# Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for pneumonia. His mother must care for his newborn sister at home and can visit him only for about an hour each evening. According to Erikson and Piaget, which pair of stages applies to this boy at his present age?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for pneumonia. His mother must care for his newborn sister at home and can visit him only for about an hour each evening.

According to Erikson and Piaget, which pair of stages applies to this boy at his present age?

## 보기

1. Autonomy vs. shame and doubt; preoperational
2. Trust vs. mistrust; sensorimotor
3. Autonomy vs. shame and doubt; sensorimotor **✔ 정답**
4. Trust vs. mistrust; preoperational

**정답: 3**

## 해설

Erikson places autonomy vs. shame and doubt at 1 to 3 years, after trust vs. mistrust ends at about 1 year. Piaget's sensorimotor stage lasts from birth to about 2 years; at 20 months the boy is in its last substage (mental representation, 18 to 24 months), and the preoperational stage begins at about 2 years. A toddler label alone does not make a child preoperational.

## 심화 해설

Developmental stage at 20 months

A 20-month-old boy sits in the overlap between two classic frameworks. Erikson’s psychosocial crisis of autonomy vs. shame and doubt spans roughly 1 to 3 years, while Piaget’s sensorimotor stage continues from birth until about 2 years. At 20 months, the child is therefore in autonomy vs. shame and doubt paired with the sensorimotor stage, not yet preoperational.

Why the preoperational stage is premature

Piaget’s preoperational stage begins around 2 years and is marked by symbolic thought, language expansion, and pretend play. At 20 months, the child is in the final sensorimotor substage—mental representation (18 to 24 months)—where he can hold images in mind and solve simple problems through internal trial and error, but still relies heavily on direct sensory and motor experience. Watch out! Calling a child a “toddler” does not automatically place him in the preoperational stage. The transition depends on age and the emergence of symbolic function, not on mobility or language milestones alone.

Erikson’s shift from trust to autonomy

Erikson’s first stage, trust vs. mistrust, closes around 1 year. By 20 months, the toddler’s central task is autonomy vs. shame and doubt. He wants to walk, feed himself, and choose objects, and he needs caregivers who allow safe exploration while setting consistent limits. In this hospital scenario, separation from the mother and restricted mobility can threaten that emerging autonomy, so nursing care should preserve as much choice and independence as the pneumonia treatment allows.

Clinical application for pediatric nursing

Understanding the correct stage pair guides the nurse’s interventions. A 20-month-old with pneumonia benefits from opportunities to manipulate safe objects, look at pictures, and make simple choices—activities that respect both sensorimotor learning and the drive for autonomy. Restraining a toddler or doing everything for him can intensify shame and doubt, which may worsen distress during hospitalization. The mother’s brief evening visits should be protected and structured so the child can reconnect through familiar routines, because consistent, predictable care supports the autonomy task even when the primary caregiver is absent.

Stage comparison at a glance

| Age | Erikson stage | Piaget stage | Key feature |
| --- | --- | --- | --- |
| 0 to 1 year | Trust vs. mistrust | Sensorimotor | Attachment, object permanence emerging |
| 1 to 2 years | Autonomy vs. shame and doubt | Sensorimotor (final substage 18–24 months) | Self-feeding, walking, mental representation |
| 2 to 3 years | Autonomy vs. shame and doubt | Preoperational | Symbolic play, language growth, egocentrism |

The 20-month mark falls squarely in the second row of this table. The correct pairing is autonomy vs. shame and doubt with the sensorimotor stage, which rules out both trust-based options and any preoperational classification.

## 임상 시나리오

Developmental Staging at 20 MonthsErikson and Piaget in the Hospitalized Toddler
At 20 months, Erikson's stage is autonomy vs. shame and doubt, which spans 1 to 3 years. Piaget's stage is sensorimotor, specifically the final substage of mental representation from 18 to 24 months.

The preoperational stage does not begin until about 2 years. A toddler label alone does not mean the child is preoperational; the transition depends on age and emerging symbolic function.

CautionHospitalization with limited maternal visits threatens the toddler's emerging autonomy. Provide safe choices and opportunities for self-feeding and mobility within safety limits to support this developmental task.

## 핵심 개념

- **Autonomy vs. shame and doubt** — Erikson's psychosocial stage from about 1 to 3 years, when toddlers develop independence through safe exploration and consistent limits.
- **Sensorimotor stage** — Piaget's first cognitive stage from birth to about 2 years, ending with the mental representation substage at 18 to 24 months.
- **Preoperational stage** — Piaget's stage beginning around 2 years, marked by symbolic thought, language expansion, and pretend play.
- **Trust vs. mistrust** — Erikson's first psychosocial stage from birth to about 1 year, focused on developing trust through consistent caregiving.
- **Mental representation** — The final sensorimotor substage from 18 to 24 months, when a child can hold images in mind and solve simple problems internally.

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