error experimentation• Can problem-solve simple problems by remembering, planning, and

imagination• Object permanency is completely developed

Imprinting and Attachment

• Imprinting-a critical period when a strong social attachment is formed to the mother or mother substitute• It is a critical period because during this time, an event in the

environment has the greatest impact on a person-occurring during specific time periods in life• Between 6-8 months, the child develops an attachment to a specific

caretaker-usually mom• If there is no significant other in the child’s life, marasmus develops

• There will be a lack of expression, lethargy, increased susceptibility to infection, anorexia, insomnia, and slowness of movement

Moral Behavior

• Behavior at first is guided by impulse• The child thinks only of how the act affects him personally• The child must be taught principles of morality• According to Freud, this took place at 5 years

• Most morals are taught but can be affected by:• Cognitive-result of mental activity• Psychoanalytic-instinct

Emotional Development

• Emotional Reaction-changes in arousal levels that may either interfere with or facilitate motivated behavior• Emotions are what is used to describe fear, anger, joy, disgust, and

affections• At birth, emotions are simple and undifferentiated---the first is diffuse

excitement• At 3 months-delight• At 3-6 months-anger, disgust, and fear appear• Jealousy is a late emotion-an example is the birth of a newborn• Joy is the last emotion to appear-anticipate the holidays

Erik EriksonTheory of Personality Development• E.E. believed personality development was the result of societal

influences• Key aspect of psychosocial development is the development of the

ego and the ego’s ability to deal with crises• Ego strength begins at birth and as each crises is met it strengthens

and the individual is ready to go to the next stage

First Stage of Personality Development• Basic Trust vs. Mistrust-(0 to 12 months)• Trust the feeling that some aspects of the environment are dependable• E.E. saw trust vs. mistrust as a kind of continuum, where it was more desirable to

be at the trust end• Stresses the quality of care provided by mother• It is a mother’s responsibility to create a warm environment• Trust of people and of the world depends on the quality of care and love the

infant receives• This is the first building block in development of a sense of identity• An infant who is handled roughly, produces an infant who is uncomfortable and

insecure with his environment--MISTRUST

Second Stage of Personality Development• Autonomy vs. Shame and Doubt (1 to 3 years)• Autonomy from total dependency on mom begins as he resists being held

because he becomes more mobile and he begins to explore the environment• The child is gaining a sense of autonomy because he can do things for himself• Must learn to feel capable of being in control• Overprotective parents raise a child who fails to get the feeling of autonomy• Parents who browbeat a child will produce a child who feels ashamed and is

doubtful of his own ability• By the end of this stage, children should not have fear of going beyond their

present capabilities

Play

• Infants-Play for the infant moves rapidly from accidental, pleasure-producing activities to purposeful, repetitive activities with an increasing awareness of the surrounding environment. By 6 months to 1 year, the infant engages in repetitive activities involving voices, sounds, music and a variety of toys which enhance the development of language and sensorimotor skills.

Age Appropriate Toys for the Infant

• Birth-3 months-soft cuddle toys, rattles, mobiles, music boxes• 3-6 months-crib gyms, squeaky toys, teething rings, noise-making

toys, peek-a-boo, patty-cake• 6-9 months-safe place to creep and crawl, bathtub toys, jack-in –the-

box, big, soft blocks, toys to bang together, drinking cup, hide-n-seek• 9-12 months-push-pull and motion toys, colorful toy blocks, paper for

tearing, building blocks, metal pots and pans, different shaped colored toys

Play-Toddler

• Play fulfills four functions for the toddler• Cognitive development by permitting exploration of the environment• Learning about objects• Solving problems• Advances social development particularly through fantasy play when acting out

roles

• A toddler’s exploratory behavior is more diverse due to increased confidence, coordination, and competence.• Toddlers usually prefer parallel play in which they play alongside other

children without interactions• Destructive play begins at about three years old

Age Appropriate Toys for the Toddler

• Pull toys• Picture books• Dress up kits• Scribbling on paper, finger paints, modeling clay• Cars and trucks• Slides, Balls• Jungle gym, sandbox• Stuffed animals• Dolls, drums• Take-apart toys• Large size legos• Block set• Puzzles

Safety and Injury Prevention

• Infants- are at risk for accidental injury, the leading cause of infant deaths especially between 6 and 12 months of age. To prevent injury-some guidelines include:• House-secure toxic chemicals, sharp objects out of reach, fans and heaters

out of reach, small objects out of reach, pool area-gated or fenced• Falls-all outlets covered with safety caps, electrical wires out of reach, clear

walkways, gated stairs, closed windows or screens that cannot be pushed out

Safety Con’t.

