The Healthy Child – Unit II | Child Health Nursing I | B.Sc Nursing 5th Semester

UNIT - 2
THE HEALTHY CHILD
CHILD HEALTH NURSING
5TH SEMESTER B.SC. NURSING
BY: RAKESH S SAJJAN

Definition and
Principles of
Growth and
Development

Growt
• Growth refers to the physical changes in the
size and structure of the body and its parts.
It is a quantitative aspect that can be
measured in units like kilograms,
centimeters, etc.
• Involves increase in height, weight, head
circumference, and body mass.
• Reflects the anatomical and
physiological development of body
organs.
• It is observable and measurable.

Development
• Development refers to the
progressive acquisition of skills
and functions that enable a child
to perform more complex
activities. It is a qualitative
process involving emotional,
intellectual, social, and motor
abilities.
• Involves maturation of physical
and mental capacities.
• Not directly measurable but
assessed through observation
(e.g., crawling, speaking,
thinking).

Difference Between Growth
and Development
Aspect Growth Development
Nature Quantitative Qualitative
Measurement
Measurable (height, weight,
etc.)
Not measurable directly
(assessed via milestones)
Focus
Physical increase in body
size and structure
Functional improvement in
skills and abilities
Time Frame Stops at maturity Continuous throughout life
Example
Weight gain from 3 kg to 8
kg
Learning to talk, write, or
solve problems

Principles
of Growth
and
Developme
nt
 Continuous and Lifelong Process
 Growth and development start
from conception and continue
until death.
 Rapid growth occurs in infancy,
slows during childhood, and
surges again during adolescence.
 Development like learning,
emotional control, and moral
values continues throughout life.
 Proceeds in an Orderly Sequence
 Follows a predictable pattern.
 Cephalocaudal Direction: Head-
to-toe progression (e.g., infants
can control head movements
before leg movements).
 Proximodistal Direction:
Center-to-periphery
development (e.g., child can
move arms before fingers).

 Rate Varies Among Individuals
 While the sequence is universal, the rate of
development differs based on genetics,
nutrition, and environment.
 One child may start walking at 10 months,
another at 14 months – both are normal.
 Development Occurs in Stages
 Each age group has distinct developmental
characteristics:
 Infancy: Rapid growth, sensory awareness.
 Toddlerhood: Walking, simple speech.
 Preschool: Social play, creativity.
 School age: Logical thinking, teamwork.
 Adolescence: Puberty, abstract reasoning.

Development Proceeds from General to Specific
 Motor development starts with general,
uncoordinated movements to refined, purposeful
ones.
 Example: Infant waves arms before being able to grasp
a toy.
Development is Multidimensional
 Involves physical, mental, emotional, and social
dimensions.
 Each domain interacts with and influences the others.
Growth and Development Are Influenced by Both
Heredity and Environment
 Heredity: Determines physical features, intelligence
potential, body structure.
 Environment: Nutrition, parenting style, socioeconomic
status, and stimulation.

 Early Years Are Crucial
 The first 5 years of life are
foundational.
 Brain development, emotional
bonding, and basic skills like speech
and mobility are established.
 Developmental Tasks Must Be
Mastered at Each Stage
 According to developmental theories
(like Erikson), each stage presents
tasks or challenges that must be
resolved for healthy progression.
 Example: Trust vs. mistrust in infancy.
 Influenced by Socio-Cultural Factors
 Culture affects parenting practices,
expectations of behavior, and
exposure to learning environments.

Nursing
Implications
Monitor growth using growth charts (height, weight, head
circumference).
Monitor
Use standardized developmental checklists to observe age-
appropriate milestones.
Use
Identify delays early and initiate referrals/interventions.
Identify
Guide parents about what to expect and how to support each
stage of development.
Guide
Encourage balanced nutrition, immunization, and a stimulating
environment.
Encourage

Factors
Affecting
Growth and
Developmen
t
• Growth and development
are influenced by a wide
range of internal
(genetic/biological) and
external
(environmental/societal
) factors.
• These factors interact
continuously and play a
crucial role in shaping a
child’s overall physical,
mental, and emotional
progress.

Genetic
(Heredit
y)
Factors
Inherited Traits: Genetic makeup
influences height, weight, body
structure, eye color, intelligence, and
temperament.
Family History of Illnesses:
Conditions like asthma, diabetes,
hemophilia, congenital heart disease
may be inherited.
Chromosomal Abnormalities:
Disorders like Down syndrome or
Turner syndrome can affect both
growth and development.
Nursing Note: A child born with a
genetic disorder may need special
care plans, early intervention, and
regular developmental assessments.

Prenatal
Factors
(Before
Birth)
• Maternal Nutrition:
Deficiencies in essential
nutrients like folic acid, iron, and
protein can lead to low birth
weight or developmental delays.
• Maternal Infections: Infections
such as rubella, toxoplasmosis,
or syphilis during pregnancy
can cause birth defects.
• Substance Use: Alcohol,
tobacco, and drugs can cause
fetal growth restriction and
neurodevelopmental issues.
• Radiation and Teratogens:
Exposure to harmful chemicals
or radiation can cause
congenital anomalies.
• Placental Function: A healthy
placenta ensures good oxygen
and nutrient delivery. Placental
insufficiency leads to
intrauterine growth retardation
(IUGR).

Perinatal and
Neonatal
Factors
• Birth Asphyxia: Lack of oxygen
during delivery can result in brain
damage and developmental issues.
• Prematurity: Preterm babies may
have immature lungs, feeding
problems, and delayed milestones.
• Low Birth Weight (LBW): Children
with LBW are at higher risk for
infections and learning difficulties.
• Neonatal Infections: Sepsis,
meningitis, and jaundice can
negatively affect brain
development.

Postnatal Factors
(After Birth)
• Nutrition
o Essential for physical and mental growth.
o Deficiency in protein, vitamins, or iron can cause
stunting, wasting, and cognitive delays.
o Overnutrition may lead to childhood obesity,
diabetes, or early puberty.
•Health Status
o Frequent infections (diarrhea, respiratory infections)
reduce nutrient absorption and energy for growth.
o Chronic diseases like congenital heart defects or
cystic fibrosis slow overall development.

• Clean water, proper sanitation, safe housing, and
pollution-free surroundings are necessary for
healthy development.
Physical Environment
• Adequate sensory and intellectual stimulation
(talking, reading, play) helps brain development.
• Lack of stimulation may cause speech delay,
behavioral issues, or poor school performance.
Stimulation and Learning
Opportunities

Psychological and Emotional
Factors
Parental Love and Security: Children thrive in
environments with emotional warmth and
bonding.
Neglect or Abuse: Physical or emotional abuse
can lead to poor self-esteem, depression,
anxiety, and behavioral disorders.
Mental Stimulation: Encouraging curiosity and
providing age-appropriate learning materials
accelerates cognitive development.

