Study guide 1 Peds
Chapter 20: Caring for the developing child
Describe the principles inherent in the developmental process:
- Principles of childhood growth and development: Although children all grow at
different paces and have different strengths and weakness. Development occurs in
an orderly fashion and each child should progress through predictable stages within
a certain time frame.
o Growth refers to a continuous adjustment in size. Growth spurts tend to be
followed by periods of rest because it takes plenty of energy to continue the
growth process. The periods of rest allow the child to master their current
growth status before they spurt into the next.
o Development refers to the ongoing process of adapting throughout the life
span.
o Cephalocaudal: development of the head first then progresses to the toes.
o Proximodistally: development from center to peripheral.
o Gross to fine motor skills: Gross motor skills like running, jumping, or riding a
bike. While fine motor skills are eating, coloring or buttoning a shirt.
o Touchpoints: idea created by T.Barry Brazelton that are defined as “in the first
three years of life the child’s spurts in growth result in disruption on the
family system”
-month old who becomes increasingly
aware of his surroundings. This will disrupt meals because baby will
search out sounds it had heard. It will disrupt sleep because at night
time baby might awaken at night.
lton and sparrow (2002) went on to develop specific aspects
about the touchpoints that related to temperament, learning, moral
development, relationships, independence, and separation issues for
each of the years from 3-6. Responding to touchpoints help the
parents to help the child to develop in a healthy manner
each developmental stage so the parent knows the child more than
anyone else.
Identify and explain the theories of growth and development:
Growth and development theories: explain, describe, and predict the various aspects of growth
and development. A developmental domain allows understanding of the total child in relation
to the mind, body and spirit. Growth and development requires energy, how that child expends
that energy is dependent on family, individual, and social factors.
Psychosocial developmental theories:
- Sigmund freud, psychosexual: focused on the influence of instincts. Instincts are
psychosexual in nature, meaning that a child progresss through developmental
stages based on resolution of conflicts surrounding urges and rules.
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o 3 aspects of human personality:
unregulated. For instance, the instant reacts to a sound automatically
by crying. Id relies solely on instinct.
Provides a sense of identity separate from others and promotes the
ability for the child to function independently.
-6. Helps regulate behavior,
allows us to fit in with society and its expectations. Child learns the
needs of self and others. Gives the child a perception of self. Learning
the difference between right and wrong.
- Erik Erikson; focused on the influence of social interaction. Seven stages of
development, mastery of a stage requires the individual to find balance between two
conflicting variables. Each stage represents a crisis that must be resolved to move on
to the next stage in a healthy manner.
o Trust vs mistrust: occurs between birth and 1 year. The task for this stage is
to identify that there are people who can be trusted to take care of basic
needs. The struggle is that the child must also learn that not everyone should
be trusted. Through trust the child learn to have confidence in personal
worth and well-being with connectedness to others. Failure to meet this goal
leads to hopelessness and detachment. Signs of failure include failure to
thrive and attachment issues. Difficulty in trusting is seen in adults who have
problems maintaining significant relationships.
o Autonomy vs shame and doubt: 1-3 years of age. The goal of this stage is for
the child to develop independence and self-sufficiency against the
predictable sense of uncertainty and misgiving when placed in life situations.
This is a time for the child to develop a can-do attitude about self. Ex. A child
wants to pick out their own clothing. The struggle is the parents allow them
to make the choice while expecting the outfit to be socially acceptable. New
found independence is accompanied with new rules that cause internal
conflict. Child must develop personal abilities while dealing with fears and
wishes. The child that has self-doubt later in life if this is not successfully met.
o Initiative vs guilt: 3-6 years old. Task is to develop resourcefulness to achieve
and learn new things without receiving self-reproach. It is difficult for the
child wanting to be independent but also relying on parents. Examples of
initiative: learning songs, jokes, or games. The child feels confident to try new
ideas. It is important for parents and teachers to encourage initiative to allow
child to develop purpose.
o Industry vs inferiority: 6-12 years old: The sense of accomplishment can be
counterbalanced by a sense of inadequacy or inferiority that comes from not
succeeding. Industry is evident when the child is able to do homework
independently and regulate social behavior. If the child cannot complete
realistic expected tasks the feeling of inferiority may result.
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o Identity vs role confusion: 12-18. This is a time for acquiring a sense of self as
an individual in the face of a new and at times of conflicting demands or
desires. Adolescent focuses on goals and life plans separate from these of
peers and family. An adolescent who is unable to make decisions about
possible career choices, a personal belief and value system, and sexual
orientation may develop a weak sense of self and may be incapable of
committing to an identity. This leads to role confusion.
