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286 Cards in this Set
- Front
- Back
what does child health reflect
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physical, mental, emotional and social well being
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when are children at highest risk for death
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infancy and adolescence
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what is the leading cause of death in children
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injury
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what are the most frequent causes of death due to injury
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MVA, drowning, burns
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what are the leading causes of death for infants under 1 year
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birth defects, SIDS, prematurity
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what are the consequences for poverty
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higher mortality from all causes except MVA and suicide. Higher morbidity from acute and chronic illness, decreased school achievement, greater risk of behavioral and emotional problems
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what are some contemporary health challenges
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poverty, insurance/ healthcare barriers, busy families, childhood-onset obesity, increasing rates of chronic illness
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what is the most significant risk factor for childhood obesity
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inactivity
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what is the most prevalent cause of disability in children
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asthma
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what is family for dependent children
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a social and biological unit with financial, emotional, and behavioral responsibilities for dependent children
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family is the source of children's sense of what
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security and belonging
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what is a traditional definition for family
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2 or more persons related by birth, marriage, or adoption, and residing together
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what is an inclusive definition for family
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whoever the person says it is
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what is family structure
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how family is organized
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what is a nuclear family unit
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parents and offspring
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what is a binuclear family
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separated/divorced parents sharing parenting roles
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what is an extended family
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relatives and significant others beyond the nuclear unit
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how came up with the family functions
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friedman
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what are the family functions
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affective, socialization, economic, healthcare and reproductive
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what is affective
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meeting emotional/psychologial needs of each member (love and belonging)
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what is socialization
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helping children assume adult roles and become productive members of society
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what is economic
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provision and allocation of resources
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what is health care
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meeting fundamental and special needs such as food, clothing, shelter and healthcare
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what is reproductive
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continuity of family and society
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what is the family systems theory derived from
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the general systems theory
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what is the foundation of the family systems theory
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a system as a whole is different from the sum of its parts.
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what does the function of a system reflect
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interaction among its parts
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what is a system defined by
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its boundaries
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what does a system change in response to
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feedback
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what are the units created by relationships among members in a system
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dyads, triads and larger groups
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what is a dyad
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parents, mother/child
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what is a triad
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mother/father/child, intergenerational
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what are larger groups
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all siblings, extended family
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what do family boundaries vary from
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open to closed
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what does working with family require
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recognizing their complexity, acknowledging their boundaries, intervening within relationships, not with an individual
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what is stress
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inevitable and is caused by both positive and negative events or change
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stressors may be what
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predictable or unpredictable
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effects of stress are what
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cumulative
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what determines how well family adjusts to stress
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resources and nature of stressor
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what are the four stages of the family stress theory
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crisis, disorganization, recovery, and reorganization
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what is the family developmental theory
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Like individuals, families progress through predictable stages with critical psychosocial tasks
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what is the marker for transition between stages
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Age of the first child is the marker for transition between stages
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what are the 8 developmental stages
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Marriage
Families with infants Families with preschoolers Families with schoolchildren Families with teens Families as launching centers Middle-aged families Aging families |
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what is the family developmental theory useful for
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Useful for anticipating transitions and the new tasks/demands they generate
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what is a major determinant of the child's physical and emotional stress
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The quality of the relationships between the child, the family, and the health care system
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what are the goals of family assessment
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Identify the players
Evaluate strengths and limitations Determine the need for additional assessment/ intervention/referral |
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what are the categories for the calgary family assessment model
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structure, development and function
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what is structure
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composition (nuclear & extended), systems, boundaries, social/cultural contexts
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what is development
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stage, critical tasks, priorities
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what are the subcategories of function
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instrumental and expressive
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what is instrumental function
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meeting tangible needs
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what is expressive function
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emotions, communication ect.
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what are the categories for the friedman family assessment model
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Identifying data - composition, social/cultural context, etc.
