Growth and Development Module 1 Study Guide

Module 1 Study Guide: Growth and Development Instructions: Complete the following questions as you progress through the assigned chapters. Utilize this study guide for quizzes and exams. Some portions of this study guide will be included in your assigned worksheet that you will submit for a grade. Some of the tables and questions in this study guide are the same as your worksheet to be submitted in Canvas for a grade. You can copy your work from this study guide.  CHAPTER 31: Growth and Development  Describe Cephalocaudal development in terms of the infant’s activity, control, and what they learn to do: o development proceeds from the head downward. o Infants gain control of head and neck before the trunk and limbs. o Infants learn to hold their head up before sitÝng and to sit before standing. o Walking involves the legs and feet develop last in infancy.  Describe Proximodistal development in terms of activity, control, and what they learn to do: o Proceeds from the center of the body outward towards the extremities. o Infants are able to control the trunk, then the arms; only later are fine motor movements of the fingers possible. o The child controls arm movements before hand movements.  How is anticipatory guidance used by nurses? To predict upcoming developmental tasks or needs of a child and to perform appropriate teaching related to them. Briefly describe each theorist’s explanation of each developmental age in the table below: (The following table is a section of your worksheet that you will submit for a grade) Birth – 1year Toddler 1 – 3 Preschool 3 – 6 School Age 6 – Identify each level and years years 12 years Nursing Applications for each theory below: Freud’s Theory of Development Erickson’s Theory of Development Piaget’s Theory of Development Adolescent 12 – 18 years Define the Common Defense Mechanisms used by Children defined in the table below and give an example of each: (page 747) Defense Definition Example Mechanism Regression Repression Rationalization Fantasy Return to an earlier behavior. Involuntary forgetÝng of uncomfortable situations. An attempt to make unacceptable feelings acceptable. A creation of the mind to help deal with unacceptable fear. A child who has been previously toilet trained becomes incontinent when a new infant is born into the family. An abused child cannot consciously recall episodes of abuse. A child explains hitÝng another because “he took my toy”. A hospitalized child who is weak pretends to be Superman. (The following table is a section of your worksheet that you will submit for a grade) Birth – 1year Toddler 1 – 3 Preschool 3 – 6 School Age 6 – years years 12 years Briefly describe the Physical Growth & Developmental Milestones for each age group. Identify Psychosocial Development (Play, Activities) appropriate for each age group while in the hospital. Describe Age Appropriate Communication Strategies for the nurse to use in the hospital setÝng. Adolescent 12 – 18 years  When does an infant’s weight double? 5 - 6 months  When does an infant’s weight triple? 1 year  When does a child weigh four times their birth weight? 30 months of age  CHAPTER 33: Pediatric Assessment (pages 806 – 813)  When beginning your interview or assessment, what strategies can you utilize in order to build rapport with the family? o Introduce yourself (name, title or position, and role in caring for the child). o Explain the purpose of the interview and why the nursing history is different from the information collected by other health professionals. o Provide privacy and remove as many distractions as possible during the interview. o Direct the focus of the interview with open-ended questions. o Ask one question at a time so that the parent or child understands what piece of information is desired and so that it is clear which question the parent is answering. o Involve the child in the interview by asking age-appropriate questions. o Be honest with the child when answering questions or when giving information about what will happen. o o Choose the language style best understood by the parent and child . Use an interpreter to improve communication when not fluent in the family’s primary language.  When collecting data, which data pieces about current health status would you include that you would not normally include in an adult’s health status? o Immunizations o Safety measures used o Activities and exercise o Nutrition o Sleep  What are the key topics to address when collecting psychosocial data for adolescents? (HEEADSSS screen tool) o Home environment o Education and employment o Eating o Activities o Drugs (substance abuse) o Sexuality o Suicidal thoughts o Safety, savagery (exposure to violence)  Developmental Approach to the Examination  Briefly describe the specific approaches for each age group when performing a physical exam: Developmenta l Age Newborns & Infants under 6 months of age Approach and Techniques to use when performing a physical exam:    Infants over 6 months of age      Toddlers    Sequence of the exam Keep the parent present to provide comfort and security for the infant by feeding, using a pacifier, cuddling, or changing the diaper to keep the infant calm and quiet. Distraction such as rocking or clicking noises may help when the infant gets distressed. Portions of the exam that may disturb the infant, such as the exam of the hips, should be performed last. Often best to examine the infant and toddler on the parent’s lap and then held against the parent’s chest for some steps, such as the ear exam. Make sure the room is warm. Smile and talk soothingly to the infant. Use toys to distract the older infant. Use a pacifier or bottle to quite the child when necessary.  