Socioeconomic Factors
Family Income: Affects the ability to
afford nutritious food, quality education,
toys, books, and healthcare.
Parental Education: Literate and
educated parents are more likely to
practice positive parenting and ensure
timely healthcare.
Occupation of Parents: Job security
affects stability at home; working
parents may also have limited time for

Cultural and Religious
Practices
Cultural beliefs influence child-
rearing practices, food habits,
play, gender roles, and social
behavior.
Some traditions may delay or
promote certain activities (e.g.,
early toilet training or delayed
weaning).

Gender
Biological differences influence
physical development patterns (e.g.,
boys may grow faster in height
during adolescence).
Social preferences (e.g., favoring
male children in some societies) can
affect nutrition, attention, and
schooling.

Government and Health
Services
Availability of immunization, child
health clinics, nutrition programs
(like ICDS) supports child
development.
Access to early intervention
services helps children with
disabilities reach their potential.

Accidents and Injuries
Falls, burns, poisoning, and road
traffic accidents may cause
temporary or permanent
disabilities.
These affect physical functioning,
psychological stability, and school
readiness.

Nursing Implications
Perform
Perform a
comprehensive
assessment
considering
physical,
emotional, and
social factors.
Educate
Educate parents
about balanced
nutrition,
immunization,
early learning,
and child safety.
Refer
Refer high-risk
children (e.g.,
LBW, abused,
developmentally
delayed) for early
interventions.
Advocate
Advocate for
better community
services like
Anganwadis,
school health
programs, and
parenting
workshops.

Growth and
Development from Birth
to Adolescence
This topic involves
understanding the
milestones and
characteristics of each
developmental stage
from infancy to
adolescence.
Growth is measured in
physical terms, while
development focuses
on skills, behavior, and
maturity.

Infancy
(0–1 year)
A. Physical Growth:
• Birth weight doubles by 5–6 months and
triples by 1 year.
• Height increases by ~25 cm in the first year.
• Head circumference increases ~12 cm in the
first year.
B. Motor Development:
• 3 months: Holds head up, follows moving
objects.
• 6 months: Rolls over, sits with support.
• 9 months: Crawls, sits without support.
• 12 months: Pulls to stand, may walk with
support.
C. Language Development:
• Coos, babbles, says “mama/dada”
nonspecifically.
• Responds to sound, turns head to voice.
D. Social & Emotional:
• Recognizes mother, shows stranger anxiety
(~6 months).
• Smiles socially (by 2 months), waves bye-bye
(by 9 months).

Toddler
(1–3 years)
A. Physical Growth:
• Growth slows slightly; steady increase in
height and weight.
• Learns to walk, run, climb.
B. Motor Development:
• 18 months: Walks independently, scribbles.
• 2 years: Climbs stairs, kicks ball.
• 3 years: Rides tricycle, builds tower of blocks.
C. Language:
• Rapid vocabulary growth.
• 2-word sentences at 2 years, understands
simple commands.
D. Social:
• Temper tantrums common.
• Begins parallel play (playing alongside but
not with others).
• Develops independence but fears separation.

Preschool
(3–6 years)
A. Physical:
• Slender appearance, steady growth.
• Improved hand-eye coordination.
B. Motor:
• Hops, balances on one foot, draws
shapes.
• Dresses self with assistance.
C. Language:
• Speaks in complete sentences.
• Asks lots of “why” questions.
• Tells stories and uses imagination.
D. Social:
• Cooperative play begins.
• Learns rules, engages in make-
believe.
• Understands gender identity.

School-age
(6–12 years)
A. Physical:
• Steady growth, better immunity,
permanent teeth erupt.
• Fine and gross motor skills refined.
B. Cognitive:
• Logical thinking (concrete
operations – Piaget).
• Enjoys problem-solving, learning
new concepts.
C. Language:
• Expands vocabulary significantly.
• Reads and writes fluently.
D. Social:
• Peer relationships important.
• Understands rules and teamwork.
• Begins to develop self-concept and
moral awareness.

Adolescen
ce
(12–18 years)
A. Physical:
• Puberty changes: growth spurts, sexual
maturity.
• Menstruation begins in girls; voice
deepens in boys.
B. Cognitive:
• Abstract and hypothetical thinking
(formal operations – Piaget).
• Better decision-making and reasoning.
C. Emotional:
• Identity formation (Erikson: Identity vs
Role Confusion).
• Mood swings common, sensitive to peer
opinion.
D. Social:
• Strong peer influence, interest in
romantic relationships.
• Desire for independence from parents.

Nursing Implications
Use growth charts and milestone checklists for
assessment.
Use
Provide age-appropriate guidance to parents (e.g.,
weaning, toilet training, sex education).
Provide
Promote mental, emotional, and social development
through play and interaction.
Promote
Identify and refer for developmental delays or
behavioral issues early.
Identify
and refer

Baby Growth and Developmental Assessment Methods

Purpose of
Assessment
To evaluate if a baby is:
• Growing physically
as per age norms.
• Meeting
developmental
milestones on time.
• At risk of delay or
disorder (early
intervention).

Growth Assessment
Component Tools/Methods
Weight
Infant weighing scale. Compared with
WHO growth charts.
Height/Length
Infantometer (for <2 yrs), Stadiometer
(for >2 yrs).
Head Circumference
Measuring tape placed above eyebrows
and ears. Indicator of brain growth.
Chest Circumference
Measured at the nipple line. Compared
to head circumference.
Mid-Upper Arm
Circumference
Simple screening for malnutrition using
colored tape.

Growth Charts Used:
• WHO Growth Standards (0–5 years)
• Indian Academy of Pediatrics (IAP) growth
charts
Growth Monitoring Tools:
• Road to Health card
• Mother and Child Protection (MCP) Card

Developmental Assessment
Development includes:
Gross Motor
Fine Motor
Language
Social/Personal

Gross Motor
Development
Definition: Gross motor skills
involve the large muscles of the
body used for activities such as
sitting, standing, walking,
running, and maintaining
balance and posture.
Assessment Method:
• Observe child in natural play.
• Ask parents about physical
activity history.
• Use Denver Developmental
Screening Test (DDST).

