Part of the unique challenge of pediatrics as a branch of medicine is having to accommodate the personal needs of different age groups of children. To help them meet this challenge, pediatricians can draw upon theories of children’s development created by such scholars as Erik Erikson, Lawrence Kohlberg, and Jean Piaget. Although those classical models and the very notion of developmental stages have come under some criticism in recent years, their relevance for everyone who works with children remains apparent (Lourenço, 2016). The enduring importance of the concept of developmental stages to pediatrics is especially obvious when it comes to the critical subject of physical assessment.
When examining school-aged children, it is crucial to keep both the physical and the psychological peculiarities of their age – between 5 and 12 years old – in mind. Unlike younger children, the members of this age category can undress by themselves and should be examined from head to toe, like adults (Jarvis, 2018). They are generally more gregarious and curious than preschoolers and tend to be more cooperative than teenagers (Cox, 2019). As a result, this can be an ideal opportunity to teach children about their health and their bodies. Answering questions about various procedures and equipment is a highly recommended strategy, though it is essential to keep in mind different levels of understanding among younger and older schoolchildren (Jarvis, 2018). Pediatricians should remember that while younger school-aged children prefer to have their family around during assessment, this may not be the case for older ones, for whom privacy is a greater concern. Physically, this is the time in which children begin to assume adult proportions, and, for older categories, hit a growth spurt, which makes a doctor’s guidance and positive feedback all the more valuable.
The value of a developmental approach can be further demonstrated in the example of John, a 9-year-old boy who is in the 4th grade. According to Jarvis (2018), by this age, John would already have “some understanding of his body” and would be “interested to learn more (p. 151).” On the other hand, he also has a concept of modesty, which needs to be respected during the examination. Compared to when he was younger, his life would revolve less around his family and more around school life, including both classes and friendships, as well as extracurricular activities (Cox, 2019). Like most children at this stage of development, he is starting to acquire a sense of empathy and morality, while also becoming more independent and rebellious.
A developmental approach allows the doctor to assess a child’s development in greater depth by drawing upon the theories of Erikson, Kohlberg, and Piaget, which shine a unique light on the development of children’s psyche (Lourenço, 2016). One particular advantage they offer is a higher degree of granularity, breaking down categories like school-age children into smaller sub-groups based on their way of thinking. To give just one example, John would fall within what Piaget defined as the concrete operations stage, during which he would begin to develop logic, but not yet master abstract thinking. The takeaway for a pediatrician would be to engage John’s flowering imagination while keeping explanations grounded and tied to tangible objects. This stage’s emerging morality of cooperation, based on empathy, means he should take well to voluntary collaboration and scrupulous fair treatment during the examination. Potential findings when using an approach informed by Piaget can include not only those related to standard physical metrics but also possible abnormalities in cognitive development and deficiencies in motor skills.
The idea of discrete developmental stages is self-evident to anyone who worked with children, though it does not have to be as rigid as its critics allege. Developmental assessment is an invaluable asset to pediatricians working with school-aged children in particular, given that those children’s psyche is halfway towards adulthood. Therefore, childcare professionals stand to benefit from studying developmental theories that combine philosophical and scientific insights with empirical observations of children’s thinking and behavior at different ages.
References
Cox, C. L. (Ed.). (2019). Physical assessment for nurses and healthcare professionals. John Wiley & Sons.
Jarvis, C. (2018). Physical examination and health assessment-Canadian e-book. Elsevier Health Sciences.
Lourenço, O. M. (2016). Developmental stages, Piagetian stages in particular: A critical review. New Ideas in Psychology, 40, 123-137.