PEDIATRIC NURSING

INFANT

ARRANGED BY:
GROUP 1

MOHAMAD FAUZAN P1337420617016

NUR CHAFIDHOH AULIYA RACHMANY P1337420617031
M.ROIS ILHAM P1337420617039
MUTIARA RAMADHANI SARASWATI P1337420617043
FAUZIYYAH FEBIANNISA P1337420617064
SALMA EKA OKTARYZA P1337420627087

POLITEKNIK KESEHATAN KEMENTRIAN KESEHATAN SEMARANG

SARJANA TERAPAN KEPERAWATAN SEMARANG
2018

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 FOREWORD

Praise and gratitude we pray to the presence of Allah subhanahuwata'ala who

has bestowed his love and affection to us so that we can finish this paper about "Infant" in
Pediatric Nursing.

This paper aims to provide knowledge to many people, besides this paper aims
to fulfill our lecture duties.

On this occasion, the authors express deep gratitude to all those who have helped
contribute their ideas and thoughts for the realization of this paper. Finally, the suggestions
and criticism of the intended readers to realize the perfection of this paper the author very
appreciate.

Semarang, January 5th 2019

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 TABLE OF CONTENTS

FOREWORD..................................................................................................................... ii
TABLE OF CONTENTS ................................................................................................ iii
CHAPTER I ...................................................................................................................... 1
PRELIMINARY ........................................................................................................ 1

A. Background.......................................................................................................... 1
B. Formulation of Problem....................................................................................... 2
CHAPTER II ..................................................................................................................... 3
CONTENT ................................................................................................................. 3

A.Growth Concept Including Anthropometry ....................................................... 3

B. Concept of Development According to Freud, Erikson, Sullivan, Kohlberg
and Piaget

a. Sigmund Freud .................................................................................................. 17

b. Eric Erikson (Trust vs Mistrust)............................Error! Bookmark not defined.
c. Sullivan (Infancy) ............................................................................................. 18
d. Piaget (Sensorimotor Period) ................................Error! Bookmark not defined.
C. Sexual Development of Infant (oral phase 0 – 1 year) ...... Error! Bookmark not
defined.

D. Patterns of Infant Communication .................................................................... 18

E. Play ....................................................................................................................... 22

F. Child Nursing with A Hospital .......................................................................... 29

CHAPTER III CONCLUSION.............................................................................. 31

REFERENCE .................................................................................................................. 33

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 CHAPTER I
PRELIMINARY

A. Background
The future of a nation depends on the success of the child in achieving
growthoptimal development. The first years of life, especially the period since the fetus is
in the wombuntil a 2 year old child is a very important period in growth and
developmentchild.
This period is a golden opportunity as well as times that are vulnerable to
negative influences.Good and sufficient nutrition, good health status, correct care, and
appropriate stimulationin this period will help children to grow healthy and be able to
achieve optimal abilitiesso that it can contribute better to society.Proper stimulation will
stimulate the toddler’s brain so that the development of movement ability, speechand
language, socialization and independence in children under five takes place optimally
according to the age of the child.Detectionearly developmental deviations need to be done
to be able to detect early irregularities
Toddler development includes following up on every parent’s complaint about a
growing problemflower of his child. If there are deviations found, then aberrant early
intervention is carried outtoddler growth and development as a corrective action by
utilizing the plasticity of the child’s brain to growthe flower returns to normal or the
deviation is not getting heavier. If toddlers need to be referred, thenreference must also be
made as early as possible according to the indications.
Infancy is a golden period as well as a period of critical development someone.
Said m very critical because of the times babies are very sensitive to environment and it is
said to be a golden period because the baby takes place very short and cannot be cut off
back. Infancy is divided into two periods, namely the neonatal period and the post neonatal
period. The neonatal period starts from 0-28 days, while the post neonatal period starts
from 29 days to 11 months. The Central Bureau of Infant Health Statistics in Central Java
in 2007 found that the prevalence of growth growth disorders occupies the highest
prevalence after nutritional problems (Depkes, 2009)

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B. Formulation of Problem
1. How growth concepts
2. Howthe concept of development according to Freud, Erikson, Sullivan,
Kohlberg and Piaget?
3. How sexual development of infant?
4. What is patterns of infant communication ?
5. How infant play ?
6. How to preparation for hospitalization for infant ?

C. Purpose
1. To know the concept
2. To know the concept of development according to Freud, Erikson, Sullivan,
Kohlberg and Piaget
3. To know the sexual development of infant
4. To know the patterns of infant communication
5. To know infant play
6. To know the preparation for hospitalization for infant

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 CHAPTER II
CONTENT

A. Growth Concept
a. Biologic development
At other time in life are physical changes and developmental achievements so
dramatic as during infancy. All body system undergoes progressive maturation. Concurrent
development of skills increasingly allows infant to respond to the environment. Acquition
of these fine and gross motor skills occurs in an orderly head-to-toe and center-to-periphery
( cephalocaudal-proximodistal ) sequence.
b. Proportional changes
Growth is very rapid during the first year, especially during the initial 6 months.
Infant gain 680 g ( 11/2 pounds ) per month until age 5 months, when the birth weight has
at least doubled. An average weight for a 6-month-old child is 7.26 kg (16 pounds ).weight
gain decreases by half that amount during the second 6 months. By 1 year of age the infant’s
birth weight has tripled, to an average weight of 9.75 kg ( 211/2 pounds ). Infants who are
breast-fed beyond 4 to 6 months of age typically gain less weight than those who are bottle-
fed, yet head circumference is more than adequate ( Lawrence and Lawrence, 1999).
Height increases by 2.5 cm ( 1 inch ) per month during the first 6 months and by
half that amount per month during the second 6 months. Increase in length occur in sudden
spurts rather than in a slow, gradual pattern. Average height is 65 cm ( 25 ½ inches ) at 6
months and 74 cm (29 inches ) at 12 months. By 1 year birth length has increased by almost
50%. This increase occurs mainly in the trunk rather than the legs and contributes to the
characteristic physique of the older infant.
Head growth is also rapid and an important determinant of brain growth. During
the first 6 months head circumference increases approximately 2 cm ( 3 / 4 inch ) per month
from birth to 3 months, 1 cm per month from 4 to 6 months, and decreases to 0.5 cm ( 1/4
inch ) per month during the second 6 months ( Johnson and Blasco, 1997). The average
size is 43 cm (17 inches ) at 6 month and 46 cm ( 18 inches ) at 12 months. By 1 year of
age head size has increased by almost 33%. Closure of the cranial sutures occurs, with the
posterior fontanel fusing by 6 to 8 weeks of age and the anterior fontanel closing by 12 to
18 months of age ( the average age being 14 month ). It is important to note that infant
growth is strongly influenced by genetic, metabolic, environmental, and nutrition factors;

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thus, the previous statements are general guidelines only. Appropriate growth chart
reflecuting weight for length and head circumference should be used in each case to
determine appropriate growth parameters.

