Peds, part 1: Principles - Types of Families, Family Theory, Parenting Styles, Piaget and Erikson

Hi, I'm Meris with Level Up RN, and in this video, we're going to get started with the principals section of the pediatric nursing deck. I'm going to be following along using our pediatric flashcards, of course. These are available on our website, leveluprn.com, if you want to grab a set for yourself. And if you already have a set, I would invite you to follow along with me. Okay, let's get started. So, first up, we're going to be talking about different types of families. So this is important for you to understand so that you can understand what a family is. Now, remember that a family is whatever the family says, it is, right? So it's not up to us to make a determination about who is considered a part of a family, but these are some general concepts of what families might look like. So we have the nuclear family. A nuclear family is the household consisting of two parents and their children. So this is kind of what I think of, the 1950s white picket fence, right? This is that the two parents, their children. That is the nuclear family. It kind of helps me remember because I think of nuclear tensions in the '50s, things like that. So that's what a nuclear family is.

Now, a blended family is going to be including the parents with their biological children from previous marriages. So this one I think of as the Brady Bunch, right? We have two parents who are together, but they may have biological children of their own together, but they may also be bringing children from previous marriages or relationships, right? So Brady Bunch is our blended family. Now, an extended family is going to be consisting of the parents and the grandparents being present. So if we have a household where we have parents, children, and grandparents, that is going to be an extended family. A single-parent family, so this is what it sounds like. The head of the household might be widowed, could be divorced, or just unmarried. So this is going to be a single parent and the biological children. And then binuclear family, binuclear meaning two nuclear, so this is going to be a post-divorce family with co-parenting by the mother and the father. So the children are members of two households. So we have a family. Maybe they divorce, and now, we have a mom in one house, a dad in the other house, and the parents go between the two households. That is a binuclear family.

Okay. Moving on, we're going to be talking about family theories. The two main ones that I want to cover today are family systems theory and family stress theory. Now, family systems theory means that the family is an interdependent unit. They all depend on one another, right? So this means that any change or stressor that is experienced by one member of the family affects the entire family unit. So if dad is experiencing a stressor at work or if the child is experiencing a stressor at school, then the whole family is affected by this change or this stress. That's family systems theory. Family stress theory states that the family's response and coping strategies to routine and unexpected stressors are the focus. So how does the family respond to these sorts of changes, these sorts of stressors, and what kind of coping strategies do they have as a unit? That is family stress theory.

Now, moving on, we're going to talk about types of parenting, and I would say that this is a pretty important concept because it's important for you to understand what type of parenting a child may be experiencing, and that can help you to understand what types of rules they're exposed to, how their behavior is addressed or not addressed, and just kind of what is the dynamic at home. So we have four big ones here, and let's start with authoritarian. Authoritarian is going to be the strict type of parenting. This is high control, so lots of rules, lots of control, low warmth. So we don't see a lot of warmth or open, loving sort of parenting going on here. There are inflexible rules. We're very strict. We don't have flexibility in the rules here, and little communication with the child. So this might be the family where, because I said so, end of story, right? There's no communication about why these are the rules or why this is the expectation. Now, we do have a cool chicken hint here on this card: authoritarian is terrible, right? So this is thought to be one of the types of parenting that is not ideal. It is high control, low warmth.

Now, moving on to authoritative, so this is not one of our cool chickens, but I think of authoritative is give and take, so if that helps you use it. But this is moderate to high control, but high warmth, right? So here, we have flexible rules, so as the situation changes, the rules change, and open communication with the child. So, "Hey, I know that this may seem like a really strange rule. The reason we have this rule is to keep you safe in the following ways, right?" Or, "Because of your behavior last week, we're going to be instituting a new rule where blah-blah-blah." We're communicating with the child. We're explaining the rationale behind these rules and behaviors. We also have a lot of warmth, a lot of open communication and love, right? This is the ideal parenting style, authoritative give and take, right? So that is the ideal parenting style. And we have two more. We have permissive. Permissive parents are going to be indulgent. There is low control, but high warmth, right? So there's very few constraints, very few rules. But there's lots of, "I love you so much. You're so great. I think the world of you." But there's not a lot of control. This may be the parents who want to be seen as the friends, right? "I want my mom to be my best friend." They may have a permissive parenting style. And lastly, we have the indifferent or passive parenting style. In this case, we are thinking more of a neglectful environment. We have low control and low warmth. So there are very little rules, but we are also showing very little positive feedback or love to this child. There are no limits, and there is a lack of affection. So I hope all of those makes sense because if you can get a little bit tricky there, but always think about it in terms of control and warmth. Each one has a different kind of mix of those things.