Attachment theories: refer to the bond or emotional or physical connection that develops
between an infant and caregiver.
- John Bowlby and Mary ainsworth: focuses on the quality of the bonding
relationship between child and caregiver. Studied the child’s bond with a mother or
mother-substitute a a means of surviving during stages of vulnerability rather than a
simple response to having biological needs met. When the child begins to know
more people the mother or mother substitute becomes a “home base”. So when
child gets frightened it returns to the home base for safety. If the infant feels secure
in knowing that the home base is reliable, the child is free to explore more social
relationships.
o Separation: studied the separation of the child and the mother. And noticed
that the child goes through three stages of separation.
or mourning caused by prolonged separation.
o Types of attachment: Created a situation room to test the attachment to the
mother when certain situations occurred.
nt: baby cries when baby leaves and is happy when
she returns.
avoids the mother upon return
leaving, is very upset when she leaves and seeks contact with her
while pushing her away upon return.
Learning theories: began to understand development as a cognitive or learning process.
Behavioral scientist saw the learner as passive while social learning scientists emphasized the
interplay of the individual within the specific environment.
- Social learning theories:
o Alberta bandura: states that learning occurs through social context through
observing and modeling. The child pays attention to a new task, retains that
image, and then reproduces that action physically. As the infant develops
more skills it is motivated to keep learning. As the infant develops a sense of
self and begins to differentiate self from others, the infant develops new skills
and hopefully resilience in the face of life’s difficulties.
o Lev Vygotsky: studied the influence of culture. Recognized that culture and
certain factors in the child’s environment had a big influence on
development. Believed that development occurs on two levels: Social and
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personal. Zone of proximal development: one learns much more wit the help
of another person. In other words, a child left alone would accomplish a lot
less than a child that had received assistance from another person.
o Urie Bronfenbrenner:
Microsystem: systems in which the child is actively involved. (family,
school, and peers)
home)
the child is not intimately involved (the parent’s work).
Cognitive theories: focus on how an individual thinks and how thinking influences worldview.
- Jean Piaget:
o Initial period (sensorimotor stage) birth-2: child takes in and processes info
strictly physically and emotionally.
o Preoperational stage: 2-7 years: development of motor skills
thinking, but child is increasingly able to connect cognitively with the
world.
o Concrete operational stage: 7-11 years. Able to organize thoughts in a logical
order. Child is able to organize and label objects.
o Formal operational stage: 11-15 years. Uses abstract thinking to handle
difficult concepts and can analyze both sides of an issue.
Intelligence theories: relies on the connectedness of cognitive, emotional, and environmental
factors. Nurses are responsible for teaching children so it is important for us to assess
intelligence levels by asking about hobbies and interests. The nurse then uses this information
to create a teaching intervention that is appropriate for the child and their learning ability.
Moral development theories: deals with perception of right and wrong.
Lawrence Kholberg: Created three levels of moral development
o Preconventional: thinking is concrete and egocentric. Obedience/Punishment
is not questioned and understood as either good or bad. Child develops a
sense of fairness and personal justification. Child begins to realize that it is
not just black and white. Child begins to take into account personal
reasoning.
o Conventional: child’s actions are justified by personal motivation to “do good”
for family and other individuals. Child understands that maintaining social
order helps society benefit as a whole by his actions.
o Post conventional: divided into social contract, individual rights, and universal
principles.
- Carol Gilligan: Held beliefs about female’s due to Kohlberg’s system being geared
more towards males. She would interview both males and females about their life
experiences. She developed two tracts of moral development. Men were based on
autonomy and justice and women were based on caring and relationship.
Spiritual development theories:
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- James Fowler: Identified 7 stages related to faith and spiritual development.
Believed that faith is commonly experienced and that it is individuals striving for
something “more than the self”. Deepening levels of believe require the ability to
think abstractly.
Family development theories:
- Duvall’s 8-stage theory is based on Erikson’s individual stages of the psychosocial
development and is the most well-known.
o Marriage: couple establishes themselves as a pair and to prepare in
parenting.
o Family with infants: Child is born and family is met with a new structure
while couple adapts to the role of parenting.
o Family with preschool childen: As the oldest child enters the stage of early
childhood the family focuses on socializing the children.
o Family with a schoolchild: Children develop friendships and launch socially
outside the family.
o Family with adolescent: oldest child turns toward launching and
independence. Parents begin to focus on their marriage.
o Family launching young adult: Begins when oldest child leaves home. Ends
when youngest child leaves home. Family focues on developing independent
entities. Marriage continues to become a major area of energy
o Middle age fam: Family focuses on reinvesting in the couple’s relationship.
o Aging family: family copes with the process of and losses involved in
retirement and aging.