Box 1

Neurologic refiexes that appear during infancy.

Labyrinth-righting Infant in prone or supine position is able to raise
head; appears at 2 months, strongest at 10 months.
Neck- righting While infant is supine, head is truned to one side;
shoulder, trunk, and finally pelvis will turn toward that side; appears at 3
months, until 24-36 months.
Body- righting A modification of the neck-righting reflex in which
turning hips and shoulders to one side causes all other body parts to
follow; appears at 6 months, until 24-36 months.
Otolith-righting When body of an erect infant is tilted, head is returned
to upright, erect position; appears at 7 -12 months, persists indefinitely.
Landau When infant is suspended in a horizontal prone position, the
head is raised and legs and spine are extended; appears at 6 -8 months,
until 12 -24 months.
Parachute When infant is suspende in a horizontal prone position and
suddenly thrust downward, hands and fingers extend forward as if to
protect against falling ; appears at 7 -9 month, persists indefinitely

c. Sensory Changes
During infance, visual acuity gradually improves and binocular fixation is
established. The major developmental characteristics of vision during infancy are listed
in box 1.
Binocularity, or the fixation ot two ocular images into one cereberal picture (
fusion ), begins to develop by 6 weeks of age and should be well established by age 4
month. Lack of binocular vision vision results in strabismus and must be detected early to
prevent permanent blindness.
Depth perception ( stereopsis ) begins to develop by age 7 to 9 month but may
exist earlier asa an innate safety mechanism. Studies have demonstrated that even 2 – to 3
– month – old infants distinguish depth. At approximately 7 months the parachute reflex
appears and may be a protective response during a fall.

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 Infants have a visual preference for looking at the human face; this preference also
has a developmental sequence. At age 6 weeks infants show more interest in a picture of a
face with eyes than in one without eyes. By 10 weeks of age a picture with both eyes and
eyebrows elicits more response, and by 20 weeks of age the mouth is also necessary. By
age 6 months infants respond to facial expressions and can distinguish between familiar
and strange faces. This is about the time that separation anxiety is manifested.
With progressive myelination of the auditory pathway, the specific responses of
locating sound replace the generalized response of the neonate. The major developmental
characteristic of hearing are listed in box 2. ( for further discussion of hearing and the senses
of smell, taste, and touch)

Box 2
Major developmental characteristic of hearing.
Age (weeks) : Development
Birth :- Respond to loud noise by startle of moro reflex
- Respond to sound of human voice more readily than to any other
sound
- Low-pitched sounds, such as lullaby, metronome, or heartbeat, have
quieting effect
8 – 12 : Turns head to side when sound is made at level or ear
12 – 16 : Locates sound by turning head to side and looking in same direction
16 – 24 : Locates sound by turning head to side and then looking up or down
24 – 32 :- Locates sound by turning head in a curving arc
- Responds to own name
32 – 40 : Localizes sounds by turning head diagonally and directly toward sound
40 – 52 : knows several words and their meaning, such as “ no,” and names of
members of the family
Learns to control and adjust own response to sound, such as listening for
the sound to occur again

d. Maturation of systems

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 Other organ systems also change and grow during infancy. The respiratory rate
slows somewhat (see inside back cover) and is relatively stable. Respiratory movements
continue to be abdominal. Several factors predispose the infant to more severe and acute
respiratory problems. The close proximity of the trachea to the bronchi and its branching
structures rapidly transmits an infectious agent from one anatomic location to another. The
short, straight Eustachian tube closely communicates with the ear, allowing infection to
ascend from the pharynx to the middle ear. In addition, the inability of the immune system
to produce immunoglobulin A (IgA) in the musical lining provides less protection against
infection in infancy than during later childhood. The ability of the entire respiratory tract
to produce mucus is diminished, decreasing the humidification of the large volume if
inspired air.

Although the lumen of the trachea and bronchi enlarges during infancy, it remains
small in comparison with the total size of the lung, maintaining high resistance to the
volume of air inspired. The small airways are easily blocked by edema, mucus, or a foreign
body. The pliant (flexible) rib cage has less elastic recoil, and during respiratory distress
the work of breathing is increased. In addition, the volume of dead space (that amount of
air needed to fill the respiratory passages with each breath) is large, requiring the infant to
breathe approximately twice as fast as the adult to provide the body with the needed amount
of oxygen.

The heart rate slow (see inside back cover), and the rhythm is often sinus
arrhythmia (rate increases with inspiration and decreases with expiration). Blood pressure
also changes during infancy (see inside back cover). Systolic pressure rises during the first
2 month as a result of the increasing ability of the left ventricle to pump blood into the
systemic circulation. Diastolic pressure decreases during the first 3 months then gradually
rises to values close to those at birth. Fluctuations in blood pressure occur during varying
states of activity and emotion.

Significant hemopoietic changes occur during the first year. (See Appendix D.)
Fetal hemoglobin (HgbF) is present up to the first 5 months, with adult hemoglobin steadily
increasing through the first half of infancy. Fetal hemoglobin results in a shortened survival
of red blood celss(RBCs) and thus a decreased number of RBCs. A common result at 2 to
3 months of age is physiologic anemia. High levels of HgbF are thought to depress the

6
production of erythropoietin, a hormone released by the kidney that stimulates RBC
production.

Maternally derived iron stores are present for the first 5 to months and gradually
diminish, which also accounts for lowered hemoglobin levels toward the end of the first 6
months. The occurrence of physiologic anemia is not affected by an adequate supply of
iron. However, when erythropoiesis is stimulated, iron stores are necessary for the
formation of the adequate amounts of hemoglobin.

The digestive processes are relatively immature at birth. Although term newborn
infants have some limitations in digestive function, studies indicate that human milk has
properties that partially compensate for decreased digestive enzymatic activity, thus
enabling the infants to receive optimal nutrition during the first several months of life
(Blackburn and Loper, 1992). The enzyme ptyalin (also called amylase) is present in small
amounts but usually has little effect on the foodstuffs because of the small amount of time
the food stays in the mouth. Gastric digestion in the stomach consists primarily of the action
of hydrochloric acid and rennin, an enzyme that acts specifically on the casein in milk to
cause the formation of curds coagulated semisolid particles of milk. The curds cause the
milk to be retained in the stomach long enough for digestion to occur.

Digestion also takes place in the duodenum, where pancreatic enzymes and bile
begin to break down protein and fat. Secretion of the pancreatic enzyme amylase, which is
needed for digestion of complex carbohydrates, is limited until about the fourth to sixth
month of life. Lipase is also limited, and infants do not achieve adult levels of fat absorption
until 4 to 5 months of age. Trypsin is secreted in sufficient quantities to catabolize protein
into polypeptides and some amino acids.

