Health Promotion and Maintenance

Trust versus mistrust. Consistent, prompt, responsive caregiving (feeding, comforting, holding) builds trust; inconsistent care or neglect fosters mistrust. The nurse encourages parents to respond promptly to the infant's cries and to keep caregivers consistent.

Autonomy versus shame and doubt. The toddler asserts independence through self-feeding, dressing, and toilet training; harsh overcontrol or ridicule produces shame and doubt. Allowing safe self-care attempts supports autonomy.

Initiative versus guilt. The preschooler plans and initiates activities and imaginative play; excessive criticism or punishment of curiosity produces guilt. Offering opportunities for pretend and medical play supports initiative.

Industry versus inferiority. The child gains competence through schoolwork, hobbies, and achievement and compares self with peers; repeated failure or lack of recognition breeds inferiority. Letting the child help with care and completing tasks supports industry.

Identity versus role confusion. The adolescent forms a personal identity, with the peer group as the major influence; failure leads to role confusion. Respecting privacy and letting the teen make decisions about care support identity formation.

Object permanence: understanding that objects continue to exist when out of sight, which develops at about 8 to 9 months. Learning occurs through senses and motor activity; games like peekaboo reflect this development, and its onset explains why separation anxiety begins.