Head-to-toe, but be flexible: take advantage of times when the infant is quiet or asleep to auscultate.  Keep toddlers with parents, even on their lap, because of their stranger anxiety. For invasive assessments, parent can hold the child close to the chest with legs between parent’s legs. Demonstrate use of instruments on the parent or security object  Begin with the feed and hands before moving to the trunk because the infant may be fearful of strangers. Take advantage of opportunities to auscultate when infant is quiet or asleep. Begin exam by touching the feet and then move gradually toward the body and head. Use instruments to      Preschoolers      School-age         Adolescents   to reduce anxiety. Avoid asking for permission to perform the exam. When a choice is possible, let the child have some control. Much of neurological and musculoskeletal exams can be performed by observing he child play and walk around the exam room. Assess the willingness of the child to be separated from the parent. Most children are willing to undress but leave the underpants on until conducting the genital exam. Allow child to touch and play with equipment. Give simple explanations about the assessment procedures and offer choice when possible. Use distraction to gain cooperation, such as asking the child to count, name colors, or talk about a favorite activity. Give positive feedback when the child cooperates. Willingly cooperate and want to be helpful, so have them sit on the exam table. Anticipate the development of modesty and offer patient own to cover the underwear. Let older school-age child determine if the exam will be conducted in privacy or with parent or siblings present. Demonstrate how the instrument are used and let he child handle them if they wish. During exam, explain what you are doing and why. Offer as many choices as possible to help the child feel empowered. The exam is a good time to teach the child about how the body works, such as letÝng the child listen to heart and breath sounds. Protect modesty by providing a private place to undress and put on the patient gown, and then during the exam by covering the part so the body not being assessed. Perform without parent or siblings unless the adolescent specifically requests parent’s presence but provide a chaperone (preferably the same genre as the client) when the parent or accompanying adult is not present. examine ears, eyes, and mouth last as they often cause anxiety.  Some prefer to have head, eyes, ears, and mouth examined first while others will prefer to postpone to the end.  Head-to-toe sequence can be used.  Head-to-toe sequence as used for adults. Only a few questions regarding the actual physical assessment will be reviewed here. These questions will highlight assessments you will typically not perform on an adult. You can review information in the rest of the chapter on your own.  Palpation of the Skull o When does the posterior fontanelle normally close? 2 to 3 months of age o When does the anterior fontanelle normally close? 12 to 18 months of age  Hearing Assessment o What are the indicators of hearing loss in an infant?  No startle reaction to loud noises.  Does not turn toward sounds by 4 months of age. o   Babbles as a young infant but does not keep babbling or develop speech sounds after 6 months of age. What are the indicators of hearing loss in a toddler?  No speech by 2 years of age.  Inability to follow age-appropriate directions, such as “Bring me the block.”  Speech sounds are not distinct at appropriate ages. Infant Reflexes (utilize your ATI Review book: page 10) – For each infant reflex, describe the test, the expected findings, and the expected age in the table below: Infant Reflex Sucking and Rooting reflexes Palmar grasp Reflex test and Expected Findings Test: Elicited by stroking an infant’s cheek or the edge of an infant’s mouth. . Expected Findings: The infant turns head toward the side that is touched and starts to suck Test: Elicited by placing an object in an infant’s palm. Plantar grasp Expected Findings: The infant grasps the object. Test: Elicited by touching the sole of an infant’s food. Moro reflex Startle reflex Tonic neck reflex (Fencer position) Babinski reflex Stepping  Expected Findings: The infant’s toes curl downward. Test: Elicited by allowing the head and trunk of an infant in a semi-sitÝng position to fall backward to an angle of at least 300. Expected Findings: The infant’s arms and legs symmetrically extend, then abduct while fingers spread to from C shape. Test: Elicited by clapping hands or by a loud noise. Expected Findings: the newborn abducts arms at the elbows, and the hands remain clenched. Test: Elicited by turning an infant’s head to one side. Expected Findings: the infant extends the arm and leg on that side an flexes the arm and leg on the opposite side. Test: Elicited by stroking the outer edge of the sole of an infant’s foot up toward the toes. Expected Findings: The infant’s toes fan upward and out. Test: elicited by holding an infant upright with his feet touching a flat surface. Expected Findings: The infant makes stepping movements. Expected Age Birth to 4 months Birth to 3 months Birth to 8 months Birth to 4 months Birth to 4 months Birth to 3 to 4 months Birth to 1 year Birth to 4 weeks Using your ATI reference book, pages 15-16, answer the following questions regarding normal Dentition for an infant: o When do the first teeth typically erupt? 