Developmental stage Environment - social support, community Family structure - roles, values, communication, power Function Family coping - stressors, strengths, adaptive and maladaptive strategies |
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parental roles are established by what
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legal system
social and cultural expectations personal goals |
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Good parenting is what
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culturally mediated and contextual
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how do parents influence childrens behaviors
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direct instruction
modeling structuring the environment |
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what is authoritarian parenting style
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emphasis on obedience, respect for authority
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what is authoritative
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combine warmth and validation with clear expectations and firm boundaries
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what is indulgent
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- maximize personal freedom, limited restraints
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what is indifferent
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minimize time and energy spent in parenting
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how came up with the parenting styles
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Macoby
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what are the goals of disciplining children
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SAFETY
socialization – learning what’s right and wrong within the specific society/culture developing self-control |
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what are the elements of positive discipline
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takes place within a supportive, nurturing relationship
emphasis on desirable behaviors clearly identify undesirable behaviors |
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what is a time out
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interrupts undesirable behavior
removal of positive reinforcement, particularly social interaction location must be safe and unstimulating < 1 minute/year of age |
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what is a time in
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positive feedback and social interaction when child is not misbehaving
acknowledge desirable behavior avoid qualifying statements reward with relaxed time together |
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what does it mean that development is systematic and hierarchical
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new accomplishments build on previously mastered skills
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children's development is both what
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predictable and individula
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physical growth and development is what
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cephalo-caudal and proximao-distal
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what does cephalo-caudal mean
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growth form head down
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what does proxio distal mean
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controlled movements closets to center of body before controlled movements distant to the body
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who came up with the cognitive development theory
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piaget
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what is the cognitive development theory
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children progress through predictable stages of reasoning towards mature, logical thinking
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what are the mechanisms of development
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assimilation and accommodation
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what is accommodation
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re-organizing existing schema to solve more difficult problems
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what is assimilation
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incorporating new knowledge and skills
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individual capabilities reflect what
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both biological potential and environmental interaction
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what are the 4 developmental stages
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sensorimotor, preoperational, concrete operational, formal operational
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what is the age for the sensorimotor stage
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birth to 2 years
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what is the age for the preoperational stage
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2-7 years
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what is the age for the concrete operational stage
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7-11 years
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what is the age for the formal operational stage
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11-15
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what is the evolution in the sensorimotor stage
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evolution from innate survival reflexes to simple problem solving though imitation
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how does learning take place
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takes place as senses develop, responses to stimuli become more organized
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what do motor skills and visual acuity do
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set limits on behavioral and cognitive performance
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what do children begin to grasp in the sensorimotor stage
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cause and effect-how to make things happen
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what are the principles of the pre-operational stage
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Development of language
Egocentric thought Symbolic play Literal interpretation of events Easily fooled and easily confused |
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what emerges in the concrete operational stage
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understanding of complex relations: classification into simultaneous categories
conservation, reversibility, seriation |
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how is problem solving done in the concrete operational stage
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through trial and error
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what is logical reasoning limited to in the concrete operational stage
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own experience
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what happens in the the formal operational stage
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Systematic and abstract thought
deductive reasoning inductive reasoning Appreciation of the hypothetical Future projection/orientation |
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who created the psychosocial theory
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erickson
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how does the psychosocial theory say that individuals mature
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through a series of critical stages
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what must happen to progress to next stage
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must master each critical period
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what are the 5 stages during childhood of the psychosocial theory
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trust vs mistrust
autonomy vs. shame and doubt initiative vs. guilt industry vs. inferiority identity vs. role confusion |
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what age is the trust vs mistrust stage
