CPHON

Pediatric hematology/oncology nurses must understand normal growth and development to assess deviations caused by illness and treatment. Several theoretical frameworks guide developmental assessment.

Piaget's Cognitive Development Theory describes four stages. The sensorimotor stage (birth to 2 years) involves learning through sensory experiences and motor actions. Object permanence develops around 8-12 months. Infants understand the world through reflexes, then intentional actions. The preoperational stage (2-7 years) features symbolic thinking, egocentrism, and magical thinking. Children in this stage may believe their illness is punishment for bad behavior. The concrete operational stage (7-11 years) brings logical thinking about concrete events. Children understand cause and effect but struggle with abstract concepts. The formal operational stage (11 years and older) enables abstract reasoning, hypothetical thinking, and future orientation.

Erikson's Psychosocial Development Theory identifies eight stages, each presenting a developmental crisis. Trust versus mistrust (birth to 1 year) requires consistent caregiving. Hospitalization can disrupt trust formation. Autonomy versus shame and doubt (1-3 years) involves developing independence. Illness may force dependence, creating conflict. Initiative versus guilt (3-6 years) centers on purpose and direction. Restrictions from treatment may limit initiative. Industry versus inferiority (6-12 years) focuses on competence and achievement. School absences and physical limitations affect self-esteem. Identity versus role confusion (12-18 years) involves developing personal identity. Altered body image and peer separation complicate this process.

Kohlberg's Moral Development Theory describes three levels. Preconventional morality (common in young children) bases decisions on avoiding punishment and seeking rewards. Conventional morality (school-age and adolescence) emphasizes conforming to rules and social expectations. Postconventional morality (some adolescents and adults) involves abstract ethical principles.

Infants (0-12 months) require attachment to primary caregivers. Palmar grasp transitions to pincer grasp. Stranger anxiety emerges around 6-8 months. Separation anxiety peaks at 8-12 months. Pain responses include crying, facial grimacing, and body rigidity. Palliative measures include holding, rocking, pacifiers, and parental presence.

Toddlers (1-3 years) demonstrate increasing autonomy and mobility. Vocabulary expands rapidly. Parallel play predominates. Temper tantrums reflect limited emotional regulation. Hospitalization threatens autonomy and routine. Preparation for procedures should occur immediately beforehand. Comfort objects from home provide security.

Preschoolers (3-6 years) engage in associative and cooperative play. Magical thinking influences illness understanding. Fear of bodily harm and mutilation is prominent. Simple, concrete explanations work best. Medical play helps process experiences. Avoid words with double meanings that may frighten children.

School-age children (6-12 years) develop logical thinking and mastery orientation. Peer relationships gain importance. They want factual information and choices when possible. Maintaining contact with school and friends supports normalcy. Privacy becomes increasingly important. They may hide fears to appear brave.

Adolescents (12-18 years) prioritize identity formation and peer acceptance. Abstract thinking enables understanding of disease processes and long-term implications. Body image concerns intensify with treatment effects. Privacy, confidentiality, and autonomy are paramount. They may engage in risk-taking behaviors despite illness. Peer support groups provide important connections.

Denver Developmental Screening Test (DDST-II) screens children from birth to 6 years across four domains: gross motor, fine motor-adaptive, language, and personal-social. The Ages and Stages Questionnaire (ASQ) is a parent-completed screening tool. The Pediatric Symptom Checklist screens for psychosocial dysfunction. Bayley Scales of Infant Development provide comprehensive assessment for infants and toddlers.

Cancer and its treatment can affect all developmental domains. Neurocognitive late effects from cranial radiation or intrathecal chemotherapy may impair learning and executive function. Growth delays result from various treatments and nutritional deficits. Social development suffers from isolation, school absences, and peer separation. Motor development may be affected by peripheral neuropathy or surgeries. Emotional development faces challenges from trauma, anxiety, and depression.