Age Expected Milestones
1 month
Moves arms and legs; lifts head briefly while
on tummy.
3 months
Holds head steadily; lifts chest while on
tummy.
6 months Rolls over; sits with support.
9 months Sits without support; pulls to stand.
12 months Stands alone; walks with or without support.
2 years Runs, climbs stairs with help.
3 years
Jumps, pedals tricycle, walks up stairs
alternating feet.
5 years
Hops on one foot, skips, balances on one leg
for 10 seconds.

Fine Motor
Development
Definition: Fine motor skills
involve small muscle
movements, especially of the
hands and fingers — used for
grasping, drawing, buttoning,
feeding self, etc.
Assessment Method:
• Ask child to stack blocks,
draw shapes, or handle small
toys.
• Observe feeding, dressing
abilities.

3 months Opens and shuts hands; holds rattle briefly.
6 months
Reaches and grasps; transfers objects hand-to-
hand.
9 months Pincer grasp (thumb and finger); bangs two objects.
12 months Scribbles; picks up small items.
2 years Builds tower of 6 blocks; turns pages.
3 years Copies a circle; feeds self with spoon.
4 years Buttons clothing; uses scissors with help.
5 years Draws person with 6 parts; prints some letters.

Language Development
• Definition: Language development refers to the
child’s ability to understand (receptive) and use
(expressive) language — including listening,
speaking, and understanding instructions.
Assessment Method:
• Talk to the child and observe response.
• Ask parents about communication patterns at
home.
• Use expressive and receptive language tools (e.g.,
ASQ).

2 months Coos, makes vowel sounds.
6 months Babbles, responds to name.
9 months Says "mama," "dada" non-specifically.
12 months Says 1–2 words with meaning; follows simple
commands.
2 years Combines 2–3 words into phrases; points to body
parts.
3 years Uses sentences; names common objects.
4 years Tells stories; asks questions; understands “why”
words.
5 years Uses future tense; speaks clearly in full sentences.

Social and Personal
Development
•Definition: This domain covers
how the child interacts with
others, shows emotions, self-
care skills, and ability to form
relationships.
•Assessment Method:
• Observe behavior during play.
• Ask questions to parents
regarding interaction at
home/school.
• Use social/emotional
checklists.

2 months Social smile.
6 months Recognizes familiar faces; responds to emotions.
9 months Stranger anxiety; plays peek-a-boo.
12 months Imitates actions; waves bye-bye; shows preferences.
2 years Shows independence; begins parallel play.
3 years Plays cooperatively; helps with dressing.
4 years Understands turn-taking; role-play; brushes teeth with help.
5 years
Shows empathy; follows rules; dresses and undresses
independently.

Nurse’s Role in
Developmental Assessment:
Monitor using
age-
appropriate
checklists.
01
Use tools like
DDST, TDSC, or
Ages and
Stages
Questionnaire
.
02
Identify
developmenta
l delays early.
03
Educate
parents on
stimulation
techniques
(talking,
playing,
reading).
04
Refer to
pediatrician
or
developmenta
l specialist
when needed.
05

Assessment Tools & Methods:
Tool What It Does
Denver Developmental Screening
Test (DDST)
Screens children 1 month to 6
years in 4 domains.
Trivandrum Development Screening
Chart (TDSC)
Indian tool for rapid community
screening.
Ages and Stages Questionnaire (ASQ)
Parent-completed tool for early
intervention identification.
Bayley Scales of Infant Development
(BSID)
Advanced test for infants'
developmental delay.

Clinical
Observatio
ns:
Observe crawling,
walking, sitting,
grasping,
babbling, social
smiling, etc.
Compare with
expected
milestones (as
covered in earlier
topics).

Nurse's Role in
Assessment
• Perform regular
anthropometric
measurements.
• Maintain growth
charts and milestone
checklists.
• Identify red flags for
developmental delay.
• Refer to pediatrician or
child guidance clinic
when needed.
• Educate parents on
normal development
and stimulating home
environments.

Growth and
Development
al Theories

Freud’s Psychosexual Theory
of Development
• Proposed by Sigmund
Freud, this theory suggests
that personality develops
through a series of stages
in which the pleasure-
seeking energies of the id
focus on certain erogenous
(pleasure) zones of the
body.
• If a child does not
successfully resolve
conflicts at any stage, they
may develop fixations,
affecting adult personality
and behavior.

Freud’s 5 Psychosexual Stages
Stage Age Range
Focus Area
(Erogenous Zone)
Major Developmental
Task
Oral Birth – 1 year Mouth Feeding, sucking, weaning
Anal 1 – 3 years Anus Toilet training and self-control
Phallic 3 – 6 years Genitals
Gender identity and exploration of
differences
Latency 6 – 12 years
None (sexual energy
dormant)
Focus on learning, skills,
friendships
Genital
12+ years (puberty
onward)
Genitals
Establishment of mature sexual
relationships

Oral Stage
(Birth to 1 year)
• Pleasure Source: Mouth –
activities such as sucking,
biting, and breastfeeding.
• Key Task: Weaning off
breastfeeding or bottle.
• Fixation Outcome (if not
resolved): May result in oral
behaviors in adulthood such as
smoking, overeating, nail
biting.
💡 Nursing Tip: Provide pacifiers,
oral stimulation during
hospitalization, and meet the
infant’s hunger needs promptly.

Anal Stage
(1–3 years)
• Pleasure Source: Bowel and
bladder control.
• Key Task: Toilet training and
learning to control body
functions.
• Fixation Outcome: Too strict →
compulsive, obsessive
behaviors. Too lenient messy,
→
disorganized.
💡 Nursing Tip: Support toilet
training efforts and allow toddlers
to express autonomy without
punishment.

Phallic Stage (3–6 years)
• Pleasure Source: Genital
area; child becomes curious
about body and differences
between sexes.
• Key Conflict: Oedipus (boys)
and Electra (girls) complex –
attachment to opposite-sex
parent and rivalry with same-
sex parent.
• Resolution: Identifying with
same-sex parent helps
resolve conflict.
💡 Nursing Tip: Encourage
modesty and privacy, answer
sex-related questions
appropriately, avoid shame-
based responses.

Latency Stage (6–12 years)
• Pleasure Source:
Social interactions
and intellectual
pursuits (sexual
feelings are inactive).
• Focus: Learning,
sports, hobbies,
building peer
relationships.
• Healthy
Development: Ability
to form friendships
and strengthen self-
confidence.
social play, group
learning, and team
participation.

Genital Stage
(12+ years – adolescence and beyond)
• Pleasure Source:
Mature sexual interests.
• Focus: Developing adult
relationships and finding
personal identity.
• Goal: Establish balanced
relationships and sense
of responsibility.
💡 Nursing Tip: Provide
guidance on puberty,
support open
communication about
changes, and ensure
privacy and respect.