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birth to 1 year
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what age does autonomy vs shame and doubt occur
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1-3 years
-toddlerhood |
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what age does initiative vs guilt occur
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3-6 years-pre-school
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what age does industry vs. inferiority occur
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6-12 years
-school aged children |
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what age does identity vs role confusion occur
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12-18 years
-adolescence |
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what happens in trust
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world is good, needs will be met
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what happens in mistrust
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world is chaotic, unpredictable
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what happens in autonomy
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independence, exertion of self, choice
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what happens in shame
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assertiveness considered unacceptable
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what happens in doubt
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mistrust of own capabilities and immediate environment
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what happens in initiative
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trying our new ways of doing things, creativity, assuming responsibility
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what happens in guilt
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behaviors reflecting initiative are discouraged, passivity develops
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what happens in industry
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mastery of social, physical and academic skills, focus on peers/society
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what happens in inferiority
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don't measure up to expectations of self, peers, adults
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what happens in identity
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coming to know self, establishing personal ideology
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what happens in role confusion
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unable to acquire sense of self
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who made the moral development theory
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kohlberg
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how does moral reasoning develop
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through an invariant sequence that parallels cognitive development
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where do principles guiding behavior evolve from in moral development
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externally driven (immediate consequences) to individual and abstract
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when does birth weight double
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5 months
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when does birth weight triple
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1 year
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how much does height increase in the 1st year
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50%
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when is chest and head circumference equal
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1 year
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rapid head growth is what
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neurological development
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when does the posterior fontanel close
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6-8 weeks
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when does the anterior fontanel close
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12-18 months
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what happens to RR and HR and BP during infancy growth
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RR and HR decrease
BP increases |
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what enhances thermoregulation
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adipose tissue deposition
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what are fluid balance issues in infants
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risk for dehydration secondary to high proportion of extracellular fluid, immature renal structures
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what happens in the GI system in infants
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immature digestion - colic, regurgitation, incomplete digestion of solid foods
increasing stomach volume, eruption of teeth, swallowing prepare older infant for solid foods |
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how long does passive immunity from mother persist
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3 months
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what production in the immune system increases in infants after 3 months
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IgM, IgG then other immunoglobins
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what is the gross motor development in infants
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gradual improvements in balance, posture and locomotion
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what is the gross motor development milestone at 2 months
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supports weight on forearms
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what is the gross motor development milestone at 4 months
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good head control while sitting, supports chest and abdomen on hands
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what is the gross motor development milestone at 6 months
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rolls from back to abdomen, bears weight in standing position
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what is the gross motor development milestone at 8 months
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sits alone without support
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what is the gross motor development milestone at 10 months
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go from prone to sitting with little or no help, pull to stand
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what is the gross motor development milestone at 12 months
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crawling to creeping to cruising and walking
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what is fine motor development in infants
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Coordination of hands and eyes to explore and manipulate environment
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when do infants grasp go from reflex to voluntary
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5 months
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when does the primitive grasp occur
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5 months
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what is the primitive grasp
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holds bottle, grabs feet
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when does the palmar grasp occur
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7 months
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what is the palmar grasp
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tranfers objects between hands, two hands simultaneously
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when does the pincer grasp occur
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11 months
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what is the pincer grasp
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picks up finger foods, small objects, objects into and out of container
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how do you describe the social interactions of infants
