Younger children need special attention from doctors and nurses, as early development determines future patterns of health. Age 0-5 years is critical because of babies’ susceptibility to many specific childhood diseases that are characteristic of the age periods of their development. In the early years of life, children usually develop according to standard patterns and exhibit certain physical, cognitive, and social development characteristics (Sharma & Cockerill, 2014).
Renowned psychologists such as Erickson and Piaget have developed theories that define developmental stages in terms of a child’s performance in behavioral, social, and cognitive functions (Cherry, 2020). More modern scholars and health practitioners also propose insightful views on the normal growth and development of younger children. This paper aims to discuss developmental theories, analyze the factors promoting or inhibiting the growth of 3 years old children, briefly discuss how the CFH nurse would support a family whose child is at risk for delays in growth and development, and provide appropriate evidence, examples, and rationales for the discussion.
The development of younger children is highly important since it lays the base for future health patterns and life success. Therefore, there is a particular demand for the child and family health routine screening and surveillance practice provided by professional CFH nurses. Modern scholars like Sharma & Cockerill (2014) and Hockenberry & Wilson (2014) also offer unique approaches to assessing child development during several developmental stages in the areas of physical, cognitive, and social development. CFH nurses must use scientific approaches and theories when performing assessment, diagnosis, planning, implementation, and evaluation of nursing interventions. Piaget’s and Erikson’s theories seem to be the most important in this regard.
Piaget’s Cognitive Development Theory is concerned with the individuals’ mental processes and how these processes impact the individual’s perceptions of the world and social interactions. Jean Piaget was the first to understand that children think in other ways than adults do and explained the stages of children’s intellectual development, illustrating these differences (Cherry, 2020). According to the theorist, there are four stages of a person’s cognitive development – the sensorimotor stage in the period between birth and the age of two, the pre-operational stage in the period between ages 2 and 6, the concrete operational stage, between ages 7 and 11, and formal operational stage between age 12 to adulthood.
The sensorimotor stage defines the period when the infants ‘knowledge and understanding of the world are determined by their sensory perceptions, impressions, and feelings. The infants also actively develop motor activity during this stage. They start by reacting to sensor stimuli and then develop some basic motor reflexes.
The pre-operational stage is of particular interest for this paper. According to Piaget, children learn to express themselves using words and discover how to use the language properly during this stage. Children of ages 2 to 6 do not understand concrete logic and cannot manipulate the information. They cannot take the perspective of other people and see the situation from their point of view (Cherry, 2020). During the concrete operational stage, children begin to think logically and mentally manipulate the information; still, they are incapable of abstract thinking during this stage and cannot understand abstract concepts. In the formal operational stage, children finally develop the capacity for abstract and hypothetical thinking, deductive reasoning, and systematic planning.
Piaget’s findings related to the pre-operational stage processes are highly valuable since they allow the CFH nurses to define the area of development to focus on. According to Piaget, at the age of 3, children’s main cognitive concern is using language. Given the intersection with Erikson’s stages, the language is often used to describe personal aspirations and plans to apply personal willpower to the outer world during this phase.
Erikson’s Psychosocial Developmental Theory also deserves particular attention. It was developed under the influence of Freud’s ideas on growth and development, and Erik Erikson is considered a Neo-Freudian. According to the scholar, there are 8 stages of psychosocial development which every person goes through during their lifetime (Cherry, 2020). These stages determine social interest areas and the character of social relationships, interactions, and conflicts during particular ages. Psychosocial development is determined by the successful or unsuccessful overcoming of the conflicts and developmental crises characteristic of the stages. In general, the age of infancy focuses on the trust vs. mistrust conflict, sees feeding as an important event, and aims to develop a sense of hope.
Age of early childhood, 2 to 3 years, focuses on autonomy vs. shame and doubt, sees toilet training as an important event, and aims to develop a sense of will. Preschool age, 3 to 5 years, focuses on initiative vs. guilt, sees exploration as an important event, and aims to elaborate the sense of purpose. The autonomy vs. shame and doubt phase preceding the preschool stage implies some independence due to developed bodily function control and greater consciousness in making preference decisions over food, toys, and clothing (Cherry, 2020). Children should not be shamed in this phase not to develop self-doubt. After completing the phase, children feel secure and confident, develop the will, and believe that they can act with intention within the limits of particular circumstances.
During the initiative vs. guilt stage, children start asserting their power and control through social interactions and by directing the play. Success during this stage brings the feeling of capability and ability for leadership. Failure in this stage leaves the kid with a lack of initiative, a sense of self-doubt, or guilt. If children show the proper extent of power, their initiative is gladly met, and they gain a sense of purpose. Otherwise, they may feel guilt or be rejected, showing too much power. The purpose is seen as an ideal balance between the initiative and the desire to cooperate with other people.