• Burns-no smoking near child, hot water-check temp. before bathing, guards on heating appliances, no hot liquids to drink, smoke detectors, fire extinguishers.• Emergency Needs- Post all emergency phone numbers, first aid kit,

emergency exit plan in case of fire, caregivers know CPR• Car Seats-All infants need to be secured in an approved infant car seat

that faces the rear if less than 20lbs. And is less than 1 year old• Sleep-To prevent SIDS-place infant on the side or back for sleeping.

Avoid soft bedding, pillows, stuffed animals and comforters.

Toddler Safety

• Toddlers are at risk for injury through accidents. The types of injuries and accidents experienced are directly related to the child’s development progression. Most injuries and deaths to toddlers are due to airway obstruction, poisonings, drowning, falls, burns and automobiles.• Car Seats-If more than 20 lbs., the child should be placed in a secure

child seat that faces forward. CT. law states that any child must be in a car seat until they are at least 6 years old and are 60 lbs.

Toddler Safety Con’t.

• Prevent accidents by teaching child to stop at crosswalk and look both ways. • Don’t run with anything protruding from the mouth• If riding a bicycle-child must wear a bike helmet• If child climbs out of the crib-place in a bed at night• Check toys for small parts that a child may choke on and remove them.• Keep all plastic bags out of the reach of children. Turn handles toward

the back of the stove.• Lock medicine and hazardous chemical out of the reach of children

Legislation Infants and Toddlers• The state of Connecticut has programs that have been approved by

the state legislature to assist infants and children. The programs include:• A law banning bisphenol A from infant formula and baby food cans

and jars.• Bisphenol A is used to make polycarbonate plastics and epoxy resins

Legislation Con’t.

• Seatbelt laws• Birth to 3 Program-Used for a child that experiences a significant

delay in 1 or more of the following: • Cognitive development• Physical development including vision or hearing• Communication Development• Social or Emotional Development• Adaptive Skills

HEAD START

• Established in 1965• Is a comprehensive child development program that serves children

from birth to age 5 and their families• Programs are child-focused and have the overall goal of increasing the

school readiness of young children in low-income families• Sponsored by the U.S. Department of Health and Human Services and

Administration for Children and Families

WIC Program

• The Special Supplemental Nutrition Program for Women, Infants, and Children-better known as the WIC Program• Serves to safeguard the health of low-income women, infants, and

children up to age 5 who are at nutritional risk by providing nutritional assessment and education, referrals to health care and nutritious foods to supplement diets

WIC Program-Eligibility Requirements• Pregnant Women-through pregnancy and up to 6 weeks after birth or

pregnancy ends• Breastfeeding women-up to infant’s 1st birthday• Nonbreastfeeding postpartum women up to 6 months after the birth

of an infant• Infants up to 1 year old-WIC serves 45% of all infants born in the

United States• Children up to their 5th birthday

WIC Eligibilty Con’t.

• Must meet the income guidelines-which is based on total number of family members and yearly income• Be a nutritional risk-• A. medically based-low birth weight• B. poor eating habits

• Must live in Connecticut• Recipients of the food stamp program are automatically income

eligible for the WIC Program

WIC Con’t.-What Does it Offer?

• Nutrition Assessment and Education-Individual counseling and nutrition classes• Breastfeeding Promotion and Support-Breast pumps, benefits of

breast feeding, and how to juggle work and breastfeeding• Nutritious Foods-A nutrition professional prescribes food checks to

participants• Referrals to Health and other Social Services• Other Nutrition Services-provides education regarding the importance

of immunizations, preventing lead poisoning, and the harmful effects of tobacco and substance use on the body