Developmental Tasks

Developmental Play type Developmental Keys

Theories
Birth to 1 year Erikson: Trust vs Solitary Play 6-8 wks: posterior Gross Motor Skills: Fine Motor Skills: Language:
mistrust fontanel closes 3 mo: Holds head up Brings hands together
Freud: Oral 6wks-4mos:
Piaget: biocularity 5-6 mo: Rolls over Grasps rattle; looks for items
Sensorimotor 6mos: Respond to taken from view
facial expressions 6 mo: Holds head steady 6 mo: Transfers object from one Imitates sounds, combines
7-9 mos: depth when sitting hand to the other; rakes finger syllables
perception develops foods with hand; hold own bottle
(parachute reflex)
12-18 mos: anterior 9 mo: Gets to sitting position 9 mo: uses thumb/ finger to grasp Obey simple commands
fontanel closes alone & can pull up to items (pincer grasp); bangs 2 toys accompanied by gestures;
2x birth weight standing position; crawling together understands 'No'
by 4-6 mo, 3x birth 10 mo: move from prone to Ascribes meaning to some
weight and 50% sitting position words
length increase by 1
yr 12 mo: stands holding on 12 mo: can nest 1 object inside Can say 3-5 words,
then alone another; build block tower understands 100+

Toddler (12- Erikson: Autonomy Parallel Play Toddler Lordosis; Developmental Skills: steady gait, climbing stairs, Limited ability to follow
36 mo.) vs Shame (ie. Domestic telegraphic speech jumping/standing on 1 foot for short period, stacking blocks, directions; must be given
Freud: Anal mimicry) (2-word phrases); drawing stick figures, undressing, feeding self, toilet training; step by step instructions,
Piaget: ritualism/negativism; Rely on predictability of routine for feeling of security one step at a time
Sensorimotor 30 mo: 4 times birth
transitions to weight
Preoperational Poorly defined body
boundaries
(bandages after
needles and for
cuts)

Preschooler Erikson: Initiative vs Associative By 5 or 6 grammar is 2 Phases of Thought development: 1st: Preoperational Vocabulary continues to
(3-5 yrs) guilt Freud: Play (ie. Group well developed thinking including Preconceptual thought (2-4) 2nd: Intuitive increase. Can now speak in
Phallic Piaget: play and sex thought (begins at 4) Developmental Skills: alternating feet on sentences, identify colors,
Preoperational role imitation) stairs, going up and down steps with ease, hopping, walking and enjoys talking
heel-to-toe, dressing without help, drawing copies of shapes on
paper, drawing a more detailed stick figure, playing on
playground equipment

Prepared by Jacqueline Fresch, 2010 Page 1

School Child Erikson: Industry vs Cooperative Concrete thought: Can understand simple analogies, Concrete Thought: Can
(6-12 yrs) inferiority Freud: Play understands time, able to understand various emotions people define many words and
Latency Piaget: experience, weight and volume seem unchanging understands rules of
Concrete Operations grammar
Adolescent Erikson: Identity vs Capable of thinking at an adult level, but don't believe Abstract thought, speak on
role confusion consequences; abstract thought possible; attention span an adult level; Adolescents
Freud: Genital lengthens develop jargon with peer
Piaget: Formal group - can communicate 1
Operations way w/ peers and another
way w/ adults

Vital Signs Temp Pulse Resp BP Primitive Reflexes In Infants

Infants 36.5-37.5 120-160 23-50 110/71 Rooting Reflex Birth to 6 mo
Children 36-38 75-100 20-30 112/66* Palmar Grasp Birth to 4 mo
Adolescents 36-38 60-90 16-19 * Plantar Grasp Birth to 8 mo
Moro (Startle Reflex) Birth to 6 mo
*BP will continue to rise as child/adolescent grows - compare readings with standard measurements Asymmetric tonic neck Reflex Birth to 3-4 mo

Age Related Interventions

Age Intervention Understanding and Hospital Impact
Infant Place close to nursing station so needs can be quickly met; Stranger anxiety b/w 6-18mo; experience sleep deprivation d/t
provide consistency of care-givers strange noises and surroundings
Toddler Encourage parents to provide routine care; give choices; Limited ability to follow directions; limited understanding for need
provide consistency of care-givers of procedures; experiences separation anxiety

Preschooler Explain procedures; encourage child to provide self care
(independence); give choices; provide toys for emotional
expression (ie. Pounding board for release, puppets to
enact fears through play); allow to handle equipment if safe
School Age Explain procedures and provide factual information; try to
maintain routine esp. for long hospitalizations (ie. Hwk
time); encourage contact with peer group
Adolescent Provide factual information; include in planning of care;
encourage contact with peer group
Has fears related to magical thinking; does not understand
cause/effect relationship (concrete thinking only); may believe
illness and hospitalization are punishments
Increased ability to understand cause and effect; fears loss of
control and seeks information to cope; experiences stress
related to separation from peers and regular routine
Severity of illness perception based on degree of body image
disturbance; feel isolated from peers; may not be compliant if
makes adolescent feel/appear different from peer group

Prepared by Jacqueline Fresch, 2010 Page 2

Blood Work Low High Units
Blood Chemistry
pH 7.35 7.45
Sodium Na+ 135 145 mEq/L
Potassium K+ 3.5 5 mEq/L
Chloride Cl- 95 105 mEq/L
Calcium Ca++ 4.5 5.5 mEq/L
9 10.5 mg/dL
Magnesium Mg ++ 1.5 2.5 mEq/L
Phosphate PO4 3- 2.8 4.5 mg/dL 1o ICF anion, nec for muscle, RBC, NS fxn
Alanine aminotransferase ALT 8 20 U/L (associated with liver fxn)
Aspartate aminotransferase AST 8 20 U/L (associated with liver fxn)
Total Bilirubin 0.2 1.3 mg/dL (associated with liver fxn)
Amylase 3 35 IU/L (associated with pancreatic fxn)
Lipase 0 12 U/L (associated with pancreatic fxn)

Blood Gases Child

Arterial
pH 7.35 7.45 7.39 n.b. 6.8 > Death < 7.8
PaCO2 35 45 mmHg 37
PaO2 75 100 mmHg 96
SpO2 95 98 % 90-95
HCO3- 22 26 mEq/L 22
Venous
pH 7.35 7.45
PaCO2 42 52 mmHg
PaO2 30 50 mmHg

Blood Nutrition
Albumin 3.5 5 g/dL
Prealbumin 15 36 mg/dL
Total Protein 6.4 8.3 g/dL
Cholesterol 140 200 mg/dL (age dependent)
HDL Male >45 mg/dL
Female >55 mg/dL
LDL <130 mg/dL
Glucose Fasting 70 100 mg/dL
Diabetes >200 mg/dL
Glucose Tolerance Test
30min 30-60mg/dL above fasting
60min 20-50mg/dL above fasting
120min 5-15mg/dl above fasting
180min Fasting level or lower

Hematology
Hematocrit Male 40 54 % (altitude dependent)
Female 38 47 %
Hemoglobin Male 13.5 18 g/dL (altitude dependent)
Female 12 16 g/dL
Platelet Count 150000 400000 /mm3

Coagulation
Prothromin Time PT 10 14 sec Measured against a control
Patrial Thromboplastin Time PTT 24 36 sec Normals differ among labs