Peds, part 1: Principles - Types of Families, Family Theory, Parenting Styles, Piaget and Erikson
by Meris Shuwarger BSN, RN, CEN, TCRN December 14, 2021 Updated: December 07, 2022 7 min read
In this article, we start exploring the principal section of the pediatric nursing deck, beginning with a discussion of different types of families.
This series follows along with our Pediatric Nursing Flashcards, which are intended to help nurses and nursing students learn and retain information about caring for pediatric patients. The flashcards are a clear, complete study tool and a helpful reference for practicing RNs, PNs, and other medical professionals.
Types of families
It is important to remember that a family is whatever the family says it is. It is not up to nurses, providers, or anyone else to make a determination about who is considered a part of a family.
What follows are some general concepts of what families might look like.
A nuclear family is a household consisting of two parents and their children.
A blended family includes the parents and their biological children from previous marriages. In this family, the two parents may have biological children of their own together, and they may also be bringing children from a previous marriage or relationship.
An extended family is a household with parents and grandparents present.
A single-parent family is when the head of the household with children is widowed, divorced, or unmarried.
A binuclear family, one with two nucleuses, is a post-divorce family with co-parenting by the mother and the father. In a binuclear family, the children are members of two households.
Family theories describe the dynamic interactions among family members, including changes in patterns of parent-child relationships, and the characteristics of family interactions that may enhance or disrupt development. These theories include family systems theory, family stress theory, and family development theory.
Family systems theory
Family systems theory pertains to a family that acts as an interdependent unit. That is, they all depend on one another, and any change or stressor that is experienced by one member of the family affects the entire family unit. For example, if the father 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.
Family stress theory
Family stress theory focuses on a family’s response and coping strategies to routine and unexpected stressors. In other words, how does the family respond to changes or stressors, and what kind of coping strategies do they have as a unit?
Family development theory
Family development theory defines eight stages of a family’s life cycle that include predictable steps families experience over time, that is, the systematic and patterned changes experienced by families as they live their lives.
Types of parenting
Understanding the different types of parenting is important when it comes to understanding what a child may be experiencing at home — for example, what types of rules they’re exposed to or how their behavior is addressed or not addressed — which can illuminate the dynamic the family members may experience at home.
The four most common types of parenting are authoritarian, authoritative, permissive, and indifferent/passive.
Authoritarian parenting is a strict type of parenting with high control, which means there are lots of rules (often inflexible ones), and there is little communication about the reason behind them — there is little communication with the child at all. Authoritarian parenting is devoid of warmth, and there is a lack of openness and loving from parent to child. It is not an ideal type of parenting.
Authoritarian = “Tarrible” parenting style.
The hallmark of authoritative parenting is a sense of give and take. It is a moderate-high control parenting style, characterized by high warmth, flexible rules, and open communication with the child.
For example, as a situation changes, the rules may change to accommodate these changes. Authoritative parents will tend to explain the reason or rationale behind their rules. And when they communicate to the child, they do so with warmth and love. This is considered the ideal parenting style.
Permissive parents are considered to be indulgent. This style of parenting exhibits low control and high warmth. There are few constraints on the child, few rules, and an overriding sense that the parent wishes to be friends with their child, eschewing control through lax permissiveness.
With an indifferent or passive parenting style, there is a neglectful environment. There is low control and low warmth between parent and child, which correlates to few rules but little positive feedback or love to the child — that is, no limits coupled with a lack of affection.
Piaget’s Theory of Cognitive Development
Piaget’s Theory of Cognitive Development is a theory that describes perception and cognition across the human lifespan. It consists of stages describing how children perceive and explore the world before they enter adulthood.
The first stage in Piaget’s theory is the sensorimotor stage, from birth to 2 years old. During the sensorimotor stage, humans learn through their senses and movement.
This is the stage where we develop object permanence (something continues to exist, even when it is out of sight). When children are born, they do not have object permanence, which means when something disappears from their sight, it ceases to exist to them.