Application in
Nursing
• Understand emotional behaviors in children
(e.g., thumb-sucking, toilet refusal).
• Use age-appropriate strategies for care,
discipline, and comfort.
• Educate parents on normal stages and how
to support their children.
• Identify and address maladaptive behaviors
that may arise from unresolved conflicts.

The Healthy Child – Unit II | Child Health Nursing I | B.Sc Nursing 5th Semester

Developed by Erik Erikson, this theory
explains psychosocial development
across the lifespan.
Erikson believed that each stage of life
involves a psychosocial conflict that
must be successfully resolved for
healthy personality development.
Successful resolution of each stage
leads to development of a virtue (a
psychological strength).

Stages of Erikson’s Theory Relevant
to Child Development
Stage Age Range
Psychosocial
Conflict
Basic Virtue Central Question
1. Trust vs.
Mistrust
0 – 1 year
Can I trust the
world?
Hope Is the world a safe place?
2. Autonomy
vs.
Shame/Doubt
1 – 3 years
Can I do things
myself?
Will Is it okay to be me?
3. Initiative vs.
Guilt
3 – 6 years
Can I take
initiative?
Purpose
Is it okay for me to do,
move, act?
4. Industry vs.
Inferiority
6 – 12 years
Am I good at
things?
Competence
Can I make it in the
world of people?
5. Identity vs.
Role Confusion
12 – 18 years Who am I? Fidelity
Who am I, and where am
I going in life?

Trust vs. Mistrust
(0–1 year)
• Key Task: Develop a sense of
trust in caregivers and
environment.
• What helps? Consistent care,
feeding, warmth, cuddling,
responding to cries.
• If unmet: The child develops
mistrust, anxiety, and
suspicion about the world.
💡 Nursing Tip: Ensure that basic
needs are consistently met;
provide comforting touch and
voice.

Autonomy vs.
Shame and Doubt
(1–3 years)
• Key Task: Learn
independence (walking,
toileting, choosing clothes).
• What helps? Allowing choices
and safe exploration.
• If unmet: Over-controlling
caregivers lead to shame,
self-doubt, and fear of failure.
toddlers to do simple tasks;
avoid scolding for accidents or
slow learning.

Initiative vs.
Guilt (3–6 years)
• Key Task: Initiate activities,
ask questions, engage in
play.
• What helps? Supporting
their curiosity and play,
setting safe boundaries.
• If unmet: The child may
feel guilty for taking
initiative or being curious.
💡 Nursing Tip: Provide
opportunities for imaginative
play, praise efforts, avoid
criticism.

Industry vs.
Inferiority (6–12
years)
• Key Task: Master skills
(reading, writing, sports), earn
praise and rewards.
• What helps? Positive
reinforcement, encouragement
in school and hobbies.
• If unmet: Leads to feelings of
inferiority and failure.
💡 Nursing Tip: Celebrate
achievements, provide tasks they
can succeed in, avoid unfair
comparisons.

Identity vs. Role
Confusion
(12–18 years)
• Key Task: Explore personal
identity, beliefs, career, values.
• What helps? Supportive
environment that allows
exploration without pressure.
• If unmet: Confusion about
self, low self-esteem,
susceptibility to peer pressure.
💡 Nursing Tip: Respect adolescent
privacy, encourage self-
expression, guide rather than
control.

Application
in Nursing
• Assess emotional maturity
and behavioral challenges at
each age.
• Tailor communication and
care plans to match the
psychosocial stage.
• Involve parents in promoting
age-appropriate
independence and self-worth.
• Support interventions for
children showing
developmental delay or
emotional distress.

Piaget’s Cognitive Development
Theory
• Developed by Jean Piaget,
this theory focuses on how
children think, reason,
and understand the world
as they grow.
• Piaget believed that
cognitive development
occurs in four sequential
stages, and children
actively construct
knowledge by interacting
with their environment.
• Each stage represents a
qualitative change in how
children process
information.

Key Concepts of Piaget’s Theory
Term Meaning
Schema
A mental framework or concept that
helps organize and interpret
information.
Assimilation
Integrating new experiences into
existing schemas.
Accommodation
Modifying existing schemas to
incorporate new experiences.
Equilibration
Balance between assimilation and
accommodation for learning.

Piaget’s 4 Stages of
Cognitive Development
Stage
Age
Group
Key Features Nursing Example
Sensorimotor 0–2 years
Learns through senses,
object permanence
Use rattles, peek-a-boo games
Preoperational 2–7 years
Egocentric thinking,
symbolic play
Use dolls or pictures to explain
procedures
Concrete
Operational
7–11 years
Logical thinking,
conservation,
classification
Explain with concrete examples
(e.g. charts)
Formal
Operational
12+ years
Abstract and hypothetical
reasoning
Involve in care decisions, allow
questions

Sensorimotor
Stage
(0–2 years)
• How they think: Through
reflexes and sensory
experiences (seeing, touching,
tasting).
• Key Developments:
• Object Permanence –
understanding that objects
still exist even if out of
sight (around 8–9 months).
• Learns cause and effect
(e.g., shaking a rattle
makes sound).
💡 Nursing Tip: Use colorful toys,
soft textures, and calm voices.
Support parental bonding and
routines.

Preoperationa
l Stage (2–7
years)
• How they think: Imaginative and
magical thinking. Egocentric –
sees the world from only their
point of view.
• Symbolic play (e.g., using a stick
as a sword).
• Difficulty understanding others’
perspectives.
• Doesn’t grasp conservation
(e.g., water in different shaped
containers still has the same
volume).
💡 Nursing Tip: Use play therapy,
picture books, puppets to explain
care. Avoid complex instructions.

Concrete Operational
Stage (7–11 years)
• How they think: Logical, organized
thinking begins but still grounded in
real situations.
• Understands conservation
(quantity doesn’t change even if
shape does).
• Can classify objects and
understand time and numbers.
• Less egocentric, can consider
others’ views.
💡 Nursing Tip: Allow them to ask
questions, explain treatment using
real-life examples (e.g., measuring
temperature, using a scale).

Formal
Operational
Stage
(12 years and
above)
• How they think: Abstract, deductive, and
hypothetical reasoning.
• Can form hypotheses, understand moral
reasoning.
• Thinks about the future and consequences.
💡 Nursing Tip: Encourage involvement in their own
care, provide truthful explanations, and allow for
expression of concerns.