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egocentric, narcissism-own needs are primary
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what should you allow the infant to do
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manipulate social environments
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infants have increasing preference for what
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toys, sensory stimulation and caregivers
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when does stranger anxiety manifest
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8 months
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what does play during infancy do
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development of language and sensorimotor skills
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what is essential in play during infancy
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interpersonal contact
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what kind of interaction is important in play during infancy
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quality of interaction more important than types of toys
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what should infant acitivites do
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stimulate developing skills
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how is physical growth in early childhood development characterized
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slower but steady increase in height and weight
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when is the height half of adult
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5 years
|
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how much brain growth is complete at 2 years
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75%
|
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how much brain growth in complete at 3 years
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90%
|
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when in myelinization of spinal cord nearly complete
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2 years
|
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what happens in the musculoskeltal system in early childhood development
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increasing bone length
muscles mature and strengthen |
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what happens in the GI system in early childhood development
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enlarging stomach size
primary dentition complete by 30 months slowed growth requirements reduce intake |
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what happens in the GU systems in early childhood development
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bladder capacity increases to near-adult function
sphincter control |
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what is the gross motor development in early childhood development
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Locomotion - walking, running, climbing, jumping
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what are the gross motor development milestones at 2 years
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running, jumping with both feet, few steps on tip toes
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what are the gross motor development milestones at 3 years
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riding tricycle, balancing on one foot, kicking stationary ball
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what are the gross motor development milestones at 4 years
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skipping, hopping on one foot
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what are the gross motor development milestones at 5 years
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riding bike with training wheels, walking in straight line, hopping on alternating feet
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what is fine motor development in early childhood development
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Refinement of hand-eye coordination, establishment of handedness
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what are the fine motor development milestones at 2 years
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self-feeding with spoon, draws vertical line
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what are the fine motor development milestones at 3 years
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self-feeding with fork, draws crude facial features, copies circle
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what are the fine motor development milestones at 4 years
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independently with dressing/undressing, draws stick figure with 3 parts
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what are the fine motor development milestones at 5 years
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ties shoelaces, competent with scissors, pencils, draws person with 6 parts
|
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what happens in language development
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Comprehension out-paces communication
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what are the milestones in language development at 18 months
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25 word vocabulary
|
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what are the milestones in language development at 2 years
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300 word vocabulary, 2-3 word phrases
|
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what are the milestones in language development at 3 years
|
: 900 word vocabulary, short complete sentences
|
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what are the milestones in language development at 4 years
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1500 word vocabulary, longer sentences, prepositions, questions
|
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what are the milestones in language development at 5 years
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2100 word vocabulary, past tense, adjectives, story telling
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what happens in social interaction in early childhood development
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Increasing independence & self control
Learning socially acceptable behaviors & language Individuation/separation allows for emerging sense of others stranger anxiety transitional objects for security peer relationships |
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what does play during early childhood facilitate
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cognitive, motor and social development
|
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what does play during early childhood allow
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exploration of the environment, tension release, role-playing for later in life
|
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what happens in play across the stage
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increasingly more social
|
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what are the stages of play
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solitary
parallel associative cooperative |
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what is physical growth in middle childhood development influenced by
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genetics and the environment
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what kind of physical growth occurs in middle childhood
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skeletal growth
|
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what happens to the oran systems in middle childhood
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nearing adult capacities
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what increases in the physical growth of middle childhood
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muscular strength and size
|
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what differences emerge in the physical growth of middle childhood
|
Gender differences emerge
Boys: more muscle cells Girls: better fine motor control |
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the first signs of what occur in middle childhood
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First signs of sexual development