6 to 10 months of age o How many teeth do they typically have at the end of 1 year? 6 to 8 o What can be used for teething pain?  Frozen teething rings  An ice cube wrapped in a wash cloth  OTC teething gels o What are the considerations for use of medications such as acetaminophen or ibuprofen for teething? o o o   Appropriate if irritability interferes with sleeping and feeding.  Should not be used for more than 3 days. At what age is it considered safe to use ibuprofen? Over 6 months What is the proper way to clean infants’ teeth? Cool, wet washcloths Why should bottles not be given to infants when they are falling asleep? Prolonged exposure to milk or juice can cause early childhood dental carries. Review the tables on page 841 and 844 of your Maternal & Child text for the Gross Motor and Fine Motor Milestones: Average age (in months) 4 6 9 12 18 24 36 Gross Motor Milestones (Table 33.14) Fine Motor Milestones (Table 33-18) If prone, pushes up on elbows Rolls over in both directions Reaches for a toy with one hand Transfers objects between hands, brings objects to mouth Thumb finger grasp to pick up small objects Gets to sitÝng position and sits without support Creeps or crawls Pulls self to standing position Takes a few steps walking alone May walk up steps Climbs on furniture without help Rides tricycle Bangs items together, releases toy without help Uses spoon to feed self Builds tower of four or more blocks  Posture and Spinal Alignment o What is the assessment specifically for the school-age child and adolescent to assess spinal alignment? Assessment for scoliosis, a lateral spine curvature.  What you expect as normal findings and what are abnormal findings?  Normal: no curve should be present when the child bends forward at he waist with head and arms toward the floor. Ribs should stay flat bilaterally. The lumbar concave curve should flatten with forward flexion.  Abnormal: A lateral curve to the spine or a one-sided rib hump is an indication of scoliosis.  Expected language Development (table 33-16): fill in the expected language milestones for each of ages in the table below: Age attained 4 - 6 months 12 months 1 - 2 years 2 - 3 years 3 – 4 years 4 - 5 years Language Milestones Babbles speech like sounds, including p, b., and m Has 1-2 words like mama, dada, bye-bye Increases words each month; two-word combinations (e.g., “Where baby?” and “Want cookie”) Two- to three-word sentences to ask for things or talk about things; large vocabulary; speech understood by family members. Sentences may have four or more words; speech understood by most people. Says most sounds correctly except a few like l, s, r, v, z, ch, sh, th; tells stores and uses same grammar as rest of family.  CHAPTER 39: Nursing Considerations for the Hospitalized Child o Effects of Hospitalization on Children and Their Families  Identify the common stressors for each of the age groups for a hospitalized child and ways to minimize these stressors: Developmental Common Stressors Age  *Separation from parents manifested by Infants separation anxiety  Painful procedures  Immobilization of extremities  Sleep deprivation, sensory overload Ways to Minimize effects of stressors     Toddler       *Separation from parents is the major stressor. Loss of self-control Immobilization Painful, invasive procedures Bodily injury or mutilation Fear of the dark      Preschooler   School-age           Adolescent   Separation anxiety and fear from abandonment Loss of control related to bodily functions Privacy issues Bodily injury or mutualization Painful, invasive procedures Fear of the dark and monsters Loss of control Loss of privacy and control over bodily functions Bodily injury Separation from family and friends Painful, invasive procedures Fear of death Loss of control Fear of altered body image, disfigurement, disability, and death              Encourage parental presence Adhere to infant’s home routine as much as possible. Utilize topical anesthetics or preprocedural sedation as prescribed. Promote a quiet environment and reduce excess stimuli. Encourage parental presence. Allow parents to hold child in their lap for examinations and procedures when possible. Allow choices when possible. Utilize topical anesthetics or preprocedural sedation as prescribed. Explain all procedures using simple developmentally appropriate language. Provide a night-light. Encourage parental presence. Allow choices when