Application in Nursing
Understand what a child can comprehend at each age to
communicate effectively.
Understan
d
Use age-appropriate teaching tools (e.g., flashcards,
models, storytelling).
Use
Recognize when a child may not be at the expected
cognitive level and adjust interventions.
Recognize
Use Piaget's principles during health teaching, procedures,
and discharge instructions.
Use

Kohlberg’s
Moral
Development
Theory
• Developed by Lawrence Kohlberg, this theory
focuses on the development of moral
reasoning — how individuals decide what is
right and wrong.
• Based on Piaget’s theory, Kohlberg proposed
three levels with six stages of moral
development.
• It emphasizes how moral thinking matures
over time, especially during childhood and
adolescence.

Kohlberg’s Levels and Stages
of Moral Development
Level Stage Age (Approx) Key Features
Level I: Pre-
Conventiona
l
1. Obedience and
Punishment
4–7 years
Rules are obeyed to avoid
punishment. Authority is never
questioned.
2. Individualism and
Exchange
7–10 years
Right behavior means acting in
one’s best interest. Fair
exchange.
Level II:
Conventiona
l
3. Good
Interpersonal
Relationships
10–12 years
Approval of others is important.
"Be a good person."
4. Maintaining Law
and Order
12–14 years
Rules must be obeyed to
maintain social order. Duty and
laws matter.
Level III:
Laws are important but not

Level I: Pre-Conventional
Morality
(4–10 years)
🧷 Focus:
Self-centered morality — external
consequences matter most

Obedience and
Punishment
Orientation
• “I follow rules to avoid being
punished.”
• Child is obedient without
understanding the reasons behind
rules.

Individualis
m and
Exchange
• “I’ll do something good if I get
something in return.”
• Morality is based on mutual benefit
(you help me, I help you).

Level II: Conventional
Morality (10–14 years)
🧷 Focus:
Group expectations — social
approval and law matter

Good
Interpersonal
Relationships
• “I want to be seen as good.”
• Behavior is guided by approval
and being liked by others (family,
teachers, peers).

Maintainin
g Law and
Order
• “I follow the rules because it’s my duty.”
• The child respects rules and authority;
believes in obeying laws for social
harmony.

Level III: Post-Conventional
Morality (Adolescence and
Beyond)
🧷 Focus:
Internal principles and
justice — personal
conscience over social rules

Social Contract
and Individual
Rights
• “I understand that laws exist for a reason,
but they can be changed for the good of
people.”
• The person questions if laws serve the
greater good.

Universal
Ethical
Principles
• “I do what I believe is right, even if it
breaks the law.”
• Guided by inner conscience and abstract
values like justice, dignity, equality.

Application in
Nursing
• Helps nurses understand how children make
decisions about right and wrong.
• Enables tailoring of discipline, instructions,
and counseling based on moral maturity.
• Encourages development of empathy, fairness,
and responsibility in children.
• Supports moral reasoning in health
education (e.g., consent, following treatment
plans).

Needs of Normal
Children Through the
Stages of Development
and Parental Guidance
• Children's needs evolve
across developmental
stages — physical,
emotional, social,
cognitive, and moral.
• Understanding these
needs helps parents and
nurses support healthy
growth and
development at each
phase.

Infancy (0–1 year)
A. Basic Needs
Need Type Description
Physical
Adequate nutrition (breastfeeding), warmth,
hygiene, immunization, sleep.
Emotional
Bonding and attachment with caregivers, love,
security.
Social Eye contact, smiling, soothing responses.
Cognitive Sensory stimulation (colors, textures, music).

Parental
Guidanc
e
• Ensure exclusive
breastfeeding for 6 months.
• Follow routine
immunization schedule.
• Practice responsive
caregiving – hold, cuddle,
respond to crying.
• Use age-appropriate toys
for visual and auditory
stimulation.
• Avoid screen exposure.
• Teach parents about infant
safety (e.g., safe sleeping,
no sharp objects).

Toddler (1–3 years)
Basic Needs
Physical
Balanced nutrition (introduction of family foods),
sleep (12–14 hrs/day), safe environment for mobility.
Emotional
Independence with support; consistent routines give
a sense of security.
Social
Interaction with family members and peers; imitation
and parallel play begin.
Cognitive
Exploration, curiosity, and learning through trial and
error.
Moral
Beginning of understanding “right and wrong”
through consequences.

Developmental
Characteristics
Walks, climbs, explores independently.
Says 2-3 word sentences; vocabulary expands.
Shows temper tantrums, possessiveness, negativism
(“No!” stage).
Begins toilet training.

Parenta
l
Guidanc
e
• Offer choices to encourage
autonomy (e.g., “Do you want the
red cup or the blue cup?”).
• Set clear, consistent limits to
reduce confusion and tantrums.
• Practice positive discipline
(redirection, distraction, praise
good behavior).
• Support toilet training with
patience and encouragement.
• Ensure a childproof environment
to prevent accidents.
• Encourage self-feeding and
independence in dressing.
• Read picture books and use simple
language to build vocabulary.

Preschool (3–6 years)
Basic Needs
Physical
Proper nutrition with reduced junk food; sleep ~10–12 hours
with naps; safety during play.
Emotional Reassurance, affection, and freedom to express feelings.
Social
Group interaction, cooperative play, learning to share and take
turns.
Cognitive
Language explosion, curiosity, and imagination; asks "why"
questions.
Moral Developing conscience; understands basic rules and fairness.

Developmental
Characteristics
• Begins formal communication with 3 – 5
word sentences.
• Enjoys pretend play and storytelling.
• Strong desire to please adults and imitate
behavior.
• Begins understanding gender roles.
• Asks many questions to understand
surroundings.

Parental Guidance
• Encourage storytelling, drawing, and role play to boost
creativity.
• Provide simple explanations to their many questions.
• Support social development by allowing playgroups or
preschool attendance.
• Teach basic rules of behavior (e.g., saying please, sharing).
• Promote independence in dressing, brushing teeth, eating.
• Use positive reinforcement for good behavior.
• Explain about "safe touch and unsafe touch" in an age-
appropriate way.

School-Age Child (6–12 years)
Basic Needs
Physical
Balanced diet, adequate sleep (9–11 hours),
regular physical activity, personal hygiene.
Emotional
Need for achievement, recognition,
encouragement, and emotional security.
Social
Peer group acceptance, team play, learning
cooperation and rules.
Cognitive
Logical thinking, academic learning, problem-
solving, responsibility.
Moral
Understands rules, justice, and fairness; wants to
follow what is "right."

Developmental
Characteristics
Learns to read, write, and perform basic math.
Becomes more independent and responsible.
Prefers same-gender friendships.
Compares self with peers; self-esteem begins to
develop.
Understands cause and effect.