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what happens to gross and fine motor development in middle childhood
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increasing coordination and strength
|
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what are the milestones for gross and fine motor development at 6-7 years
|
rides 2-wheel bike, throws overhand, prints legibly, cuts & pastes
|
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what are the milestones for gross and fine motor development at 8-9 years
|
increasing flexibility & fluidity, team sports, cursive writing, 3-dimensional drawing
|
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what are the milestones for gross and fine motor development at 10-12 years
|
balances on 1 foot for 15 seconds, catches fly ball; awkwardness as growth spurt begins
|
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what moves to the forefront of social interaction in middle childhood
|
School moves social relationships to the forefront
|
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what do peers provide in middle childhood social interaction
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support for increasing independent from parents
|
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what occurs in middle childhood social interaction
|
Strong sense of belonging, desire to be liked and accepted
Best friendships Often segregate by gender Bullying emerges |
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what does play in middle childhood develop
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Continued development of cognitive, motor, and social skills
|
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what is the emphasis on in play in middle childhood
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Emphasis on group activities, rules and standards
|
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what emerges from play in middle childhood
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Friendships emerge from shared interests
|
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what types of activities are important in middle childhood
|
Importance of both solitary and participatory activities
|
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adolescent physiological development is second to infancy in what
|
amount of change encountered
|
|
how long do adolescent growth spurts occur
|
4-5 years
|
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what occurs first in adolescent growth spurts
|
weight first, then height
|
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what is the difference in adolescent weight gain by gender
|
weight gain in girls = fat, in boys = muscle
|
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what is achieved in the physiological development of adolescents
|
Achievement of full bone length, muscle mass & strength
|
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what is an increased need of adolescents
|
sleep
|
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what is girls tanner staging
|
breast development, pubic hair
|
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what is boys tanner staging
|
pubic hair, penis, testes
|
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when does menarche begin
|
Menarche follows about 2 years after breast development starts
|
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when does ejaculation begin
|
Ejaculation about 1 year after penis begins to lengthen
|
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what are the stages of tanners breast staging
|
preadolescent (before age 8)- nipple is small, slightly raised
early adolescent stage- breast bud development (after age 8), nipple and breast form a small mound, areola enlarges, height spurt begins adolescent stage- (10-14 years), nipple is flush with breast shape, breast and areola enlarge, menses begins, height spurt peaks late adolescent stage (14-17 years)- Nipple and areola form a secondary mound over the breast, height spurt ends Adult stage-nipple protrudes, areola is flush with the breast shape |
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what is the characterization of social interaction in adolescence
|
Preparing for the transition to adulthood
Identity formation sexual identity academic/vocational achievement attracting romantic partner(s) |
|
what are the primary peer relationships in adolescents
|
dyads, cliques, crowds
|
|
what increases in social interaction in adolescence
|
Increasing segregation by ethnicity/culture
|
|
family relationships are a source of both of these in adolescence
|
security - nurturance, acceptance, values
conflict - priorities, responsibilities, choices |
|
what is positive peer influence
|
supportive relationships
healthy choices |
|
what is negative peer influence
|
risk-taking
age-inappropriate associations desire to move from periphery to core of group |
|
play during adolescence is an outlet for what
|
tension and anxiety
|
|
what are the acute effects of hospitalization for children
|
significant illness
first hospitalization |
|
what are the chronic effects of hospitalization for children
|
prolonged illness
repeated hospitalizations |
|
what are major illness stressors for kids
|
Separation anxiety
Loss of control Uncertainty Bodily threat Intrusion of illness/care regimen into everyday life Changes in family roles/relationships |
|
separation anxiety is particularly important for who
|
toddlers (16-30 months)
|
|
separation anxiety in manifested with what
|
even short periods of separation (minutes)
|
|
what may happen if separation from familiar caregiver is prolonged
|
may progress through different stages
|
|
what are the stages of separation anxiety
|
protest, despair, detachment
|
|
what happens in the protest stage
|
manifested in young children as screaming, inconsolable crying, resistance to comforting by others
can last minutes to days |
|
what happens in the despair stage
|
looks a lot like depression; crying stops, child appears sad & lonely
|
|
what happens in the detachment phase
|
resignation to separation improves behavior but challenges on-going relationships with primary caregivers
uncommon unless separation is prolonged (days to weeks) |
|
what is the significance of older children in separation anxiety
|
not as susceptible to major trauma from separation but still stressed by it
Most likely response is withdrawal, sadness, behavioral regression |
|
when does loss of control occur
|
Unfamiliar/unpredictable environment
lack of cues to behavior, meaning |
|
what happens with loss of control
|
Loss of autonomy: little say in what happens when
true regardless of age, although particularly frustrating for older children Loss of dignity |
|
loss of control is heightened by what
|
restrictions
disruption of routines enforced dependency |
|
who is particularly vulnerable to threat of bodily injury and pain
|
younger children
|
|
why are younger children vulnerable to threat of bodily injury or pain
|
limited grasp of anatomy, body boundaries, physical integrity
|
|
how does sense of threat fall
|
As environment becomes more familiar
|
|
why are Hospital environment not conducive to sleep
|
disruptions of routines
environmental cues (noise, light, activity, etc.) mood disturbances pain or other symptoms |
|
what are some common chronic illness stressors
|
illness intrudes into everyday life, threat to body image, uncertainty, prolonged dependency on others, changes in family roles and relationships
|
|
what are some Specific Chronic Illness Stressors
|
stigma
invasive procedures treatment side effects |
|
what becomes more important as children mature
|
social domain
|
|
what are some variations to children's responses to stresses of illness and hospitalization
|
Individual temperament
Family strengths/limitations Developmental level Level of experience |
|
what are some Typical behavioral responses to acute stressors/aversive experiences
|
Violent protest/avoidance
Delaying tactics Outright refusal to cooperate |
|
what can happen in childrens responses to chronic illness
|
Adjustment disorders, e.g., depression, anxiety)
particularly in first year of illness older children most at risk Diminished self-esteem Poor adherence to medical regimen Emphasis on normalcy, pathways to success |
|
what are some parental responses to illness
|
Anger: particularly at health care providers, spouses
Guilt: what did I do wrong? I can’t do enough! Fear/worry/anxiety Depression Overprotection |
|
what may be the initial response of problems or death at birth
|
avoidance/withdraw
|
|
what are some profound changes in the parents role with child illness
|
loss of other life roles (professional, spouse, etc.)
