Makalah Infant Fix.docx

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 bottlefed, 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 established.

infance, visual acuity gradually improves and binocular fixation is

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

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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

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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 otolithrighting 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 selfcentered 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.

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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

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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.

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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.

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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.

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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 developmental

assesses

communication

to

identify possible

abnormalities

or

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.

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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 voices to express joy and displeasure letters and vowels, and begin to pay attention to how to combine these two letters to become syllables, sentences. • Rattling somewords, consonants 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

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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

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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

(month)

Audiorius

Tactile

Kinetic

stimulation

stimulation

stimulation

Recommended activities

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-

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

New

-

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-

- Encourage

cake

towel

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

contrast colors

held will make a

Baby swing

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.

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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.

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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

REFERENCE

Digilip. 2018. Bab II Kajian Pustaka. http://digilib.uinsby.ac.id/9302/5/bab2.pdf (akses 5 Maret 2019) Dini, Randini. 2012. TeoriPerkembangan Eric Ericson di http://randinidini.blogspot.com/2012/11/teori-erkembangan-eric-erikson.html?m=1 (akses 24 Januari 2019) Husaini, Muhammad. 2013, TeoriPerkembanganMenurut Sullivan di http://muhammadhusainiamin.blogspot.com/2013/03/teori-perkembangan-anak-menurutsullivan.html?m=1 (akses 24 Januari 2019) Khodijah, Siti. 2017. TeoriPerkembangan Erikson dan Piaget di http://dizahe.blogspot.com/2017/10/teori-perkembangan-erikson-dan-piaget.html?m=1 (akses 24 Januari 2019) Rofiah. 2010. TeoriPerkembanganMenurut Kohlberg di https://orthevie.wordpress.com/2010/05/29/teori-perkembangan-moral-menurutkohlberg/amp/ (akses 24 Januari 2019) Soetjiningsihdan IG. N. Ranuh. 2013. TumbuhKembangAnakEdisi 2. Jakarta : EGC. Sugiri, Prameshwari. 2018. TahapanPerkembanganAnakMenurutAhliPsikoanalisa Sigmund Freud di https://m.kumparan.com/@kumparanmom/tahapan-perkembangan-anak-menurut-ahlipsikoanalisa-sigmund-freud (akses 24 Januari 2019) Wong, Donna L. 2003. “Wong and Whaley’s Clinical Manual of Pediatric Nursing”dalam Monica Ester (Eds.) PedomanKeperawatanKlinisPediatrik editor.Jakarta : EGC. Wong danHockenberry. 2003. Nursing Care Of Infants and Children. Jakarta : Mosby.

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