- Temperament: is defined as the characteristics a child is born with and it governs the
way the child reacts to its surroundings. Thomas and Chess actually did a study and
came up with nine temperament traits and they are as follows:
o 1. Regularity: Child needs regularity with sleep, eat, and bowel habits. An
“easy” child is one who easily adapts to changes, where as a “difficult” child is
one who is disturbed when the schedule is altered.
o 2. Adaptability to change: Childs willingness to change routine. Easy:
responds easily to new people in their environment. Other children may
withdraw when new people are around.
o 3. Sensory sensitivity: Easy: will appear much less disturbed by external
stimuli. A difficult child may react strongly when exposed to sensory stimuli.
o 4. Emotional intensity: Easy child shows little to no response to a situation. A
difficult child reacts dramatically and profoundly.
o 5. Level of persistence: refers to the child’s willingness to stay engaged
regardless of setbacks. A persistent child has difficulty giving up until the goal
is reached. A less persistent child is more flexible and may give up more
easily.
o 6. Activity level: An easy child will be generally less frantic with activity. A
difficult child has difficulty with inactivity preferring to always be on the
move.
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o 7. Distractibility: The distractible child has a hard time staying focused, a less
distractible child stays with the task longer.
o 8. Mood: an easy child tends to see the world in a more positive way, a
difficult child tends to react in a more negative manner.
o Identifying these factors allows the caregiver to better understand what goes
on with the child to better handle their care.
Growth and development milestones: It is important to be able to identify growth milestones
so that way you can tell when a child is falling short of certain needs. This is where early
interventions come in to help correct shortages so that the child can stay in tune with his/her
peers.
- Newborn and infant: encompasses the time between birth and 12 months.
Detecting early alterations in growth and development is important to the life of the
child and the family.
o Reflexes and neurological development: The infant has primitive reflexes
which are purely for survival. The reflexes are controlled by lower parts of the
brain, the lower parts are important for basic body functions and primitive
reflexes. The child is born with specific reflexes, and at 9 months they
naturally disappear. As the child begins to growth and develop, the upper
brain will begin to grow as well.
or lower lip is stroked
nfant
to take in sustenance
head. The hands abduct and move upward and the hands form a C
shape.
stroked causing fingers or toes to curl inward.
sole of the foot is stroked.
o Sensory development:
child to learn about the world around it. It is important for the child to
enjoy soft touches, but learning from pain is also essential. The child
responds to pain by extending the entire body and then retracting the
extremities.
respond to smells
after the first few days and commonly favor sweet smells. The child
can identify their mother’s smell long before they can visually
recognize her.
females voices and will respond more to female voices. By week 2 the
child can recognize mom’s voice. By 3 months baby begins to jabber
and imitate sounds.
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fascinated with faces or shapes that look like faces. A newborn is able
to remember an object, but only in its original form (would recognize
grandma if she did her hair exactly the same as she did the first time
they met). Newborns are attracted to bright colors and black and
white. Poor peripheral vision until 10 weeks old. At three months
baby will watch faces intently and focus on moving objects, may also
begin hand-eye coordination. The ability to use both eyes to see
(binocular vision) occurs at 4-5 months. Colors and seeing things in
the distance occurs at 7-12 months.
- Physical development: Growth is rapid. Infants gain about 1.5 lbs a month, double
their weight by 6 months, and triple it by 1 year. Height increases by 1 inch per
month for the first 6 months. The newborn has a head that is big compared to the
body due to the rapid growing of the brain, by 1 years the child’s head and chest
circumference are the same.
o For the infant to perform actions, there must be muscle development. A
newborn has involuntary movements, but gross motor skills are the first to
develop (the ability to use large muscles for movement). By the end of the
first 3 months of life the infant can move its head and chest while lying on his
belly and stretch the legs out and kick from a prone position, and roll from
side to side. The infant can turn over completely at 6-7 months. By 8-9
months the infant can crawl and then by using high object the infant may
begin pulling up. Once the child masters sitting upright, he may begin to
“cruise” walk while holding on to furniture, or even attempt to walk alone.
o Fine motor skills (the ability to use smaller muscles to accomplish minute
tasks like pinching) build on the gross motor skills. Motor skills develop
between 6-12 months. The child may be able to stack objects, scribble,
transfer objects from one hand to the other, etc.
