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1. Describe briefly the Sensory motor stage.
The sensorimotor stage is the first of the four stages in Piaget developmental theory. Piaget’s theory of cognitive development is a theory about the nature and development of human intelligence specially for newborn babies. It was created by the Swiss developmental psychologist Jean Piaget (1896–1980). The Piaget’s theory is mainly known as a developmental stage theory.
Piaget’s theory of cognitive or intellectual development divided the childhood in to four major stages.
1. Sensorimotor stage (Birth to 2 years of age) – Children learn about physical object; get experience with physical activities by coordinating sensory.
2. Preoperational stage (2 to 7 years of age) – Children learn about symbols in language, dreams and fantasies.
3. Concrete operational stage (7 to 11 of age) – Children learn about relationship and reasoning thereof.
4. Formal operational stage (11 years of age through adulthood) – Children master logical thinking.

Sensorimotor stage:
The sensorimotor period refers to the earliest stage (birth to 2 years) in Jean Piaget’s theory. During the sensorimotor stage infants are only aware of what are the objectives in front of them. They focus on what they see, what they are doing, physical interaction with their immediate environment. Because they don’t know how thinks react with each other’s, so they always experimenting with activates such as putting things their mouths, throwing things, shaking things and learning about the world through trial and error experiments.
When the babies born he or she developing birth physicality and cognitively. Physical skills are include crawling, grasping, pulling as well as general physical growth. However as baby developed cognitive skills, they start thinking about their behaviors and reacting to deferent stimuli such as noises, movement and emotions. This is what defines a sensorimotor stage. For an examples a baby might giggle or smile because he or she precious something is funnier interesting. Also giggling or smiling is an example of overreaction in to cognitive development, so it falls under the sensorimotor stage. To father understand of sensorimotor stage it divided in to substages.
There are six additional substages including,
1. Simple reflex (0-1 month)
2. Primary circular reactions (1-4 month)
3. Secondary circular reactions (4-8 month)
4. Coordination of circular reactions (8-12 month)
5. Tertiary circular reactions (12-18 month)
6. Early Representational Thought (18-24 month)

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2. Major areas of focus when we plan a health education session about cognitive development for mothers with children up to 2 years of age.
As a nursing officer when we plan health education session about cognitive development for mothers with children up to 2 years of age, we have to focus many major areas specially developmental milestone. We have to instruct to the mothers about what are the milestone which have to be achieving according to age and what are the problems can be occur during to that cognitive developmental age and also how to solving that problems.
During this cognitive development stage up to 2 years children behaviors lack a sense of thought and logic. Behaviors gradually move from acting upon inherited reflexes to interacting with the environment with a goal in mind and being able to represent the external world at the end.
When considering up to 2 years of age about cognitive development applies to the sensorimotor stage. To more understand about this topic, we can divide substages and describe that according to the behaviors of children.

Assessment of growth and development.
1. Reflex (Birth to 1 month old)
Within this beginning substage an infant will comprehend their physical environment merely through inborn reflexes and instinct such as sucking, looking, blowing bubbles & grasping fingers.
2. Primary circular reactions (1 – 4 months)
This substage revolves around and displays coordinating sensations/ satisfactions like sucking on toes/ fingers because they are found amusing and satisfactory to their senses.
3. Secondary circular reactions (4 – 8 months)
this substage involves the infant growing more conscious and focused on the world beginning to intentionally repeat an action to gain a response in their environment like purposely picking up a toy and placing it in their months.
4. Coordination of reactions (8 – 12 months)
this substage involves the child to start show intentional actions to archive their desired effect like imitating the observed behavior of other like their parents.
5. Tertiary circular reactions (12 – 18 months)
substage where child begins experimenting different sounds/ actions through a trial and error pattern in order to be exhibited to the parent’s attention more and more.
6. Early representational through (18 – 24 months)
final stage where imagination roams free children begin to comprehend the world through mental than pure action of case and effect.

Introduce what are the advantages of breast feeding, introduction of weaning foods
Education the parents about,
Along breast feeding is adequate and sufficient to maintain optimum growth and development of an infant up to the age for 4-6 month. There for necessary to introduce more energy rich concentrated nutritional supplements such as proteins, carbohydrates, vitamins, minerals and water by this age.
During introduction of weaning foods following principles can be followed by parents,
• Milk is the main food of infant, so additional feeds should provide extra requirement as the needs of baby. That food items should be home made and obtain from good quality.
• A small amount of new foods item should be introduce in the beginning and gradually can be increase amount of foods.
• Additional food can be introduce in a day time. Initially it can be given once, then twice or thrice.
• Observe the problems related to weaning process. Specially in case of food allergies, skin rashes, abdominal pain, symptoms of diarrhea. That kind of problems should be manage carefully and medical management.
• We need should be started between 4-6 month of age to all children but breast feeding to be continued up to 2 years of age or beyond.

Introduction of national Immunization schedule and Expanded program on Immunization on Sri Lanka

NATIONAL IMMUNIZATION SCHEDULE – SRI LANKA
NATIONAL IMMUNIZATION PROGRAM
Age Vaccination
0-4 Weeks BCG
2 Month OPV ; Pentavalent (DTP-HepB-Hib) (1st dose)
fIPV (Fraction IPV) (1st dose)
4 Month OPV ; Pentavalent (DTP-HepB-Hib) (2nd dose)
fIPV (Fraction IPV) (2nd dose)
6 Month OPV ; Pentavalent (DTP-HepB-Hib) (3rd dose)
9 Month MMR (1st dose)
12 Month Live JE
18 Month OPV ; DTP (4th dose)

Given an information about important of play, selection of play materials and care of play materials.
Play is an universal for all children. Also is pleasurable and enjoyable aspect of child’s life and essential to promote growth and development. Selection of play material and toys depends upon age, abilities, culture, experience likes & dislikes. The play material should have following characteristics.
• safe, washable, lightweight, simple, durable, easy to handle and non-breakable.
• No sharp edges and no small removable parts witch may be swallowed or inhaled.
• No toxic paints, not inflammable.

Improved parental knowledge about preventions of accident and safety precautions.
Safety measures are important of child care to minimized the accidental hazards. Parents play a major role in prevention of accidents and safety precautions.
For infants and toddlers,
• Never leave and infant or toddler alone on cot or unprotected place.
• Never give very small things to the child. (coins, buttons, beads, marbles)
• Keep the stove or fire source and hot things far away from the child.
• Electrical appliances should be kept out of reach.
• Provide continues supervision.

3. What are your responsibilities to enhance cognitive development of the sick children of your pediatric unit?

Nurses are responsible for the daily monitoring and management of the quality of health care delivered to patients. The nurse’s role includes immediate detection and intervention when patients’ clinical conditions change. As a pediatric nurse we should interact both children and their parents.
Always the age and Development of each child may vary. So as a pediatric nurse we should identify needs of each child, maintain and restore health in both children and their parent by health counseling and teaching about the needs.
When the hospitalization of child in cognitive developmental age, they always suffering from anxiety due to that separation of family members and disease condition. To prevent that anxiety situation we have to arrange our hospital ward setup like their home environment by preparing play areas, providing small library

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