The immaturity of the digestive processes is evident in the appearance of stools.

During infancy, solid foods (e.g., peas, carrots, corn, and raisins) are passed incompletely
broken down in the feces. An excessive quantity of fiber easily disposes the child to loose,
bulky stools.

During infancy the stomach enlarges to accommodate a greater volume of food. By

the end of the first year the infant is able to tolerate three meals a day and an evening bottle
and may have one or to bowel movements daily. However, with any type of gastric irritation
the infant in vulnerable to diarrhea, vomiting, and dehydration. (See Chapters 28 and 29.)

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 The liver is the most immature of all the gastrointestinal organs throughout infancy.
The ability to conjugate bilirubin and secrete bile is achieved after the first couple of weeks
of life. However, the capacities for gluconeogenesis, formation of plasma protein and
ketones, storage of vitamins, and deaminization of amino acids remain relatively immature
for the first year of life.

Maturation of the sucking, swallowing and breathing reflexes and the later eruption
of teeth parallel the changes in the gastrointestinal tract and prepare the infant for the
introduction of solid foods. Sucking activity is observed in utero as early as 15 to 28 weeks
gestation. Weak, disorganized mouthing movements may be noted at 27 to 28 weeks
gestation, yet complete maturation of sucking, swallowing, and breathing patterns are not
reported to be present until 35 to 36 weeks (Wolf and Glass, 1992). Sucking is further
divided nutritive and nonnutritive; the latter is observed in infants of all ages and is reported
to be primarily for the purpose of satisfying the basic sucking urge. On the other hand,
nutritive sucking has as its primary purpose the intake of food. Suckling is a term often
used in denoting breast-feeding (Lawrence and Lawrence, 1999), yet use of the term often
varies among different sources.

Swallowing (deglutition) is the ability to collect the food (bolus) and propel it into
the esophagus. During the infantile (visceral) swallow reflex food lies in a shallow groove
on the top (dorsum) of the tongue. As the tongue is pressed upward toward the palate, the
milk flows by gravity down the sloping tongue and along the sides of the mouth in lateral
furrows between the tongue, cheek, and gum pads. As the bolus moves downward, the
posterior wall of the pharynx comes forward to displace the soft palate. This swallowing
process is efficient for fluids but not for solids.

As the infant grows, the tongue becomes smaller in proportion to the oral cavity
and attains greater motility, the orofacial muscles develop, and teeth erupt. Consequently,
the mature (somatic) swallow reflex is significantly different. The tongue remains behind
the central incisors, and the mandible no longer thrusts forward. The dorsum of the tongue
is less concave and remains higher and parallel, not inclined, against the palate; the lateral
furrows movement against the hard palate pushes the bolus back into the pharynx.

Infants also exhibit a special reflex called the Santmyer swallow. When a puff of
air is directed at the face, the infant will exhibit a reflex swallow.

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 The immunologic system undergoes numerous changes during the first year. The
term newborn receives significant amounts of maternal immunoglobulin G (IgG), which
for approximately 3 months confers immunity against many antigens to which the mother
was exposed. During this time the infant begins to synthesize IgG; approximately 40% of
adult levels are reached by 1 year of age. Significant amounts of IgM are produced at birth
yet specificity is decreased, thus limiting recognition of certain pathogens. Adult levels of
IgM are reached by 9 to 12 months of age. The production of IgA, IgD, and IgE is much
more gradual, and maximum levels are not attained until early childhood.

Secretory IgA is not present at birth but is found in saliva and tears by 2 to 5 weeks.
IgA is present in large amounts in human colostrum; this is believed to have a protective
role In the gastrointestinal tract against many bacteria such as Escherichia coli and viruses
such as poliovirus. The function and quantity of T-lymphocytes, lymphokines, and
complement is reduced in early infancy, thus preventing optimal response to certain
bacteria and viruses.

During infancy thermoregulation becomes more efficient; the ability of the skin to
contract and of muscles to shiver in response to cold increases. The peripheral capillaries
respond to changes in ambient temperature to regulate heat loss. The capillaries constrict
in response to cold, conserving core body temperature and decreasing potential evaporative
heat loss from the skin surface. The capillaries dilate in response to heat, decreasing internal
body temperature through evaporation, conduction, ad convection. Shivering
(thermogenesis) causes the muscles and muscle fibers to contract, generating metabolic
heat, which is distributed throughout the body. Increased adipose tissue during the first 6
months insulates the body against heat loss.

A shift in total body fluid occurs. At birth 75% of the infant’s body weight is water,
and there is an excess of extra cellular fluid (ECF). As the percentage of body water
decreases, so does the amount of ECF from 40% at term to 20% in adulthood. The high
proportion of ECF, which is composed of blood plasma, interstitial fluid, and lymph
predisposes the infant to a more rapid loss of total body fluid and, consequently,
dehydration.

The immaturity of the renal structures also predisposes the infant to dehydration.
Complete maturity of the kidney occurs during the latter half of the second year, when the
cuboidal epithelium of the glomeruli becomes flattened. Before this time the filtration

9
capacity of the glomeruli is reduced. Urine is voided frequently and has a low specific
gravity (1.000 to 1.010).

The endocrine system is adequately developed at birth, but its function are
immature. The interrelatedness of all the endocrine organs has a major effect on the
function of any one gland. The lack of homeostatic control because of various functional
deficiencies renders the infant especially vulnerable to imbalances in fluid and electrolytes,
glucose concentration, and amino acid metabolism.

For example, corticotropin (ACTH) is produced in limited quantities during

infancy. ACTH acts on the adrenal cortices to produce their hormones, particularly the
glucocorticoids and aldosterone. Because the feedback mechanism between ACTH and the
adrenal cortex is immature during infancy, there is much less tolerance for stressful
conditions, which affect fluid and electrolytes and the metabolism of fats, proteins, and
carbohydrates. In addition, although the islets of Langerhans produce insulin and glucagon
during fetal life and early infancy, blood sugar levels tend to remain labile, particularly
under conditions of stress.

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B.Development

a. Fine Motor Development

Fine motor behavior includes the use of the hands and fingers in the prehension (
grasp) of an object. Grasping occurs during the first 2 to 3 months as a reflex and gradually
becomes voluntary. At 1 month of age the hands are predominantly closed, and by 3 months
they are mostly open. By this time infants demonstrate a desire to grasp an object, but they
“grasp” it more with the eyes than with the hands. If a rattle is placed in the hand, the infant
will actively hold onto it. By 4 months of age the infant regards both a small pellet and the
hands and then looks from the object to the hands and back again. By 5 months the infant
is able to voluntarily grasp an object.