- Cognitive development: The infant uses the 5 senses to learn about the world. Child
may being associate lip smacking with getting food, which leads to the infant
realizing they can have an impact on their environment with simple actions. The
infant must achieve three major tasks during this phase of development:
o Separation: The infant realizes they are not physically attached to the people
around them.
o Object permanence: the infant knows that a person or object still exists even
if covered upor removed from sight. This is why they respond so strongly to
peek-a-boo.
o Mental representation: infant has ability to use symbols to communicate.
o Paigets 6 substages within the sensorimotor stage that describe mental
representation.
that go away at 9 months.
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pleasure. 1-4 months
rcular reactions: the actions that the infant can do
independently begin to grab the child’s attention. Cause and effect.
-12 months: infant intentionally
seeks out objects. The child knows that pushing buttons on a toy
does.
as hitting a drum with a stick over and over.
down to open a drawer.
- Language development: infants communicate via crying to indicate discomfort or
loneliness. As parents respond to cries the child learns to communicate more
deliberately. The infants early speech involves crying, babbling, and imitation. The
family has an influence on the development of the child’s language. Allowing the
child to call the bottle “ba” and calling dad “Da” with positive reinforcement it brings
the child closer to native language.
- Psychosocial development: The infant’s first display of emotions are related to
physiological needs vs stimuli. At first the infants may smile involuntarily during
sleep, but eventually it will begin to be used in a social way. It is important for the
caretakers to develop a trusting relationship with the newborn to give the child a
sense of reliability.
o Ainsworth attachment: During the first 2 months the child responds
randomly to anyone. But 8-12 week old children begins to respond more to
mother than anyone else, but will still respond to others without
discrimination. At around 6-7 months the bond between mother and baby
really begins to form and the child may develop a fear of strangers. The child
takes the first year of life to develop relationships with those around it. Child
begins to respond to people or animals that are at eye level.
- Discipline: Discipline takes place when the caregiver molds and structures the child’s
daily routines and responds to the infants needs. Limit setting is important to teach
the child about the worth and keep the child out of harm’s way.
- Anticipatory guidance: During infancy the child is growing very rapidly, parents are in
needs of information to know what to expect at each stage. It is important for the
nurse to teach about nutrition, health promotion, safety, sleep-wake patterns,
growth and development, and discipline. Health promotion and safety are priority
topics to approach parents with. Nurses also need to remind parents to take care of
themselves, the tend to forget that they need time to be a couple.
- Toddler 1-3 years: By this time growth has slowed, for each year child gains 3-5 lbs &
grows 3 inches taller. As toddler develops mobility, she explores how things work and
senses are refined. By age three a child may learn how to ride a bike or go down a
slide independently. (newly acquired gross skills). Newfound freedom creates more
danger for the child as they jump from experience to experience.
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o Fine motor skills develop more rapidly, toddler can hold a spoon or crayon
and makes artwork that is more representative of objects.
- Cognitive: Toddler is transitioning between tertiary circular reaactions, and mental
combinations when she understands cause and effect and is able to imitate and
problem solve. Toddler learns through repetition and imitation. Toddlers also like
order and may respond negatively if there is a lack of it.
- Language development: toddlers are able to listen and understand short
explanation. Language is about fulfilling needs “I do” or “want drink”. The child
moves from single words to short phrases. Parents tend to get worried if their child
seems off with language, but its important to focus more on understanding.
- Psychosocial: The child develops a sense of self separate from their mother. The
toddlers task is to move away from caretaker while still feeling secure or safe its
called reproachment.
o Toddler is also responding to autonomy vs shame and doubt: this is a time
where the child makes an effort to “do it myself”. This is a valuable level
because the child’s abilities begin to surpass the cognitive judgment, which
makes things more dangerous for the child. It is often times of bumps and
booboos. Terrible twos is a rough time for both parent and child, The child
must learn social standards while also developing independence. The word
“no” begins to signify the toddlers simple response to frustrated emotions
encountered.
- Moral development: Toddler is a concrete thinker, he knows that something is good
or bad but doesn’t know why. The toddler identifies good or bad based on reward or
punishment.