Parental
Guidanc
e
• Encourage regular school
attendance and help with studies.
• Allow children to take age-
appropriate responsibilities (e.g.,
chores).
• Recognize efforts and praise
achievements to build self-esteem.
• Teach values like honesty, respect,
and discipline.
• Discuss body changes (especially
toward late school age) to prepare
for puberty.
• Guide proper use of screen time
and online safety.
• Support participation in sports,
hobbies, and team activities.

Adolescence (12–18 years)
Basic Needs
NEED TYPE DESCRIPTION
Physical
Increased nutritional needs (especially for iron, calcium, protein);
regular exercise; adequate sleep (~8–10 hours); awareness about
puberty and hygiene.
Emotional Identity formation, emotional support, trust, respect, and privacy.
Social
Peer acceptance, friendships, and sometimes risk-taking
behavior; need for social identity.
Cognitive
Abstract thinking, career planning, moral judgment, decision-
making.
Moral
Development of personal values, ethical thinking, questioning of
societal rules.

Developmental
Characteristics
• Puberty brings rapid physical and hormonal
changes.
• Development of sexual identity and body image.
• Strong influence of peers; sometimes conflicted
with parents.
• Desire for independence and privacy increases.
• Seeks purpose and personal beliefs (religion,
politics, career).

Parental Guidance
• Encourage open and non-judgmental communication.
• Provide accurate information about puberty, sexuality,
and health risks (e.g., substance abuse, STIs).
• Promote balanced freedom with responsibility.
• Respect their need for privacy and involve them in
decision-making.
• Guide them in career choices and long-term goals.
• Be alert to signs of mental health concerns
(depression, anxiety, suicidal thoughts).
• Encourage participation in community work, hobbies,
or sports for positive identity building.

Nutrition
al Needs
of
Children
and
Infants
• Nutrition is a critical
determinant of a child’s growth,
development, immunity, and
overall health.
• The nutritional needs vary by
age, growth rate, and activity
level.

Breastfeedi
ng
Definition
Breastfeeding is the
process of feeding
an infant or young
child with milk from
a mother’s breast.

Nutritional Composition of Breast Milk
Component Function
Proteins Easy to digest (mainly whey); supports growth.
Fats Rich in essential fatty acids for brain development.
Carbohydrates
Mainly lactose – aids digestion and calcium
absorption.
Antibodies
Immunoglobulin A (IgA) – protects against
infections.
Vitamins/Minerals Adequate for first 6 months (except Vitamin D).
Enzymes Help digestion and nutrient absorption.
Water
Provides sufficient hydration; no need for extra
water.

Advantages of
Breastfeeding
🔸 For the Baby:
• Provides complete nutrition for the first 6 months.
• Boosts immunity – lowers risk of diarrhea, respiratory
infections, and allergies.
• Promotes bonding with the mother.
• Reduces risk of childhood obesity, diabetes, and ear infections.
• Supports brain development and better cognitive performance.
🔸 For the Mother:
• Promotes uterine involution (oxytocin release).
• Delays return of menstruation (natural contraception -
Lactational Amenorrhea Method).
• Reduces risk of breast and ovarian cancer.
• Enhances mother-child emotional bonding.

Nursing Tips
• Initiate breastfeeding within 30 minutes of
birth (normal delivery) or within 4 hours (C-
section).
• Educate mothers on correct latching and
positioning.
• Counsel against bottle feeding unless medically
necessary.
• Support mothers experiencing difficulties (e.g.,
sore nipples, low milk supply).

Exclusive
Breastfeeding
Definition:
• Exclusive breastfeeding means
feeding the infant only breast
milk for the first 6 months of life,
without any additional food or
water, not even herbal drops or
juices — except for prescribed
medications or oral rehydration
solution (ORS).
Duration:
• Recommended for the first 6
months of life by WHO, UNICEF,
and the Ministry of Health and
Family Welfare (MoHFW), India.

Benefits of Exclusive
Breastfeeding
For the Infant:
Benefit Explanation
Optimal nutrition
Contains the right amount of fat, sugar,
water, and protein.
Strong immunity Provides antibodies (IgA) to fight infections.
Digestive health
Easy to digest; reduces constipation and
colic.
Prevents malnutrition
Helps prevent protein-energy malnutrition
and micronutrient deficiencies.
Reduces risk of allergies
Delays exposure to allergens and irritants in
other foods.

For the Mother:
Benefit Explanation
Natural contraception
Delays ovulation through
Lactational Amenorrhea
Method (LAM).
Reduces postpartum
bleeding
Stimulates uterine
contraction.
Promotes emotional
bonding
Skin-to-skin contact builds
emotional attachment.
Convenient and economical
No cost or preparation

WHO
Recommendations
Start within the first
hour of life.
01
Continue exclusively
for 6 months.
02
After 6 months,
introduce
complementary
feeding while
continuing
breastfeeding until 2
years or beyond.
03

Nursing Role in
Promoting
Exclusive
Breastfeeding
• Educate mothers during
antenatal visits and
post-delivery.
• Promote Baby-Friendly
Hospital Initiative
(BFHI) practices.
• Address myths and
cultural misconceptions
(e.g., discarding
colostrum).
• Support working
mothers with
information on
expressing and storing
breast milk.

Supplementar
y / Artificial
Feeding
Definition
• Supplementary feeding
refers to the addition of
foods or liquids other
than breast milk to an
infant’s diet, typically
started after 6 months of
age alongside continued
breastfeeding.
• Artificial feeding refers
to feeding an infant with
commercial formula
milk when breast milk is
not available or
insufficient. This may
involve bottle-feeding or
cup and spoon feeding.

When is Supplementary or
Artificial Feeding Used?
Mother is ill or on medications incompatible
with breastfeeding.
Orphaned or abandoned infants.
Maternal death.
Insufficient breast milk production.
Mother chooses not to breastfeed.

Common Types of Artificial Feeds
Feed Type Description
Cow’s Milk
(Modified)
Diluted and boiled – not
recommended before 1 year
due to high protein and low
iron.
Infant Formula
Commercially prepared milk
substitute with added
nutrients (e.g., Lactogen,
Nan-Pro).
Soy-based Formula
For babies with lactose

Risks of Artificial
Feeding
Risk Reason
Infections
(Diarrhea, RTI)
Contamination due to
poor hygiene or unclean
bottles.
Allergies
Cow’s milk proteins may
trigger allergic reactions.
Malnutrition
Improper dilution or
preparation of formula.