The second stage in Piaget’s theory is the preoperational stage, which occurs between the ages of 2 and 7. During this stage, children engage in symbolic thought, or “magical thinking,” that is, children think that magic is real, that their thoughts or wishes cause events to occur, and that things can happen in the child’s environment because of magic.
The preoperational stage also features animism, which means that we attribute human-like characteristics to inanimate objects. This could be anything from a stuffed animal to a decoration in the house. If a child has an imaginary friend, that is also an example of animism.
Concrete operational stage
The third stage in Piaget’s theory is the concrete operational stage, which occurs from ages 7 through 11. Here, children engage in logical thought and have a more accurate understanding of cause and effect.
The concept of conservatism — that matter does not change when its form is altered — starts to be understood in the concrete operational stage. For example, if you have 100ml of liquid and pour it into a short, fat glass, then pour it into a tall, skinny glass, a child who had not mastered conservatism would think that those were different amounts of liquid. An understanding of conservatism is evident when the child knows the volume of liquid didn't change.
Formal operational stage
The fourth and final stage in Piaget’s theory is the formal operational stage, which begins at age 11 and continues through adulthood. This is where children develop the ability to engage in abstract thinking, deductive reasoning, and logic-based problem solving. Abstract thinking is the ability to think of concepts (e.g., “dogs” in general as opposed to the child’s actual, specific pet dog) and abstract ideas (things that exist but you can’t touch, for example, love, freedom, or poverty).
Erikson’s Stages of Psychosocial Development
Erikson’s Stages of Psychosocial Development is the name for a theory that describes key stages in human development and the “psychosocial crisis” encountered during each stage. A psychosocial crisis in this context is a conflict that can involve mental health and the social environment. For each stage of human development, Erikson posited that people have a main conflict that they are concerned with, whether they are aware of it or not.
For a more in-depth examination of nursing and treating patients with mental health issues, you can watch our Psychiatric Mental Health Nursing video and article series, which follows along with our Psychiatric Mental Health Nursing Flashcards.
Infancy: Trust vs. Mistrust
The first stage of Erikson’s theory is infancy. From birth to 1 year of age, we are learning what we can trust and what we cannot. For example, a baby cries, does someone attend to its needs?
Toddler: Autonomy vs. Shame and Doubt
The second stage of Erikson’s theory is the toddler stage. From 1 to 3 years of age, we are learning our own autonomy in the world, and that we can act on the world around us. Additionally, we can internalize shame and doubt if our autonomy is suppressed. For example, if a three-year-old wants to dress herself, she is exhibiting autonomy, but if she were prevented from doing so by a strict parent or authority figure, she might learn to doubt her abilities.
Preschooler: Initiative vs. Guilt
The third stage of Erikson’s theory is the preschooler stage. From 3 to 6 years of age, children take initiative in the world and assert themselves through their social and physical interactions on the environment. However, if a child is prevented from doing so, they may internalize guilt.
School Age: Industry vs. Inferiority
The fourth stage of Erikson’s theory is when a child is school age. From 6 to 12 years of age, we become more part of “industry” by attending school, making crafts, learning, participating in sports, and competing with peers. However, this can also have the effect of stack ranking us against our peers, which can lead to the development of an inferiority complex.
If a child was hospitalized during this time, they are away from their peers and the learning environment. Nurses can remember this Erikson stage (and its related needs) and give the child some crafts to do, or ensure they get their homework and other projects sent to them from their school.
Adolescence: Identity vs. Role Confusion
The fifth stage of Erikson’s theory is adolescence. Erikson posited that from 12 to 18 years of age, we are forming our own identity in the world with our beliefs, actions, values, and choices (e.g., what clothes to wear). However, at this time we may also become confused about our place in the world. Teens may ask themselves, “What do I want to do with my life?”
Erikson’s theory continues beyond childhood with stages for young adulthood, adulthood, and older age, each with its unique psychosocial development challenges.
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.
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