- Discipline: the purpose of discipline is to teach the child socialization and safety. It is
the parent’s responsibility to provide structure while setting safe limits. Parents must
learn to structure the toddler’s surroundings by allowing enough flexibility to test
limits. A child this age needs guidance to determine how to act appropriately.
Temper tantrum may result when ther is a conflict in what the toddler wants to do
and what the toddler is allowed to do. Praise is a valuable component bc the child
wants to please the parent.
- Temper tantrums: A tantrum is a way of working things out internally for a toddler.
Caregivers need to know that they are normal. Tantrums may be avoided or
minimized if they are anticipated. Get a tired child to rest and feed a hungry one to
decrease he frustration level. If the child is wailing or thrashing and not causing any
harm, ignore her. Touching and distractions may help soothe the tantrum of one
child, the other may need to continue the tantrum under a watchful eye. This means
the parent must be present but not to engage in communication with the child.
- Anticipatory guidance: constant supervision in required. As toddler explores
environment he does so with little understanding of consequences. Cabinet doors
need to have a safe lock, mini blind cords must be secured and out of reach,
windows and doors must be locked. As a toddler is learning how to ride a tricycle
teach them while always wearing a helmet, the child is learning new rules and
consequences at this time. Consistency in rules must be applied, if a rule is broken
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there must be a consequence. Putting child in a brief time out is an effective
discipline tool. A general rule of thumb for time-outs with toddlers is 1 minute for
each year of age.
- Early childhood (preschooler 3-6 yrs): begins to grow taller and thinner. Abdomen
will flatten as she grows and the muscles with strengthen. Avg weight gain is about 5
lbs per year and 2.5-3 inches taller. The child has more coordination in doing
activities. Fine motor skills rely on the use of the index finger and thumb. Hand
dominance begins to develop at around the age of 3, at 4 the preference is
established.
- Cognitive development: increased ability to verbalize. Child is egocentric (focuses
only on their own senses) and is socially limited. This is due to the lack of ability to
shift focus from self to others.
- Language development: 1500-2000 words by the age of 3-5. Child is able to convey
an intended message and tantrums tend to subside. Loves silly words, and rhymes
and begins to ask why. Parents should keep explanations simple. Stuttering happens
when the child is trying to get out too many words at once, teach parents not to be
worried, it usually subsides quickly.
- Psychosocial development: Preschooler is really getting an idea of how to do things
for oneself. They enjoy positive feedback for accomplishments. While the child is
able to do many things, he may face the dilemma of deciding which things are more
important. When parents do not approve of the decisions of the preschooler she
may become conflicted when limits are set. The child begins to ponder about doing
the right thing or doing the wrong thing and risking the parents dismay.
o Magical thinking: is when a child wishes something bad to happen to
someone, and if something bad actually does happen the child may feel that
her thinking caused it to happen.
o Phallic or Oedipal period: Child is more aware of gender differences, may
want to marry dad or the male preschooler rather than relate to her best
female friend. Preschooler begins to value friendships and looks towards her
peers for new ideas and information and understanding what it means to be
kind. More social and willing to share toys with others.
- Moral development: the major influence of moral judgement is to avoid discipline.
Common for child in this age group to tell lies to avoid consequences. The young
child is only guilty if the parent has seen the actions.
- Disclipline: Preschooler is able to understand that there are rules and not obeying
the rules leads to consequences. It is best that rules are explained before the
fractions occur. This helps the child learn more clearly how to behave. Consequences
should fit the behavior, for example: making the child clean up the mess they made
is a good way for them to learn the consequences of making a mess. Some parents
use behavior charts to reward good behaviors. Simply getting a sticker is enough to
encourage good behavior. The ultimate goal of discipline is to teach the preschooler
how to control their own behavior.
- Anticipatory guidance: Parents can encourage language development and
comprehension by reading or singing to the preschooler. Parents can expect the
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preschooler to test limits. It is important to set and maintain consistent limits.
Preschools provide children with opportunities to interact with other children, learn
cooperative play, enhance cognitive, social and physical skills. Working closely with
the preschool teacher can let the parent know when their child is ready to attend
school.
- School age child 6-12 years:
- Physical development: They begin to grow taller, reducing baby fat. Gain about 4-6
lbs and grow about 2 inches per year. Facial features become more refined. Most
school age children develop axillary sweating. In girl’s hips and pelvis start to widen.