Gradually the palmar grasp ( using the whole hand ) is replaced with a pincer grasp
( using the thumb and index finger ). By 8 to 9 months of age the infant uses a crude pincer
grasp and by 10 months of age the pincer grasp is sufficiently established to enable infants
to pick up a raisin and other finger foods. By 11 months the infant has progressed to a neat
pincer grasp.

By 6 month of age infants have increased manipulative skill. They hold their bottle,
grasp their feet and pull them to their mouth, and feed themselves a cracker. By 7 months
they transfer object from one hand to the other, use one hand for grasping, and hold a cube
in each hand simultaneously. They enjoy banging objects and will explore the movable
parts of a toy.

By 10 months of age infants can deliberately let go of an object and will offer it to
someone. By 11 months they put objects into a container and like to remove them. By age
1 year infants try to build a tower of two blocks but fail.

b. Gross motor development

Gross motor behavior includes developmental maturation in posture, head balance,
sitting, creeping, standing, and walking. The full-term neonate is born with some ability
to hold the head erect and reflex assumes the postural tonic neck position when supine.
Several of the primitive reflexes have significance in terms of development of later gross
motor skills. The righting reflexeselicit certain postural responses, particularly of flexion
or extension. They are responsible for certain motor activities, such as rolling over,
assuming the crawl position, and maintaining normal head-trunk-limb alignment during all
activities. The neck-righting reflex, which turns the body to the same side as the head,

11
enables the child to roll over from supine to prone. Other reflexes, such as the otolith-
righting and labyrinth-righting reflexes, enable the infant to raise the head.

The asymmetric tonic neck reflex, which persists from birth to 3 months, prevents
the infant from rolling over. The symmetric tonic neck reflex, which is evoked by flexing
or extending the neck, helps the infant to assume the crawl position. When the head and
neck are extended, the extensor tone of the upper extremities and the flexor tone of the
lower extremities increase. The child extends the arm and bends the knees. Because of the
stronge flexor tone of the lower extremities, the infant may initially crawl backward before
crawling forward. This reflex disappears when neurologic maturity allows actual crawling
to occur because independent limb movement is required.

Head Control. The full-term newborn can momentarily hold the head in midline
and parallel when the body is suspended ventrally and can lift and turn the head from side
to side when prone. This is not the case when the infant is lying prone on a pillow or soft
surface; infants do not have the head control to lift their head out of the depression of the
object and therefore risk suffocation. Marked head lag is evident when the infant is pulled
from a lying to a sitting position. By 3 month of age infant can hold their head well beyond
the plane of the body. By 4 months of age infants can lift the head and front portion of the
chest approximately 90 degrees above the table, bearing their weight on the forearms. Only
slight head lag is evident when the infant is pulled from a lying to a sitting position, and by
4 to 6 months head control is well established.

Rolling Over. Newborns may roll over accidentally because of their rounded back.
The ability to willfully turn from the abdomen to the back occurs at 5 months, and the
ability to turn from the back to the abdomen occurs at 6 months. It is noteworthy that the
parachute reflex, which elicits a protective response to falling, appears at 7 months .

Sitting.The ability to sit follows progressive head control and straightening of the
back. For the first 2 to 3 months the back uniformly rounded.

Locomotion.Locomotion involves acquiring the ability to beat weight, propel

forward on all four extremities, stand upright with support and, finally, walk alone.
Following a cephalocaudal pattern, infant 4 or 6 months old have increasing coordination
in their arm. Initial locomotion result in infant propelling themselves backward by pushing
with the arm. By 6 to 7 months of age they are able to bear all their weight on their legs
with assistance. Grawling( propelling forward with belly on floor ) progresses to creeping

12
on hands and knees ( with belly off floor ) by 9 months. At this time they stand while
holding onto furniture and can pull themselves to the standing position, but they are unable
to maneuver back down expect by falling. By 11 months they walk while holding onto
furniture or with both hands held, and by age 1 year they may be able to walk with one
hand held. A number of infants attempt their first independent steps by their first birthday.

c. Psychosocial development
Developing a sense of trust (Erikson)

Erikson’s phase 1 (birth to 1 year) is concerned with acquiring a sense of trust

while overcoming a sense of mistrust. Erikson was a Neo-Freudian who incorporated much
of Freud’s theory. The trust that develops is a trust of self, of others, and of the world.
Infants ‘‘trust’’ that their feeding, comfort, simulation, and caring needs will be met. The
crucial element for the achievement of this task is the quality of both the parent (caregiver)
child relationship and the care of the infant receive. The provision of food, warmth, and
shelter by itself is inadequate for the development of a strong sense of self. The infant and
parent must jointly learn to satisfactorily meet their needs in order for mutual regulation of
frustration to occur when this synchrony tails to develop mistrust is the eventual outcome.
For adolescent who does not understand the infant's behavioral cues due to his/herown self-
centered phase of development

Failure to learn "delayed gratification” leads to mistrust. Mistrust can result either
from too much or too little frustration. If parents always meet their children's needs before
the children signal their readiness, infants will never learn to test their ability to control the
environment. If the delay is prolonged, infant will experience constant frustration and
eventually mistrust other in their efforts to satisfy them. Therefore consistency of care in
essential.

The trust acquired in infancy provides the foundation for all succeeding phases.
Trust allows infants a feeling of physical comfort and security, which assists them in
experiencing unfamiliar, unknown situations with a minimum of fear. Erikson has divided
the first year of life into two oral/social stages. During the first 3 to 4 months, food intake
is the important social activity in which the infant engages. The newborn can tolerate little
frustration or delay of gratification. Primary narcissism (total concern for one-self) is at its
height.

13
 However, as bodily processes such as vision, motor movements, and vocalization
become better controlled, infants use more advanced behaviors to interact with others. For
example, rather than cry, infants may put their arms up to signify a desire to be held.

The next social modality involves a mode of reaching out to others through
grasping. Grasping is initially reflexive, but even as a reflex it has a powerful social
meaning for the parents. The reciprocal response to the infant’s grasping is the parents’
holding on and touching. There is pleasurable tactile stimulation for both the child and the
parents.

Tactile stimulation is extremely important in the total process of acquiring trust.

The degree of mothering skill, the quantity of food, or the length of sucking does not
determine the quality of experience. Rather, it is the total nature of the quality of the
interpersonal relationship that influences the infant’s formulation of trust.

During the second stage, the more active and aggressive modality of biting occurs.
Infants learn that they can hold onto what is their own and can more fully control their
environment. During this stage infants may be confronted with one of their first conflicts.
If they are breast-feeding, they quickly learn that biting causes the mother to become upset
and withdraw the breast. Yet biting also brings internal relief from teething discomfort and
a sense of power or control.