Factors that Promote or Inhibit Optimal Growth and Development
Social and Emotional Factors
According to experts, during the preschooler stage, 3 to 5 years, children can often develop a desire that the same-sex parent was dead since this is a part of their sexual development at this stage. However, if such a tragic event happens, the child can be overwhelmed with guilt and should be told by the adult that wishes do not have real power. Besides, the magical thinking characteristic of this stage may cover other parts of life and should be properly addressed if there is a need.
During this stage, the kids are more susceptible to the warnings of danger and rules than at the earlier stages; they can develop a better social understanding if they are allowed to disagree and ask questions. Children have egoistic thinking during the age of 2 to 4 years and assume that there is no need to explain their words. Hockenberry & Wilson (2014) advise parents and caregivers to encourage children’s play since play is the child’s way of understanding, working out, and adjusting to social experiences. In this stage of separation-individuation, children are ready to be separated from their parents for a while. They are not afraid of strangers, but the long separation may cause problems.
Language and Communication Factors
Developing language and communication abilities is the most important assignment for a preschooler. Hockenberry & Wilson (2014) notice that inhibiting drawing activities may lead to reading problems since these two areas are closely related. Inhibited reading may have a future consequence of more deficient language structures, vocabulary, and overall understanding. On the opposite, children who are allowed to experiment with forms develop better capabilities for learning a symbolic language.
Hockenberry & Wilson (2014) also note that parents and caregivers should be attentive to the clues and meanings presented in children’s drawings since this stimulates their cognitive and social abilities. In this stage, caregivers should also use appropriate time determinants to develop trust in their predictions in children, using determinants like “after dinner,” “before sleep,” and “on your birthday” because children do not understand concepts like “tomorrow,” “at 9,” or “on Tuesday.”
Children in this developmental stage do not have the capacity for reasoning; they believe in the power of words and understand them, so they should not be labeled as “bad,” but rather should be explained that they made a bad thing. Some children may perceive illness as punishment for some wrongdoing, so spiritual development and believing in some good and loving power can promote their sense of security and help them during the stresses. In general, spirituality is a great promoting factor for conscience development.
Physical Development Factors
According to Hockenberry & Wilson (2014), uninhibited drawing leads to motoric function development, including muscle skills and eye-hand coordination. During this stage, there is a danger of intrusive experiences; children may disrupt their skin since they do not understand their bodies. In terms of sexual development, modesty and fear of mutilation may inhibit optimal growth and development. Preschoolers may have questions about reproduction, and these questions should be addressed honestly, as a matter of fact, like the answers to the question “why the sky is blue.”
Supporting a Family with a Child at Risk for Delays in Growth and Development
An optimal environment and adequate care have a significant impact on children’s development during their lifetime and should be provided as a priority. In the WHO report, it is particularly mentioned that an adverse environment is dangerous for children’s development (WHO, 2018). Most scientists agree that all sectors, including education, social care, and health care, should ensure the satisfaction of young children’s holistic needs (Richter et al., 2017). Therefore, one of the first steps of the caregiver’s surveillance is to determine the environment’s safety and execute the routine screening of child growth and development.
The particular delays in growth and development can be traced back to the stage of development. Using theoretical knowledge, the CFH nurse can teach the parents and caregivers about the mistakes made in communication with children. For example, some parents fail to establish the limits and boundaries for their 3 to 5-year-olds, which can become a reason for social and emotional development problems. Other parents may establish too strict boundaries and forbid any initiative or asking questions, which could affect cognitive development. Neglected children may show physical development deficiencies due to the lack of healthy nutrition; they may injure themselves and experience physical hazards.
Therefore, in case of problems in social and emotional development, the CFH nurse should pay utmost attention to how the caregivers and parents communicate with the child and are they assertive, attentive, and open to the child’s problems. Aggressive or ignorant parents’ behavior may have severe consequences for the child’s future socialization and cause problems with emotional development, like personality disorders.
Language and communication development delays may be related to an inadequate amount of time spent teaching and supervising children when they read letters, draw, or play with toys and other children. Cognitive development can be delayed to both problems with language, communication, and social and emotional development. The most important part of cognitive development is paying attention to children’s expressed meanings and ideas and giving simple and honest answers to their questions.
Thus, two developmental theories were discussed, and their importance for understanding the children’s growth and development was explained. The factors promoting and inhibiting the growth of 3 years old children were analyzed, and the CFH nurse’s support for a family whose child is at risk for delays was briefly presented. At the age of 3, children start to develop initiative and are eager to play and learn, sharing their thoughts and emotions. They need supervision in establishing the rules and attention to their emotions, ideas, and initiatives. Delays in development may occur due to adverse environment, aggressive or ignorant treatment, or lack of time spent on cognitive and language development.
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