Breasts begin to enlarge and become tender. Vaginal pH changes, and develops a
mucus lining. Pubic hair begins to develop between 8-14 years. The average year of
menses in the US is 12. In boys their bodies become more muscular. Between age
10-12 the testes become more sensitive to pressure, skin of the scrotum darkens,
and pubic hair begins to develop. Boys tend to develop gynecomastia due to
hormonal changes. School age children are assessed with Tanner staging to
document levels of normal puberty development.
- Cognitive development: School age is better at using logical thinking. Why questions
turn into how questions. Mastery is in figuring out how things work. In school, they
work on tasks of awareness of space, causality (logical consequences), categories
(how things fit together), conservation, and numbers. They are able of
metacognition – the ability to think about thinking. Memory deepens as child begins
to grow. A child at this age is able to identify what is important to remember vs what
is not.
- Language development: Child uses words more accurately, particularly verbs,
metaphors, and similes.
- Psychosocial development: There is a vast emotional growth during the middle child
years. They being to assess what they can and cannot accomplish. They need to seek
praise and have more of a sense of self-esteem based on the ability or lack of ability
to perform. Between ages 6-9 magical thinking is still present, so the child may think
that bad things happen due to negative wishes. Later between ages 9-12 the child is
more independent but still wants approval and validation. Through this stage sorting,
collecting, and board games are common. Competing and winning become
important to self-competence. School age child looks more to friends than family but
family is still important. Close friends are usually of the same gender but groups of
both genders form before they enter their teenage years.
- Moral development: By the age of 10 the child has more internalized rules and is
intently gaining approval. The older child operates within a morality of cooperation
that implies recognition of the interaction between self and the bigger world. Most
children at this age are motivated to adhere to laws as ways to keep order.
- Discipline: it is important to allow the child more independence as they begin to
internalize rules. This gives them a more natural idea of natural consequences of
behavior. An effective action of the parent is to avoid trying to recue them from the
consequences of their behavior. Ex. Rushing home to get the homework the child
forgot rather than allowing him to learn a valuable lesson.
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- Anticipatory guidance: It is important to educate the parents on how to deal with
changes in their child and how to talk to them about puberty before these changes
occur. It gives the child an insight of what to expect and what to be aware of. A good
idea is to have parents go over the health information regarding puberty that is given
out in school, so they know what to build off their own teaching at home.
- Adolescence: 12-19 years:
- Physical development: it is a period of great growth second to infancy. Girls may gain
15-55 lbs and grow 2-8 inches. Boys gain 15-30 lbs and grow 4-12 inches. As usual
girls usually develop sooner than boys.
- Cognitive development: Adolescent is able to think abstractly and use logic to solve
problems. She begins to be concerned about things like philosophy, morality, and
social issues. Adolescent is able to project her thoughts over the long term, making it
possible to set goals an make plans. Often compares beliefs with those of her peers.
- Language development: Has highly develop and sophisticated language skills. Ability
to speak and write correctly. Also able to communicate and debate alternative points
of view.
- Psychosocial development: Identity vs role confusion: adolescent must begin to
identify who she is and who she will be in life. Major source of influence her peer
group. Members of peer groups offer different viewpoints, this allows for
establishment of strong relationships and provides opportunity for the adolescent to
practice adult behaviors by becoming active within a social group. There are three
major issues that must be confronted by the adolescent: 1. Finding an occupation, 2,
establishing a set of values, 3. Developing a satisfactory sexual identity. While the
adolescent makes these decisions, she gets more confident in her sense of who she
is becoming.
o Informed consent: a child under 18 is given a right to consent under these
conditions: when they are minor parents of a child patient, when they are
seeking birth control, counseling, or help for substance abuse.
- Moral development: conflicts emerge between what an adolescent has believed to
be right or wrong and what others may believe. This is a time where the adolescent
learns that it is possible for several views of morality to exist.
- Discipline: This is a stage where the adolescent begins to internalize responsibility
for behavior. She still needs parental guidance and input in terms of rules. It is most
important in this stage that the parent focus on the positives of the adolescent’s
behavior. Natural consequences are powerful motivators but at this time the
adolescent may have learned that she can avoid consequences by being crafty.
Removing privileges may be an effective consequence for poor decisions.
- Anticipatory guidance: adolescent is deeply influenced by her peers. She may miss
out on family events in favor of being with peers. Peers may pressure adolescent to
drink, smoke, do drugs, or engage in sexual activity. Parents must keep the lines of
communication with their adolescent open and teach her how to resist peer
pressure. It is important for the adolescent to identify a trusted adult with whom she
can talk to about sensitive issues and from who to get advice.