Okay, now everyone's favorite stuff. We're going to be talking about Piaget's theory of cognitive development. As you can see, we have a really nice chart here. We did the hard work for you. We've separated it by the stage, the age range, and the key characteristics. I would greatly encourage you to review this chart if you are struggling with Piaget's because we really put it all here in black and white for you, and a little bit of bold, red text. Now, big ones that I want to point out to you would be sensorimotor, sensorimotor meaning I am exploring the world through my senses and my touch, right? This is going to be from birth to age two. This is the point in time where children develop object permanence. So that is, when I move the pen behind the piece of paper, do you still know that it exists? That is object permanence. This is going to be a really important time because the child is experiencing the world with their senses. So they're going to be touching everything. They're also going to be mouthing things. This is where you see children putting toys in their mouths, licking things, right? So if you've ever seen a small child, they're just putting everything in their mouths, which puts them at risk for choking, right? Very big risk for choking in that birth to age two range based on the Piaget's theory. Pre-operational is going to be ages two to seven. This is where we might have magical thinking or animism, where we give-- we treat inanimate objects as though they are alive. Maybe we're treating our stuffed animals like they have thoughts and feelings and voices.

Concrete operational is going to be from 7 to 11 years old. This is where we're starting to develop that logical thought and we're having a more accurate understanding of cause and effect. Conservatism is an important concept here in this stage, which is that, when something changes its form, the amount does not change, right? So if I have ice and that ice melts into water, it's still the same amount of that matter. It has just changed its form. Now, lastly, we have-- from age 11 into adulthood, we have formal operational. So this is where we have the ability to have abstract thought. This is something that is very difficult for children to grasp until they reach that age of about 11 years old. Okay, moving on, our last topic today is going to be Erikson's theory of psychosocial development. I know everyone just loves Piaget and Erikson. Very important stuff here, though. Again, we made you this super nice chart. It's all broken down by age, the age range, the psychosocial crisis, all of the things that you need to know. So, again, if you're struggling with Erikson, look at this card.

Okay, so infancy, that's birth to one year. The biggest thing here is trust versus mistrust. When I cry, does somebody come? When I have a need, is it addressed? That's a very important thing for a child to understand and develop that trust in their parent or caregiver. Toddlers age one to three years are going to have autonomy versus shame and doubt. So this is where they may be trying to do things on their own. Are they allowed to explore the world and do those things on their own, or are they told, "No, no, no, don't do that. You're too little for that," right? That's going to be important. We want to allow for choices and autonomy and independent thinking. The preschoolers, three to six years, they are going to have initiative versus guilt. So this is going to be where we are interacting socially, and we may be initiating play activities. So, "Do my friends want to play with me, or do they not?" Right? That's going to be a big deal there. So we want to give these opportunities for play and creative expression.

Now, school age, 6 to 12, this is a really big one too. This is going to be industry versus inferiority. These kids love school, right? They love crafts. They love learning. This is where we're learning new skills and gaining a sense of pride and accomplishment in the things that we have done, created, or learned. So I don't know if you remember that age you might have really loved school. That would be the appropriate Erikson stage for you at that age, which then changes when you hit adolescence. But from adolescence, ages 12 to 18 years, here, we have identity versus role confusion. So this is where we're starting to get that sense of who am I, right? How do I fit into society? This is where we're going to start to identify with our friend group and see how we don't identify with other groups. We want to have that sense of inclusion, and this is why adolescents are so easily susceptible to peer pressure. Okay. I hope that review was helpful for you. I'm going to give you some quiz questions to test your knowledge of key facts, so stay tuned.

Okay, I hope you were paying attention because I've got some good questions for you today. How would you describe a family where a child's parents are divorced, but they co-parent the child from two different households? What term is used to describe that type of a family? All right. Next up, a child describes to the nurse that, in their household, there are no real rules, but they describe their parents as being warm and loving. What type of parenting does the nurse believe this to be? Okay, third question. What is a key risk to children ages zero to two based on Piaget's theory of cognitive development? Hope you were paying attention. This is an important one. Okay. Lastly, the nurse is caring for a child who says that they feel sad to miss school because they love learning. In which age range might the child be, and what is the name of the Erikson's stage they are in? So two questions there. What age range, and what is the name of the stage? Let me know how you did. I can't wait to hear. Thanks so much, and happy studying.

True story. My son choked on a hot dog when he was 18 months old. We did not give our son a hot dog when he was 18 months old. I want to be very clear about that. But we had given my daughter a hot dog; cut up, but a hot dog. She was several years older, and a piece of it had fallen off of her plate and rolled underneath the TV stand. And the next day, my son, who was eight months old, was crawling around on the floor, and what does he do? He sees this thing, picks it up, and puts it in his mouth. Again, he's exploring the world, using his senses, sensorimotor. He's eight months old, exact right age range. Sure enough, he choked on that and nearly-- I mean, he could have died. Luckily, I happened to be home, and I was able to pick him up. I did CPR-- not CPR, but I did the choking resuscitation for him, and it wasn't coming out, and I was panicking a little bit and had my husband call 911. And I kept doing the back slaps and chest thrusts because I knew you did that until they go unresponsive. And I think it was like the fifth round; it finally came out. I mean, he was blue. It finally came flying out of him, and he took a great, deep breath, and then he just immediately started crying, but I was so relieved. And that's when I became really hypervigilant about looking under things because you have to think about the fact that you perceive the world from a different physical level than the child does. And so, at the end of the night, when we were cleaning up, I would literally get down on my hands and knees and crawl around to look under things like the TV stand, the table, the couch, to see if there was anything that I wasn't seeing from my big adult perspective that would pose a risk to my son. So very scary, very legitimate risk for choking in that age.