This conflict may be solved in variety of ways. The mother may wean the infants
from the breast and begin bottle-feeding, or the infant may learn to bite substitute “nipples,”
such as a pacifier, and retain pleasurable breast-feeding. The successful resolution of this
conflict strengthens the mother-child relationship because it occurs at a time when infants
are recognizing the mother as the most significant person in their life.

d. Cognitive development
Sensorimotor Phase (Piaget)

The theory most commonly used to explain cognition, or the ability to know, is that
of Piaget. The period from birth to 24 months is termed the sensorimotor phase and is
composed of six stages; however, because this discussion is concerned with ages birth to
12 months, only the first four stages are discussed

During the sensorimotor phase infants progress from reflex behaviors to simple
repetitive acts to imitative activity. Three crucial events take place during this phase. The

14
first event involves separation, in which infants learn to separate themselves from other
objects in environment. They realize that others besides themselves control the
environment and that certain readjustments must take place for mutual satisfaction to occur.
This coincides with Erikson’s concept of the formation of trust and mutual regulation of
frustration.

The second major accomplishment is achieving the concept of object permanence,

or the realization that objects that leave the visual field still exist. A typical example of the
development of objects they observe being hidden under a pillow or behind a chair. This
skill develops at approximately 9 to 10 months of age, which corresponds to the time of
increased locomotion skills.

The last major intellectual achievement of this period is the ability to use symbols,
or mental representation. The use of symbols allows the infant to think of an object or
situation without actually experiencing it. The recognition of symbols is the beginning of
the understanding of time and space.

The first stage, from birth to 1 month, is identified by the infant’s use of reflexes.
At birth the infant’s individuality and temperament are expressed through the physiologic
reflexes is the beginning of associations between an act and a sequential response. When
infants cry because they are hungry, a nipple is put in the mouth, and they suck, feel
satisfaction, and sleep. They are assimilating this experience while perceiving auditory,
tactile, and visual cues. This experience of perceiving certain patterns, or “ordering,”
provides a foundation for the subsequent stages.

The second stage, primary circular reactions, marks the beginning of the
replacement of reflexive behavior with voluntary acts. During the period from 1 to 4
months, activities such as sucking or grasping become deliberate acts that elicit certain
responses. The beginning of accommodation is evident. Infants incorporate and adapt their
reactions to the environment and recognize the stimulus that produced a response.
Previously they would cry until the nipple was brought to the mouth. Now they associate
the nipple with the sound of the parent’s voice. They accommodate this new piece of
information and adapt by ceasing to cry when they hear the voice before receiving the
nipple. What is taking place is a realization of causality and a recognition of an orderly
sequence of events. The environment is taken in with all the senses and with whatever
motor ability is present.

15
 The secondary circular reactions and lasts until 8 months of age. In this stage the
primary circular reactions are repeated and prolonged for the response that results.
Grasping and holding now become shaking, banging, and pulling. Shaking is performed to
hear a noise, not solely for the pleasure of shaking. Quality and quantity of an act become
evident. “More” or “less” shaking produces different responses. Causality, time, deliberate
intention, and separateness from the environment begin to develop.

Three new processes of human behavior occur. Imitation requires the

differentiation of selected acts from several events. By the second half of the first year
infants can imitate sounds and simple gestures. Play becomes evident as they take pleasure
in performing an act after they have mastered it. Much of infant’s waking hours are
absorbed in sensorimotor play. Affect (outward manifestation of emotion and feeling) is
seen as infants begin to develop a sense of permanency. During the first 6 months infants
believe that an objects exists only for as long as they can visually perceive it. In other
words, out of sight out of mind. Affect to external objects is evident when the object
continues to be present or remembered even though it is beyond the range of perception.
Object permanence is a critical component of parent-child attachment and is seen in the
development of separation anxiety at 6 to 8 months of age.

During the fourth sensorimotor stage, coordination of secondary schemas and their
application to new situations, infants use previous behavioral achievements primarily as
the foundation for adding new intellectual skills to their expanding repertoire. This stage is
largely transitional. Increasing motor skills allow for greater exploration of the
environment. They begin to discover that hiding an object does not mean that it is gone but
that removing an obstacle will reveal the object. This marks the beginning of intellectual
reasoning. Furthermore, they can experience an event by observing it, and they begin to
associate symbols with event (e.g., “bye-bye” with “Daddy goes to work”), but the
classification is purely their own. In this stage they learn from the object itself this is in
contrast to the second stage, in which infants learn from the type of interaction between
objects or individuals. Intentionality is further developed in that infants now actively
attempt to remove a barrier to the desired (or undesired) action. If something is in their
way, they attempt to climb over it or push it away. Previously an obstacle would cause
them to give up any further attempt to achieve the desired goal.

16
 e. Sexual Development (Sigmund Freud)
Sexual development in infants has actually occurred since 7-8 weeks of embryonic
life, in male infants marked by the formation of testicles and external sexual organs, and in
infant women begins to form a clitoris, labia majora, labia minora and others.At birth,
women have a supply of primordial follicles (around 500.00) in their ovaries for life; about
500 primordial follicles will develop into deaf follicles. And in normal infant boys there is
a decrease in testicles when newborn.

In this sexual development the infant experiences the oral phase, the source of
pleasure felt by the infant coming from the mouth. infant gain satisfaction by sucking,
chewing food, or drinking breast milk. This stage focuses on the interactions that occur
through the baby's mouth, so that the reflexes suck are very important. When the mother
feeds her baby, the child experiences oral pleasure and then sucks his finger to restore this
pleasure.

Characteristics of the oral phase:

1. Occurs in newborn children

2. Babies are very dependent on breast milk
3. Sensori is very close to the nipples or objects that resemble it like a pacifier
4. It's easy to get frustrated if it's not immediately breastfed when the baby
wants it
5. The mouth is the first tool to obtain satisfaction
6. Requires the outpouring of deep love from mother
7. The delay in giving milk to a baby has an effect on his mental development.

The task of the main development of the oral phase is to gain trust, both to oneself
and others. The effect of rejection on the oral phase will shape the child to be a fearful
person who is insecure, thirsty for attention, jealous, aggressive, hateful, and lonely.

Sexual identity is reported to begin in utero because hormonal influences, which

are not entirely understood. touch is crucial to infant development and plays a primary role
on sexual development. infant have a great oral sensitivity, which is manifested through
sucking and mouthing. they enjoy skin-to-skin contact and explore their own body for
pleasure. parents' responses to these early manifestations of sexuality influence children's
evolving attitudes; therefore a healthy, accepting response by parents is important.