sadness over impact on sick child and sibling |
|
what are some sibling reactions to child illness
|
fear
guilt jealousy loneliness/rejection confusion |
|
how can nurses reduce stress of illness during initial/stressful hospitalizations
|
minimize unnecessary separation
help parents balance other demands support parents in being honest about leaving and returning maintain home routines/familiar belongings/ normal daily activities (hygiene, meals, play/school, napping, etc.) provide information/explanations at developmentally appropriate level play! |
|
what are some nursing interventions to reduce impact of illness
|
Encourage self-care
Encourage parental involvement Increases parents’ sense of mastery Promotes continued closeness/intimacy Offer assistance to avoid exhaustion Give choices WHENEVER possible Listen and reflect Model acceptance Provide parents with information and coaching support for the ill child support for well siblings Referral for psychological support Promote emphasis on normalcy |
|
why are children vulnerable to inadequate pain management
|
Limited by language and development in their ability to communicate about pain
Misconceptions about how children perceive and respond to pain Exaggerated fears of opioid side effects Medical, cultural, and individual expectations and values |
|
when do neural mechanisms to perceive pain in play by
|
20 weeks gestation
|
|
why does pain tolerance increase with age
|
neurological maturation
Experience |
|
what are some exaggerated fears of opioids
|
Respiratory depression - extremely rare in appropriately dose patients, and easily managed
Addiction - also extremely rare in appropriately treated patients |
|
when is metabolism of opioids similar to adults
|
3 months
|
|
what are some common barriers to pain management in children
|
Developing language skills or cognitive impairment may limit child’s ability to communicate effectively
Caregiver overconfidence in “objective” (behavioral and physiological) markers of pain Consequences for reporting pain may seem aversive Social context may inhibit child’s free expression |
|
what is the most reliable indicator of pain
|
verbal self-report
|
|
what are the verbal self-reports of pain for children
|
FACES scale by ~ 3-5 yrs
VAS (0-10) by ~ 8 yrs |
|
what should be done in the absence of a self-pain report
|
consider behavioral indicators of pain
facial expression level and quality of motor activity cry/consolability |
|
why should physiological indicators of pain be employed very cautiously
|
non-specific – could be influenced by disease process, fever, etc.