possible. Utilize topical anesthetics or preprocedural sedation as prescribed. Explain all procedures. Provide a night-light or flashlight. Encourage parental participation. Allow the child choices when possible. Explain all procedures and offer reassurance. Utilize topical anesthetics or preprocedural sedation as prescribed. Encourage peer interaction via internet, phone calls, and other methods of communication. Include the adolescent in the plan of care. Encourage discussion of fears and   Separation from peer group Loss of privacy and identity    anxieties. Explain all procedures. Ask the adolescent about the desire for parental involvement. Encourage peer interaction. (The following questions related to support before, during, and after a procedure are required on your worksheet that you will submit for a grade). This information begins on page 949 of the Maternal and Child text.  Describe appropriate methods for preparing children for procedures. Identify techniques appropriate for each developmental level (page 951). o Infants:  Explain to parents the procedure, th reason for it, and their role.  Allow parents the option of being present for procedures.  Parents may be able to touch a foot, rub a cheek, and talk soothingly to the infant. o Toddler:  Give explanation just before the procedure, since toddler’s concept of time is limited.  Explain that the child di nothing wrong, and that the procedure is imply necessary. o Preschool child:  Give simple explanations of the procedure.  Basic drawings may be useful.  While providing supervision, allow the child to touch and play with equipment to be used, if possible.  Since any entry into the body is viewed as a threat, state that the child’s body will remain the same, and use adhesive bandages to reassure the child that the body Is intact and parts will not “fall out”. School-age child:  Clear, thorough explanations are helpful.  Use drawing, pictures, books, and contact with equipment.  Teach stress-reduction techniques such as deep breathing and visualization.  Offer a choice of reward after the procedure is completed. Adolescent:  Give clear explanations orally and in writing.  Teach stress-reduction techniques.  Explore fear of certain procedures, such as staple removal or venipuncture. o o  Describe appropriate methods for supporting a child during a procedure. Identify techniques appropriate for each age group (page 941). o Infant:  Nursing staff should immobilize the infant securely and gently. Parents should not be asked to hold the child down.  Perform the procedure quickly. use touch, voice, pacifier, and bottle as distractions. o Toddler: Perform in treatment room. Nursing staff should immobilize the child securely. Give short explanations and directions in appositive manner. Avoid giving choices when one is available. For example, “We are going to do this now” is better than “Is it okay to do this now?”  Allow child to cry or scream. Preschool child:  Perform in treatment room. Nursing staff should immobilize the child securely.  Give short explanations and directions in a positive manner. Encourage control by having he child count to 10 or spell their name.  Allow child to cry. Give positive feedback for cooperation throughout the procedure. School-age child:  Be ready to immobilize the child if needed. Allow child to remain in a position by self if child is able to be still.  Explain throughout the procedure what is happening.  Facilitate use of stress-control techniques.  Praise cooperative efforts throughout. Adolescent:  Assist adolescent in self-control. Assist with use of stress-control techniques.     o o o  Describe appropriate methods for supporting a child after a procedure is completed. Identify techniques appropriate for each age group (page 941). o Infant: Ask parent to hold, rock, and sing to the infant after the procedure. o Toddler: comfort the child after the procedure. Give the child a choice of their favorite drink, if allowed, or a special sticker. o Preschool child: give positive feedback for cooperation and for getÝng through the procedure. o School-age child: give positive feedback for cooperation and for getÝng through the procedure. Encourage the child to draw afterward to explore the experience. o Adolescent: explain the expected outcome and tell them when results of the test will be completed.  Describe appropriate techniques when giving children IM injections (page 950). o The gluteus maximus muscle (dorsal gluteal site) is not recommended in children because of danger of injury to the sciatic nerve. o The vastus lateralis site is preferred for children. o The deltoid muscle is rarely used in young children except for the small amounts injected in some vaccines. o Amounts to be administered should be limited to no more than 1-2 mL for ventrogluteal and vastus lateralis sites and 0.5 mL for deltoid depending on muscle size. o Z-track technique is often used.  