17
 f. Sullivan’s Theory (Infancy)
According to Sullivan as stated by Calvin S. Hall and Gardner Lindzey (2000) that
the development of individual personalities through 6 stages before reaching maturity.
This phase lasts from the baby is born to when learning to speak. The main organ
to interact between baby and the environment is oral. The environment that concerns the
baby is an object that provides food when hungry, such as a mother's milk nipples or
pacifiers.
A distinctive feature of this stage, namely:
a. Development of conception of the nipple, namely: good nipples; nipples are good but
not satisfying; wrong nipple; and bad nipples, broken down into:
 Good nipples signify maintenance and bring satisfaction.
 Good nipples, when the baby is not hungry, will cause dissatisfaction.
 Milk nipples are wrong because they do not remove breast milk, causing
judgment and need to find alternative alternatives.
 Poor nipples because of anxious mothers, is a sign that mothers avoid children.
b. The emergence of apathy and release by drowsiness.
c. The emergence of personification about mothers who are good, bad, anxious, rejecting,
accepting and giving satisfaction.
d. The emergence of learning experience and the basis for the formation of a self-concept
system.
e. Can distinguish the baby's own body, sucking the thumb to release dependence on the
mother.
f. Learn to do coordinated movements, such as: hands and mouth, hands and eyes, and
ears and sounds.
g. The important development task here is the fulfillment of security needs as a basis for
developing valuable beliefs.

C. Patterns of Infant Communication

Even a few weeks of age, infant communicate and engage in two way interaction,
and express comfort by soft sounds, cuddling, and eye contact . the infant display
discomfert by thrashing the extramities ,arching the back, and crying vigorousely .from this
rudimentary Skills, communication abilities continue to develop until the infant speaks
several words at end of the first year of life

18
 Nurses assesses communication to identify possible abnormalities or
developmental delays Language abilities may be assessed with the Denver II
Developmental Test and other specialized language screening tools .Normal infants and
toddlers understand (receptive speech) more words than they can speak (expressive speech)
abnormalities may be cause by a hearing deficit, developmental delay, or lack of verbal
stimulation from care takers.futher assesment may be required to pinpoint the cause of the
abnormality.
Nursing interventions focus on providing a stimulating environment. Parents are
encouraged to speak to infants and teach words. Hospital nurse should include the infants
known words when providing care.

a. One month age up to three months (hearing and making sounds)

Just as babies naturally prefer human faces to other visual patterns, babies also
prefer human voices to other sounds. Her mother's voice is the most like because the baby
connects this sound with warmth, food and comfort. in general babies like high-pitched
sounds a fact that most adults seem to understand this instinctively and give appropriate
responses without even realizing it.
By the age of one month the baby can identify the presence of the mother through
sound, even though the mother is in another room, and when the mother talks to her she
will feel calm, happy, and entertained. when the baby will see excitement on the mother's
face and realize that conversation is a two-way process. this first conversation will teach
the baby a lot of communication such as talking alternately, tone of voice, imitation and
pauses and the speed of verbal interaction.
At the age of two months the mother will start to hear your baby repeating some
vowels (ah - ah - ah, ooh - ooh - ohh) especially if the mother often invites her to speak
with clear and simple words or sentences. throughout this conversation maybe the mother
mixes the conversation with adult language and removes the baby's language after the
baby is 6 months old.
By the age of three months babies will babble on a regular basis often comforting
themselves for long periods of time by making strange new sounds (muh-muh, bah-bah)
babies will also be more sensitive to tone of voice and pressure given to certain words or
sentences . Because the mother spends time together from day to day, the baby will learn
from the voice of the mother when the mother will give milk, change the diaper, go for a
walk, or put him to sleep.

19
 The way the mother speaks will tell a lot about the mood and personality of the
mother while the way the baby responds will tell her the same thing. if the mother speaks
in a soft and pleasant tone, the baby will smile. if the mother yells or speaks in an angry
tone, chances are the baby will be surprised or cry

Important auditory and speech milestones towards the end of this period
• Smile when listening to your voice
• Start babbling
• Start mimicking some sounds
• Turning your head towards the sound

b. Age four to seven months (language development)

Your baby learns language gradually. from birth, babies receive
information about language by listening to other people making sounds and paying
attention to how they communicate with each other. at first the baby is very
interested in the tone and height of the mother's voice.
When the baby talks to him in a gentle tone, the baby stops stopping
because the baby hears that the mother wants to comfort her. conversely if the
mother yells angrily most likely the baby will cry. because the voice of the mother
tells the baby that something is wrong.

Language milestones towards the end of this period

• Respond to his own name
• Start responding "no"
• Distinguish emotions with tone of voice
At the age of 4 months the baby will begin to pay attention not only to the
• Responds to the sound by making a sound
way you speak but also the individual that you make. the baby will listen to dead
• Use
letters voices to
and vowels, express
and joy
begin to and
pay displeasure
attention to how to combine these two letters
• Rattling
to become somewords,
syllables, consonants
sentences.
Apart from receiving sound, the baby also produces sounds from birth, first
in the form of crying and then chattering. at about 4 months the baby will start

20
babbling. use a lot of rhythms and characteristics from the original language. even
though the sound is like a mess, if the mother listens carefully the mother will hear
the baby will raise and lower her voice as if the baby is as if the baby is making
questions or asking questions. Encourage babies to often talk to them every day.
When babies say simple words that contain these syllables. For example,
if the sound is said to contain the syllable. For example, the voice he says is "bah"
introduce him to the word "bench" or "ci luk ba". Mother's participation in the
development of the baby's language will become more important after the age of
six or seven months when the baby actively mimics the speech sounds of speech.
until that point the baby may repeat one sound during the whole day or even days
before trying other sounds.
However, babies now are far more responsive to the sounds that mothers
make out, and babies will try to follow the mother's guidance. so introduce the baby
to simple syllables and words such as "baby, cat, duck" "mama" "daddy" even
though it takes 1 year before the mother can translate any babble. babies can
understand a lot of mother's words well before their first birthday.
If the baby does not babble or mimic every sound before the age of seven
months, it can mean problems with his hearing or the development of his speech.
a baby with a hearing loss can still be partially surprised by a loud sound or will
turn his head toward the sound, and even respond to the mother's voice. but babies
will have difficulty imitating speech. if the child does not babble or make a variety
of sounds, tell the pediatrician if he has an ear infection, maybe there is still a little
fluid in the inner ear that can interfere with his hearing.

c. Age of eight months to twelve months

Can mothers pay attention to voices that are not clear in the early months
now turning into known syllables such as "ba, da, ga, and ma"? babies can say
like "mama" and "see you" accidentally, and mothers are happy to realize that the
baby has said something that is supportive. Beforehand the baby will start using
the word "mama" to invite or attract the attention of the mother.
At this age the baby can say "mama" only to practice the words. But it will
use words only compile when the baby wants to communicate the
meaning.Picture books can also improve the overall process. with his agreement.
Large size fabric, wood, and can be rotated on its own. Also looking for color