Nursing Responsibilities
Educate mothers on correct formula preparation (water-
to-powder ratio).
Educate
Emphasize hygiene practices: boiling bottles, using
clean water.
Emphasiz
e
Encourage cup feeding over bottle feeding to avoid
nipple confusion.
Encourage
Monitor infant for signs of intolerance or inadequate
weight gain.
Monitor

Counseli
ng Tip
Encourage mothers to re-
lactate or increase milk
production through
proper diet and frequent
breastfeeding, whenever
possible.
Artificial feeding should
always be a last option,
and breastfeeding should
be resumed if possible.

Weaning
Definition
• Weaning is the
gradual process of
introducing solid
and semi-solid
foods to an infant’s
diet while reducing
dependence on
breast milk.
• It usually begins at 6
months of age, as
the child’s nutritional
needs exceed what
breast milk alone can
provide.

Ideal Age to Start Weaning
At 6 months of age.
Continue breastfeeding alongside
weaning up to 2 years or beyond.

Principles of
Weaning
Principle Explanation
Start with small
quantities
Begin with 1–2 spoonsful
of soft food once a day.
Consistency should
progress
From liquid semi-solid
→ →
soft solid.
One new food at a time
To identify allergies or
intolerance.
Hygienic preparation
To prevent infections; use
clean hands and utensils.
Avoid force-feeding
Respect the baby’s cues;

Examples of Weaning Foods
Age Food Examples
6–8 months
Mashed fruits (banana, papaya),
dal water, soft rice, porridge.
8–10 months
Khichdi, mashed vegetables, soft
idli, upma, scrambled eggs.
10–12 months
Finger foods, soft chapati soaked
in milk, paneer, soft fruits.

Foods to Avoid During Early
Weaning
Cow’s milk (before 1 year)
Sugar, salt, honey (risk of botulism)
Small hard foods (choking hazard – e.g.,
nuts, raw carrots)
Spicy and fried items

Signs of
Readiness for
Weaning
• Able to sit with minimal support
• Shows interest in food others are
eating
• Opens mouth when food is offered
• Loss of tongue-thrust reflex

Nursing
Guidance
Counsel
mothers to
begin weaning
at 6 months.
01
Demonstrate
preparation of
healthy,
homemade
weaning foods.
02
Monitor weight
gain and signs
of food allergies.
03
Emphasize
continuation of
breastfeeding
during and after
weaning.
04

Age-wise
Nutritional
Needs of
Children
Nutritional
requirements vary
with age due to
differences in
growth rate,
activity level, and
metabolic needs.

Infants (0–1 year)
Nutrient Needs
Calories 100–120 kcal/kg/day
Protein 1.5–2 g/kg/day
Fluid 150 ml/kg/day
Iron
Essential after 6 months due
to depletion of stores
Vitamin D
400 IU/day (may need
supplementation)

Dietary
Plan:
0–6 months: Exclusive
breastfeeding.
6–12 months: Complementary
foods + continued breastfeeding.

Toddlers (1–3
years)
Nutrient Needs
Calories ~1000–1200 kcal/day
Protein 1.1 g/kg/day
Calcium
Bone development; ~700
mg/day
Iron 7 mg/day

Dietary
Plan:
3 meals + 2
nutritious
snacks.
Encourage self-
feeding and
family food
with mild
flavors.

Preschoolers (3–6
years)
Nutrient Needs
Calories ~1200–1600 kcal/day
Protein 13–19 g/day
Calcium & Iron
Important for bone
growth and cognitive
development

Dietary
Plan:
Variety of
foods: cereals,
pulses, milk,
vegetables,
fruits.
Limit junk food
and sugary
snacks.

School-Age Children
(6–12 years)
Nutrient Needs
Calories
1600–2200 kcal/day (based on
activity)
Protein 19–34 g/day (increases with age)
Micronutrien
ts
Iron, iodine, calcium, and zinc are
critical

Dietary
Plan:
Promote
balanced diet
and physical
activity.
Prevent obesity
by limiting
screen time
and unhealthy
foods.

Adolescents (12–18
years)
Nutrient Needs
Calories
Boys: 2500–3000 kcal/day; Girls:
2200–2400 kcal/day
Protein Boys: 52 g/day; Girls: 46 g/day
Calcium
1300 mg/day (peak bone mass
development)
Iron
Boys: 11 mg/day; Girls: 15
mg/day (due to menstruation)

Dietary
Plan:
Nutrient-dense meals with focus
on iron, calcium, protein.
Avoid fast food, promote home-
cooked meals and hydration.

Common Nutritional
Deficiencies in Children
Nutritional deficiencies
are a major cause of
growth retardation,
lowered immunity,
and developmental
delays in children.

Protein-Energy Malnutrition (PEM)
Type Description
Kwashiorkor
Protein deficiency edema,
→
moon face, fatty liver, dermatosis,
irritability.
Marasmus
Calorie deficiency severe
→
wasting, old man’s face, loose
skin, no edema.
• Seen in children aged 6 months to 3 years,
especially after weaning.

Iron Deficiency
Anemia
Feature Description
Cause
Inadequate iron intake or
absorption, frequent infections.
Symptoms
Pallor, fatigue, delayed cognitive
and motor development, poor
attention.
Prevention
Iron-rich foods (green leafy
vegetables, dates, eggs), iron
supplements.

Vitamin A
Deficiency
Feature Description
Symptoms
Night blindness, Bitot’s spots,
dry conjunctiva
(xerophthalmia).
Prevention
Supplementation every 6
months (as per national
program), carrots, green
vegetables, liver.

Iodine Deficiency
Disorders
Feature Description
Symptoms
Goiter, cretinism, mental
retardation, deaf-
mutism.
Prevention
Use of iodized salt;
public awareness

Calcium and Vitamin D
Deficiency (Rickets)
Feature Description
Symptoms
Bowed legs, delayed tooth
eruption, swollen joints, bone
pain.
Prevention
Exposure to sunlight, fortified
milk, egg yolk, calcium-rich
foods.

Zinc Deficiency
Feature Description
Symptoms
Growth retardation, delayed
wound healing, frequent
infections.
Prevention
Animal protein, legumes, whole
grains, nuts.

Nurse’s Role in Preventing Nutritional
Deficiencies
Educate families about balanced diets and age-appropriate
nutrition.
Encourage exclusive breastfeeding and timely weaning.
Conduct growth monitoring and nutrition assessments.
Administer micronutrient supplementation (Iron, Vit A, Zinc).
Support implementation of government nutrition programs like
ICDS, Mid-Day Meal Scheme, etc.