CHAPTER 40: Pain Assessment and Management in Children o What are the misconceptions about pain in children? That children feel less pain than adults. o What is the truth about pain in children? Infants and children of all ages feel pain, just as adults do. o What changes as the child develops, in respect to pain? Their understanding, response to pain, and memory of painful events. o Review each of the pain scales and indicate the suggested age range: (use your Maternal and Child text for the NIPS and your ATI book, page 44, for the other specific age ranges)  Neonatal Infant Pain Scale (NIPS) (page 968 in Maternal and Child text): preterm and full-term newborns up to 6 weeks  Faces, Legs, Activity, Cry, and Consolability (FLACC): infants and young children (2 months to 7 years)  Faces Pain Rating Scale: 3 years through adolescence  Oucher Scale: 3 to 13 years  Numeric Pain Scale: 5 years and older  Non-communicating children’s pain checklist: 3 years and older o What Clinical Manifestations will you see with each age group? (there is a good summary in the ATI book, page 43)  Young Infant:  loud cry  rigid body or thrashing  local reflex withdrawal from pain stimulus  expressions of pain (eyes tightly closed, mouth open in a squarish shape, eyebrows lowered and drawn together)  lack of association between stimulus and pain.  Older Infant:  loud cry  deliberate withdrawal from pain  facial expression of pain  Toddler:  loud cry or screaming  verbal expressions of pain  thrashing of extremities  attempt to push away or avoid stimulus  noncooperation  clinging to a significant person,  behaviors occur in anticipation of painful stimulus  requests physical comfort  School-age child:  stalling behavior  muscular rigidity   any behaviors of the toddler, but less intense in the anticipatory phase and more intense with painful stimulus Adolescent:  More verbal expressions of pain with less protests  Muscle tension with body control o List the distraction activities that can be helpful for each of the age groups (page 979: Growth and Development Distraction Activities)  Infants: holding, rocking, pacifier, mobiles, music, soft toys, massage  Toddlers: massage, pinwheels, stories, bubbles, touch, holding, rocking, music  Preschoolers: puzzles, action figures and other toys, being a superhero, kaleidoscopes, books, videos  School-age children: rhythmic breathing, muscle relaxation, guided imagery, talking about pleasant experiences, playing games, watching a video, video games  Adolescents: rhythmic breathing, muscle relaxation, guided imagery, having visitors, video games, watching videos, listening to CD player or iPod o The ATI book also lists some nonpharmacological measures on page 45. Review and/or list those here: Distraction Relaxation Guided Imagery Positive self-talk Behavioral contracting Containment Nonnutritive sucking Kangaroo care Complementary & alternative medicine o                      Use play, radio, a computer game, or a movie. Tell jokes or a story to the child. Hold or rock the infant or young child. Assist older children into a comfortable position. Assist with breathing techniques. Assist the child in an imaginary experience. Have the child describe the details. Have the child say positive things during a procedure or painful episode. Use stickers or tokens as rewards. Give time limits for the child to cooperate. Reinforce cooperation with a reward. Swaddle the infant. Place rolled blankets around the child. Maintain proper positioning. Offer pacifier with sucrose before, during, and after painful procedures. Offer nonnutritive sucking during episodes of pain. Skin-to-skin contact between infants and parents. Offer foods, vitamins, or supplements. Offer massage or chiropractic options. Review energy-based treatments such as magnets. Discuss mind-body techniques such as hypnosis, homeopathy, or naturopathy. Clinical Therapy for pain management (Maternal and Child textbook)    When are NSAIDs and acetaminophen used for pain relief? Effective for the relief of mild to moderate pain and chronic pain. When are opioids commonly used? For severe pain, such as after surgery or a severe injury.  Which routes for children are preferred and why? Oral and IV routes because the IM and subcutaneous routes cause pain and stress at the time of administration.  What is an ‘equianalgesic dose’? the amount of drug needed to produce the same analgesic effect regardless of the route used.  Why is meperidine rarely prescribed for children? Because of adverse effects on the CNS, including seizures, agitation, and depressed mood.  What is the Safety Alert (Black Box Warning) regarding codeine? The FDA issued a boxed warning that contraindicates the use of codeine after tonsillectomy or adenoidectomy.  What ages is sucrose solution used for? preterm and term newborns up to 1 month of age. Additional questions from ATI, page 44:  To manage pain that is expected to last for an extended period of time, is it suggested to give medications only PRN or routinely? routinely  Which opioids are commonly used for children? morphine sulfate, oxycodone, and fentanyl  What is the advantage to combining a nonopioid and an opioid medication to treat pain? it treats pain peripherally and centrally and offers greater analgesia with fewer adverse effects (respiratory depression, constipation, and nausea)  Review and/or list the Nursing Considerations for the different routes and medications given for those route (page 45 of ATI) in the table below: Route Oral Nursing Considerations  Route is preferred due to convenience, cost, and ability to maintain steady blood levels.  