21
 images that the child will recognize.
Mothers read or invite babies to talk, give babies plenty of opportunities
to join. Ask questions and wait for the resons or let the baby lead. if the baby says
"why" repeat again and see what the baby is doing. yes this exchange can seem
insignificant but it shows the baby that communication is going both ways and
that the baby is a participant.
By paying attention to what the baby is saying, the mother will be able to
identify the words that the baby understands and make the first words
spoken.This first word accidentally is often not a good language. for children a
"word" is a sound that consistently refers to the same person, object, or event. so
if the baby says the word "mog" every time the baby wants milk, then "mog" must
be valued as a legitimate word. but speaking to him use the word "milk" so the
baby will correct the word

Language milestones towards the end of this period

• Increasing attention to words

• Responds to simple verbal requests
• Responding to the word "no"
• Using simple gestures such as shaking your head shake your head which
means "no"
• babbling in different tone of voice
• Say "chest" and "mama"
• Try to imitate words

D. Play

Age Visual stimulation Audiorius Tactile Kinetic

(month) stimulation stimulation stimulation
Recommended activities

22
New - Look at the - Talk to babies; - Carry, love - Swing baby;
born – baby at singing in a soft and love place it on the
1 close range voice - Keep the baby train
- Hang - Play music warm Use carriage to
brightly boxes, radio, Maybe like to walk around
shiny television be blunted
objects - Place a clock
within a ticking or a
distance of metronome near
20-25 cm his
from the
baby's face
and in the
center line
2–3 - Give a bright - Talk to babies - Buy a baby - Use baby
object - Enter in family while bathing, swingers
- Make the room togetherness on diaper - Take it to the
bright with pictures - Expose to a replacement car to drive
and mirrors variety of Comb the hair - Train the body
- Take the baby to environmental with a soft by moving the
various chili rooms noise in addition brush extremities in
to carry out the to house noise swimming
tasks Use toys if you movements
Place the baby in shake it will - Use the game
the baby seat for a make a sound swing
vertical view of the (eg rattles or
environment wind chimes)

23
4–6 - Place the baby in - Talk to the - Give baby - Use a swing
front of the mirror baby, repeat the toys that are or stroller
can not be broken sound made by soft with a - Roll the baby
Give a light colored the baby variety of in the sambal's
toy to hold (small - laugh when textures lap to hold it in
enough to hold) the baby laughs - Let it plunge a standing
- Call the baby when bathing position
by his name Place the naked - Support the
- Squeeze baby's body on baby in a sitting
different paper a soft, soft rug position, let the
in the baby's ear and move the baby lean
Place a wiggled extremities forward for self
toy that will balance
make a sound or Place the baby
bell in the on the floor to
baby's hand crawl, roll over
and sit
6–9 - Give the baby a - Call the baby - Let the baby - Hold upright
large toy with by his name play with to feel weight
bright colors, - Repeat simple fabrics of and stomach
moving parts, and words like various textures weight
can sound "chest", "mama" - Give a bowl - Raise it, say
- Place a mirror that - Speak clearly of food of 'go up', lower it
is not easily broken - Tell me what different sizes and say lower it
where the baby can you did and textures to - Place the
see himself - Use "no" only feel game out of
- Play peekaboo, if necessary - Let the baby reach, push the
especially hiding - Give a simple "catch the baby to take it
your face behind a order flowing water - Play pat-a-
towel - Encourage cake
children to

24
 - Create funny faces Show how to "swim" in large
to encourage clap your hands, tubs or shallow
imitation hit the drum pools
Give knitted balls Give sticky
or threads to draw plaster clumps
to manipulate

9 – 12 - Show the baby a - Read the baby - Give the baby - Give big toys
big picture in the for a simple food that is that can be
book lullabies story held in pulled and
- Take the baby to a - Show body different pushed
place where parts and name patterns - Place furniture
animals, lots of one of them - Let the baby in the
people, different Imitate the destroy and environment to
objects (shopping sound of destroy food encourage
centers) animals - Let the baby exploration
- Play the ball by feel cold Return to a
rolling it and teach objects (ice different
it to throw it back cubes) or position
- Demonstrate how warm, say what
to build a two-block is the
tower temperature of
each

25
 Let the baby
feel the breeze
(wind blows)
Recommended toys
New - Children's toy - music box - Animal toys - Basket / swing
born – cars - Mobile music - fine clothes - Toys that are
6 - Mirror that - Baby basket - Soft or soft aggravated or
cannot be broken bell cotton blanket smoked
Blankets with Small toys that if Baby swing
contrast colors held will make a
sound if held
6 - 12 - Various colored - Toys that, if - Dolls with - Activity book
blocks shaken, cause a different with baby
- Box or mesh cup sound (rattling) textures and basket
- Story books with with different colors - Toys that can
bright images bright colors and - Toys that can be pushed or
- Large diameter different sounds float pulled
thread - Animals or - Toys that can Wind swing
- Toys with easily dolls who be squeezed
detached parts squeak - Toys that can
- big ball Light and be bitten
- Cup and spoon rhythmic music Books with
- big puzzle record textures like
Jack-in-the-box fur and zipper

a. Characteristics of the Game

Based on research conducted by Susanna Billion et al; Garvey; Rubin; Fein; and
Vendenberg (in Rahardjo, 2007) revealed the existence of several characteristics of game
activities, namely: a.) Conducted based on instrumental motivation, meaning arising from
personal desires and for their own interests. b) Feelings from people involved in play
activities are colored by positive emotions. c). Flexibility marked by the ease of activities
switching from one activity to another. d). More emphasis on the process that takes place
than the end result e) Free to choose, this feature is a very important element for the concept

26
of playing in young children f.) Has pretend quality. Play activities have a certain
framework that separates from real life everyday.

Playing in childhood - children have certain characteristics that distinguish it from adult
games, According to Hurlock (1995: 322- 326) the characteristics of the game in childhood
are as follows :

a) Playing is filled with tradition

Little children mimic a larger child's play, which mimics the previous generation
of children. So in every culture, one generation decreases the form of the game that most
satisfies the next generation.

b) Playing follows a predictable pattern

From infancy to maturity, certain games are popular at an age level and not at other
ages, without questioning the environment, nation, socio-economic status and gender. This
play activity is very popular universally and can be predicted so that it is the thing it is
common to divide childhood into more specific stages.
Various types of games also follow predictable patterns. For example, wooden
blocks are reported through four stages. First, children hold more, explore, carry blocks
and stack them in an irregular form; second, build rows and towers; third, floating
techniques for building more complex designs; fourth, dramatize and produce the actual
shape.

c) Variety of game activities decreases with age.