Baby-Friendly Hospital
Concept (BFHI)
Introduction
• The Baby-Friendly
Hospital Initiative
(BFHI) is a global
program launched
by WHO and UNICEF
in 1991 to support
hospitals and
maternity centers in
providing the best
start in life for
newborns by
promoting exclusive
breastfeeding.

Goals of BFHI
To protect, promote, and support
exclusive breastfeeding.
To ensure every newborn receives
optimal nutrition and care.
To empower mothers with skills and
confidence to breastfeed.

10 Steps to Successful
Breastfeeding
(WHO & UNICEF)
Step Action
1. Have a written breastfeeding policy communicated to all staff.
2. Train all healthcare staff in the skills necessary to implement the policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation.
6. Give infants no food or drink other than breast milk, unless medically indicated.
7. Practice rooming-in: allow mothers and infants to remain together 24 hours.
8. Encourage breastfeeding on demand.
9. No artificial teats or pacifiers to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them.

Criteria for BFHI
Accreditation
• Hospital must
implement the 10
steps.
• Follow the
International Code of
Marketing of Breast-
milk Substitutes.
• Pass a BFHI
assessment conducted
by a national or
international body.

Importance of BFHI
Increases the rate of early initiation and
exclusive breastfeeding.
Reduces neonatal and infant morbidity and
mortality.
Builds a supportive environment for maternal
and child health.
Encourages health workers to provide evidence-
based practices.

Nurse’s
Role in
BFHI
• Educate mothers during
antenatal and
postnatal periods.
• Encourage skin-to-skin
contact and early
initiation of
breastfeeding.
• Support proper latch
and positioning.
• Monitor newborn
feeding patterns and
maternal confidence.
• Act as an advocate for
breastfeeding-friendly
practices in the
hospital.

Types and Value of
Play and Selection of
Play Material
Introduction
• Play is the work of
children — a natural
and essential part of
their growth and
development.
• It helps children
learn, explore,
express emotions,
and develop
physical, cognitive,
and social skills.

Types of Play Based on
Developmental Stage
Type of Play
Age
Group
Description
Unoccupied Play Infants Random movements, observing surroundings.
Solitary Play 0–2 years Plays alone; does not interact with others.
Parallel Play 2–3 years
Plays side-by-side with others without direct
interaction.
Associative Play 3–4 years
Children play together, sharing toys but with
different goals.
Cooperative Play 4+ years
Organized play with roles and rules (e.g.,
games, pretend play).
Dramatic/Imaginative
Play
3+ years Uses imagination to role-play or make-believe.
Constructive Play 3–6 years
Builds or creates something using blocks, toys,

Value of Play in Child
Development
Aspect Benefits of Play
Physical Develops motor skills, coordination, muscle strength.
Cognitive
Encourages problem-solving, creativity, memory, and
decision-making.
Emotional
Helps express feelings, manage anxiety, and build
resilience.
Social Teaches cooperation, sharing, negotiation, and empathy.
Moral Learns fairness, honesty, and following rules.
Language
Expands vocabulary, communication skills, and
storytelling ability.

Selection of Play Materials
Age Group Suggested Play Materials
Infants (0–1 yr)
Rattles, soft toys, musical mobiles, mirrors,
cloth books.
Toddlers (1–3 yr)
Blocks, stacking toys, balls, push-pull toys,
picture books.
Preschoolers (3–6 yr)
Crayons, puzzles, dolls, pretend play sets,
simple board games.
School-age (6–12 yr)
Board games, crafts, bicycles, sports kits,
science kits.
Adolescents (12+ yr)
Strategy games, music instruments, books,
digital learning tools.
Safety Tip: Ensure play materials are age-appropriate, non-toxic,
and free from choking hazards.

Nurse’s Role in Therapeutic
Play
(especially in hospital)
• Use play to reduce anxiety
and fear.
• Facilitate expression of
emotions (medical play with
toy stethoscope, syringe,
etc.).
• Help in preparation for
procedures (role play).
• Encourage group play in
pediatric wards for social
bonding.

Field Visit to
Anganwadi / Child
Guidance Clinic
Field Visit to Anganwadi
• An Anganwadi is a
government-sponsored child-
care and mother-care center
under the Integrated Child
Development Services
(ICDS) scheme.
• It plays a crucial role in
improving nutrition,
health, and early education
among children and mothers
in rural and urban settings.

Objectives of
Anganwadi Visit
• Observe the functioning of
ICDS and role of Anganwadi
Workers (AWWs).
• Understand nutrition
supplementation and
health education services.
• Learn about growth
monitoring and preschool
education.
• Witness community
participation and
intersectoral collaboration.

Key Activities in Anganwadi
Activity Purpose
Supplementary Nutrition
Mid-day meals for 0–6-year-old
children and pregnant/lactating
mothers.
Health Check-ups
Monthly weight monitoring,
deworming, immunization follow-up.
Growth Monitoring
Maintain weight charts and identify
malnourished children.
Preschool Non-formal Education
Teaching rhymes, colors, numbers,
and social behavior to 3–6-year-olds.
Health & Nutrition Education
For adolescent girls, mothers on diet,
hygiene, and family planning.
Referral Services
Referring sick or malnourished
children to PHC/CHC.

Nursing
Outcom
e
• Understand child health
indicators in the
community.
• Identify nutritional
deficiencies and growth
issues.
• Learn how early
childhood development
is supported at the
grassroots level.
• Participate in health
education and awareness
sessions.

Field Visit to Child Guidance
Clinic
A Child Guidance Clinic
(CGC) is a specialized
center focused on mental
health, behavioral,
developmental, and
emotional problems in
children and adolescents.

Objectives
of CGC Visit
• Observe the
multidisciplinary
approach to child mental
health.
• Understand roles of
pediatrician, psychologist,
psychiatrist, and social
worker.
• Learn about assessment
tools for behavior, IQ,
speech, and emotional
problems.
• Familiarize with
interventions like play
therapy, behavior
modification, counseling.

Common Cases Seen in
CGC
Condition Examples
Developmental
Delays
Speech delay, motor
milestones, autism spectrum
disorder.
Behavioral Problems
ADHD, aggression, bed-wetting,
tantrums.
Emotional Issues
Anxiety, phobia, depression,
grief reaction.
School Problems
Poor academic performance,

Nurse's Role
During CGC
Visit
• Assist in history
taking and
observation.
• Support child
during
psychological
assessment.
• Participate in
health education
for parents.
• Maintain
confidentiality and
non-judgmental
attitude.

The Healthy Child – Unit II | Child Health Nursing I | B.Sc Nursing 5th Semester

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The Healthy Child – Unit II | Child Health Nursing I | B.Sc Nursing 5th Semester