Takes 1-2 hours to reach peak analgesic effects. Oral medications are not suited for children experiencing pain that requires rapid relief or pain that is fluctuating in nature. Topical/transdermal Lidocaine and  prilocaine       Fentanyl      Available in a cream or gel. Used for any procedure in which the skin will be punctured (IV insertion, biopsy) 60 min prior to a superficial puncture and 2.5 hr prior to a deep puncture. Place an occlusive dressing over the cream after application. Prior to procedure, remove the dressing and clean the skin. Indication of an adequate response is reddened or blanched skin. Demonstrate to the child that the skin is not sensitive by tapping or scratching lightly. Instruct parents to apply medication at home prior to the procedure. Use for children older than 12 years of age. Use to provide continuous pain control. Onset of 12 to 24 hours and a duration of 72 hours. Use an immediate-release opioid for breakthrough pain. Treat respiratory depression with naloxone. Intravenous  Bolus  PCA  Familycontrolled analgesia         Rapid pain control in approximately 5 min. Use for medications such as morphine, hydromorphone. Continuous: provides steady blood levels. Self-administration of pain medication Can be basal, bolus, or combination Has lockouts to prevent overdosing Same concept as PCA Parent or caregiver manages the child’s pain Family-Centered Nursing Care (you will find answers to the next group of questions in your ATI Content Mastery Series: RN Nursing Care of Children book, chapter 1)   Positive family relationships are characterized by: parent-child interactions that show mutual warmth and respect What are the Components of Care included in Family-Centered Care? o Agreed-upon partnerships between families of children, nurses, and providers, in which the families and children benefit. o Respecting cultural diversity and incorporating cultural views in the plan of care. o Understanding growth and developmental needs of children and their families. o Treating children and their families as clients. o Working with all types of families. o Collaborating with families regarding hospitalization, home, and community resources. o Allowing families to serve as experts regarding their children’s health conditions, usual behaviors in different situations, and routine needs.  Review the Characteristics of Healthy Families on page 3.  What are the 2 Nursing Considerations when the nurse is performing a comprehensive family assessment? o Nurses should pay close attention when family members state that a child “isn’t acting right” or has other concerns. o Children’s opinions should be considered when providing care.  Briefly describe each of the Family Theories: o Family systems: the family is viewed as a whole system, instead of the individual members.  A change to one member affects the entire system.  The system can both initiate and react to change.  Too much and too little change can lead to dysfunction. o Family Stress: describes stress as inevitable  Stressors can be expected or unexpected.  Explains the reaction of a family to stressful events. o  Describe each of the Parenting Styles listed in the table and give an example of each: Dictatorial or Authoritarian Permissive Democratic or Authoritative Passive  Description Parents try to control the child’s behaviors and atÝtudes through unquestioned rules and expectations. Parents exert little or no control over the child’s behaviors and consult the child when making decisions. Parents direct the child’s behavior by setÝng rule and explaining the reason for each rule setÝng. Parents negatively reinforce deviations from the rules. Parents are uninvolved, indifferent, and emotionally removed. Example The child is never allowed to watch television on school nights. The child assists with deciding whether he will watch television. The child can watch television for 1 hour on school nights after completing all of his homework and chores. The privilege is taken away but later reinstated based on new guidelines. The child may watch television whenever he wants. What guidelines should parents be encouraged to use for promoting acceptable behavior in children? o Set clear and realistic limits and expectations based on the developmental level of the child. o Validate the child’s feelings and offer sympathetic explanations. o Provide role modeling and reinforcement for appropriate behavior. o   Offers guidance for adapting to stress. Developmental: views families as small groups that interact with the larger social system  Emphasizes similarities and consistencies in how families develop and change.  Uses Duvall’s family life cycle stages to describe the changes a family goes through over time.  How the family functions in one stage ha a direct effect on how the family will function in the next stage. Focus on the child’s behavior when disciplining the child. What are the components of a Family Assessment? o History o Structure o Developmental tasks o Family characteristics o Family stressors o Environment o Family support system