The variety of children's activities carried out gradually decreases with increasing
age. This decrease is caused by a number of reasons. Older children have less time to play
and they want to spend their time by creating the greatest pleasure.
With the increasing attention environment, they can focus their attention on the
more long-playing activities of jumping from one game to another such as those performed
like younger ages. Children leave it for reasons because they are bored or consider it
childish.

27
d) Playing becomes increasingly social with increasing age.
With the increase in the number of social relationships, the quality of children's
games becomes more social. When children reach school age, most of their toys are social,
such as those in collaborative play activities, but this is done when they already have a
group and at the same time, the opportunity arises to learn to befriend social ways.

e) The number of playmates decreases with age

In the preschool phase, children consider all members of the group as playmates,
after becoming members of the gang, all are beruabah. They want to play with that small
group where members have the same attention and the game creates certain satisfaction for
them.
Playing more and more according to gender. Boys not only avoid female playmates
when they enter school, but also keep away from all play activities that are not in
accordance with their gender.

g) Childhood games change from informal to formal

Little boy games are spontaneous and informal. They play anytime and with
whatever toys they have like, without considering the place and time. They don't need
special equipment or clothing to play. Gradually becoming more formal.

h) Playing physically less active with increasing age Children's attention in active play
reaches its low point during early puberty. Children not only withdraw to play actively, but
also spend a little time reading, playing at home or watching television. Most of the time is
spent daydreaming - a form of play that doesn't require much energy.

i) Play can be predicted from children's adjustments.

The type of game, variety of play activities, and the amount of time spent playing
as a whole is an indication of the child's personal and social adjustment.

j) There are clear variations in children's play.

Although all children go through similar and predictable stages of play, not all
children play the same way at the same age. Variations in children's play can be traced to
a number of factors.

28
 b. Game Development Stage

The stages of playing activities according to Piaget (in komariyah, 2010) are as
follows: a) Sensory motorbike games. Playing in this period cannot be categorized as play
activities. This activity is only a continuation of pleasure obtained such as eating or
changing something. So it is a repetition of previous things and is called reproductive
assimilation. b) Symbolic games. It is a feature of the pre-operational period found at the
age of two to seven years characterized by fictional play and fake play.
At this time the child asks more and answers questions, tries various things related
to the concept of numbers, space, quantity and so on. Often children just ask questions, do
not pay too much attention to the answers given and even though the child has answered
the question will continue. Children have used various symbols or representations of other
objects. For example brooms as piggyback, torn paper as money and others.
Symbolic play also serves to assimilate and consolidate children's emotional
experiences. Every thing that impresses the child will be done again in his playing
activities. c) social games that have rules. At the age of eight to eleven children are more
involved in games with rules where children's activities are more controlled by game rules.
d) games that have rules and sports (eleven years and over).
This play activity is fun and enjoyed by children even though the rules are far away
more stringent and enforced rigidly. Children love to do repeatedly and are encouraged to
achieve the best performance.

E. Child Nursing with A Hospital

c. Role of family in hospitalization
Hospitalization whether it is a choice, planned in advance or the outcome of an
emergency or trauma is stressful for children of all ages and their families. But now,
children are rarely hospitalized because of good management in the community. Children
treated in hospitals are usually very sick. They were in an unknown environment,
surrounded by strangers, equipment and scary sights and sounds. These children experience
unknown procedures, some of which are invasive, and may even undergo surgery or
undergo treatment in the intensive care unit.
To reduce the stress of hospitalization nurses need to provide support to children
and their families before, during and after being hospitalized. Through prepositions before
entering the hospital the child and his family are introduced to acute care settings. During

29
hospitalization, nurses work with parents with various strategies to introduce several coping
and adaptation mechanisms or prepare children for a surgical or invasive procedure. Nurses
play an important role in ensuring that children's development and educational needs are
met, especially when prolonged hospitalization. The nurse also works with the family to
help prepare long-term care or rehabilitation facilities.
d. Stressor hospitalization for children separation anxiety
The majority of the causes of hospitalization at the age of the infant to pre-school
are the anxiety of separation. Basically split anxiety is divided into three stages, namely the
stage of the stage of protest, the stage of despair and the stage of release. At the stage of
protest children tend to be aggressive and reject the presence of others. They cry and scream
for their parents and cannot be comforted by others in their sadness. At the stage of
dropping out inversely with the stage of protest, the child begins to stop crying and become
depressed.
Not interested in playing, not interested in eating and withdrawing from the
environment or other people. And the last stage is the release that is usually the child has
begun to be interested in his surroundings, interactive with strangers and care givers and
looks more happy or happy.
c. Loss of control
One of the factors that influence stress and hospitalization is
the amount of control felt by the person himself. The reduced ability to control results in
child coping mechanisms and adds to the feeling of being threatened by children.
Usually that affects the condition of the hospital in the form of surrounding scenery,
extraordinary sounds and smells. A conducive environment affects optimal growth for
children, environmental conditions in hospitals can be an obstacle in children's growth.
The most important thing in a baby's growth is a healthy personality that is
upheld through consistent and loving care. Babies try to control their environment with
expressions like crying and laughing. In hospital settings that may be overlooked is the
arrangement of routine meetings between babies and hospital staff must be adjusted to
the needs of the baby. Inconsistent care and daily routine for babies can cause a feeling
of distrust and cause the baby to lose control.

30
Reactions of Parents to Hospitalization in Children
The children's disease crisis and hospitalization affect every family member. The
reaction of parents to their child's illness depends on various factors. Although one cannot
predict which factors most influence the response, but a number of variables have been
identified including:
Serious threat to children
1. Previous experience with illness or hospitalization
2. The payment procedure involved in the treatment
3. Available support systems
4. Strength of personal ego
5. Previous coping abilities
6. Additional emphasis on the family system
7. Inter-religious cultural and religious patterns
8. Pattern of communication between families
Research has identified among parents whose children are hospitalized that parents
usually m, asking staff expertise, accepting the reality of hospitalization, needing to
have information explained in simple language, overcoming fears, overcoming
uncertainty, and seeking guarantees from caregiver. This guarantee involves staff who
are passionate, express children's concerns, and pay attention to details in child care.

CHAPTER III
CONCLUSION

31
 Growth and development of children, especially during the golden age, needs
considerable attention for parents. Maybe indeed at the age of 0-12 months there hasn't
been much meaningful movement, but this needs attention to achieve optimal child
development.

During the newborn (0 to 28 days), there is adaptation to the environment and

changes in blood circulation and the functioning of the organs. After 29 days to 11 months,
a rapid growth process occurs and the maturation process continues continuously,
especially the increase in nervous system function.

32
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