VS changes in response to acute pain attenuate over time absence of indicators does NOT mean child’s not in pain |
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what is the only first step of a pain assessment
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documentation
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what allows for optimal pain management
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Systematic assessment and documentation of results of interventions allow for optimal management
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what is the goal of Non-pharmacological pain management techniques
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alter pain perception and thereby minimize pain
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how can Non-pharmacological pain management techniques be used
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Can be used alone or in combination with analgesics
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what can non-pharmacological pain management techniques do
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May offer secondary benefits of decreased anxiety, greater sense of control, reduced helplessness
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when are non-pharmacological pain management techniques most successful
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Most effective if introduced in advance of painful event or during period of relative comfort to allow for familiarization/training
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what does distraction do
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interferes with activation of pain signaling pathways
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what are some types of pain distraction
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progressive muscle relaxation
guided imagery/hypnosis technology assisted imagery – virtual reality devices |
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what does Cognitive-behavioral training do for pain
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empowers child to take action in response to pain
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what are some types of Cognitive-behavioral training
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biofeedback
positive self-talk, cognitive reframing |
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there is emerging evidence for what kind of pain control
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Acupuncture/acupressure
Therapeutic massage Music therapy |
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what are some TLC measures to reduce pain
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Position changes
Transitional objects Adhesive removers Emotional support Parental encouragement |
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what are the Goals of Effective Communication with Children and Families
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Establish rapport and promote trust
Demonstrate understanding of children’s & families’ developmental status and individual differences Elicit accurate and meaningful information Active listening |
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what are some general guidelines for effective communication
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Introduction/role clarification
Initiate contact with child first unless developmentally, culturally, or individually unwelcome Place yourself at child’s eye level Use specific, understandable terminology Establish expectations for cooperation, duration, privacy, etc. |
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what are the guidelines for effective communication in infants
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quiet, sing-song tone; respond to baby’s social cues
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what are the guidelines for effective communication in toddlers
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approach cautiously! Limit information and anticipate short attention span
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what are the guidelines for effective communication in preschoolers
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incorporate play, imagination; focus explanations on sensory experience
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what are the guidelines for effective communication in school aged children
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incorporate written/visual information; elicit specific questions/concerns
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what are the guidelines for effective communication in adolescents
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be authentic, straight-forward; respect boundaries
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what are the principles of physical assessment with children
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Minimize anxiety/threat:
Least to most invasive/aversive Maintain contact with parent Work around clothing whenever possible Enlist participation of parent/older siblings as appropriate Every interaction is an opportunity for assessment Compare findings to previous assessment(s) Provide choices where possible and as age-appropriate order of exam positioning privacy vs. parent present Be patient but firm: let the child know what’s expected reinforce appropriate behavior praise specific behavior, NOT character |
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what is the physical growth assessment in children
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Consider purpose and frequency of assessment
Note conditions under which values obtained Height/length: supine up to 2-3 yrs, then upright Weight: limited or light clothing (unclothed if small variations critical) subtract adult weight from combined infant/adult weight Head circumference: widest diameter (occipital prominence, center of forehead); part of standard measures up to 36 months |
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what is the vital signs assessment in children
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Remember: least to most invasive
Temperature: rectal: up to 1 year; note exceptions! oral: assure child understands and follows directions axillary: chart environmental conditions Pulse: apical whenever possible and always up to 2 years; palpate radial/brachial to count along Respirations: watch/palpate chest rise and fall for infants/toddlers Blood pressure: use of electronic device problematic in younger children – verify abnormal findings with manual technique |
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what is the skin assessment in children
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Children at greater risk for skin breakdown from medical intervention
Closely monitor diaper area for rash/breakdown |
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what is the head and neck assessment in children
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note muscle control, symmetry of external structures (eyes, ears, etc.), presence of discharge
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what is the chest assessment in children
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Nipple line as landmark
Superficial (transmitted) sounds common in younger children – should clear with cough/crying Sinus arrhythmia common in children – should clear when breath held |
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what is the abdomen assessment in children
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Listen at least 30 seconds before noting absent/diminished bowel sounds
Sandwich child’s hand between yours to reduce ticklishness Note whether abdominal hernia present |
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what is the genital assessment in children
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Expect/accommodate shyness by pre-school
Retract foreskin GENTLY |
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what is the neuromuscular assessment in children
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Focus on symmetry, mobility, strength, and tone
Evaluate throughout entire interaction For ambulatory children: note abnormalities in gait, posture, balance, and coordination |
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how do you give oral meds to kids
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may require crushing tablets
camouflage taste mix in smallest volume possible to assure it all gets in |
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how do you give IM meds in kids
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know age-based norms for site, needle length & gauge
plan on requiring restraint except in oldest kids |
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what are some challenges in feeding hospitalized kids
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loss of appetite
refusal nausea/vomiting/diarrhea |
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what are some suggested approaches to help feed reluctant children
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favorite foods/accommodate personal preferences
limit pressure from staff and parents be creative consider nutritional value in light of goals of hospitalization |
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how are kids kept safe in the hospital
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Identification bands
Hospital must be child-proofed just like home When the environment can’t be made safe - supervision restriction/containment Cribs & beds should be a safe haven can be used to “contain” active toddlers but still require supervision |