Growth & Development

Introduction
Growth and Development Extends through out
the life cycle
Principle changes occur from conception to
end of Adolescence
Conception period is complex one. i.e. Two
cells joins and becomes one
Important for the nurse to understand total life
cycle and behaviour to provide care for every
individual
A knowledge of growth & development is
essential for the nurse for following reasons

1. What to expect from the child according to
the age

2. To plan for nursing management & help in
formulating plan for total care of each child
contd
3. Understand the reason for particular
conditions and illnesses occur in various
age groups

3. To teach the parents how to observe the
children & use their knowledge to help
the children achieve optimal growth &
development

Definitions of Terms
Growth : Refers to an increase in physical
size of the whole or any parts and can be
measured in inches or centimeters and in
pounds or kilograms

- It results because of cell division & synthesis
of proteins

- It gives quantitative change
contd
Development : Refers to a progressive increase
in skill & capacity to function

- It causes a qualitative change in the childs
functioning

- Development is orderly not haphazard

- Direct relation between each & the next
contd
Maturation : Refers to the development of
traits carried through the genes

- It produces an increase in competence, an
ability to function at a higher level of depending
on the child's heredity
Concepts of Growth & Development
The Growth & Development patterns can be
studied in two methods

- Cross Sectional method

- Longitudinal method
contd
Cross Sectional Method
Many of the students of same age group
studied to establish the norms of growth and
development of specific group
Eg ; Tests / Measurements taken from many
children in a particular age range
Scores of 3 year old Average of each
Scores of 4 year old = group considered
Scores of 5 year old as base line

Longitudinal Method
Individual children of large group are measured
at intervals throughout their stages of growth and
development over a period of year
It is more difficult than Cross Sectional method
Characteristics of Growth &
Development
Individual Differences
Critical periods
Rate of Development
Principles of Growth & Development
1. Continuous, Orderly and Sequential process
2. Growth & Development is Directional
3. Growth & Development is Unique
4. Development is related
5. Development become increasingly
differentiated
contd
6. Development becomes increasingly integrated
and complex
7. Children are competent
8. New skills predominate
9. Development involves changes
10.Early Development is more critical than latter
11.Development is the product of Maturation &
Learning
contd...
12. Development pattern is Predictable
13. Development pattern has its own
characteristics
14. Development pattern has periods
15. There are social expectations for every
developmental periods
16. Every area of development has potential
hazards
17. Happiness varies at different periods in
development
Stages of Growth & Development
Prenatal period Conception to Birth
a) Embryonic conception to 8 wks
b) Fetal - 8wks to 40 wks
New born - From birth to 2-4 weeks
Toddler - 1 to 3 years
Early child hood 3 to 6 yrs
Late child hood 6 to 12 yrs
contd
Adolescence - Puberty to beginning of adult
life
Early Adult hood - 18 25 yrs
Middle Adult hood 25 -40 yrs
Late Adult hood 40 60 yrs
Old age - After 60 yrs

Theories of Growth & Development
Theories classified as
1.Intellectual development Jean Piaget
2.Moral development - Jean Piaget & Kohl berg
3. Emotional development Erik H.Erikson
4.Development of sexuality Freud
5.Spiritual Development James W.Fowler
Factors influencing Growth &
Development
Factors influencing fetus Growth & Development
1. Effects of Maternal infection & Nutrition
2. Placental dysfunction
3. Fetal infection
4. Treatments of infection and drugs
5. Pre Pregnancy infection
6. Alcohol, Caffeine, Artificial sweetners and Smoking
contd
7. Role of Hormones
8. Genetic Endowment
9. Ratio of surface & volume
10.Structural limitations
11.Diabetes Mellitus
12.Pregnancy Induced Hypertension ( PIH )
13.Rubella, Toxoplasmosis & Syphilis
14.Rh-Incompatability
15.Maternal Cardiac Diseases
16.Incompetent Cervix
1.Effects of Maternal infection &
Nutrition
Maternal Nutrition affects Fetal Programming ie
Fetal origin of Adult diseases
- Alterations in fetal nutrition & endocrine status
Result in developmental adaptations
- Change in structure, physiology & metabolism
- Maternal under /over Nutrition Placental fetal
blood flow Stunt growth
contd
Impaired placental blood flow

Impaired placental synthesis of nitric oxide &
Polyamines

IUGR
Promoting optimal nutrition ensure optimal
fetal growth & risk of chronic diseases in
adults
contd
The impact of Malaria, Diarrhea, AIDS,PID, Severe
Reproductive tract infections and UTI

Affect chemical messengers Cytokines

Suppress appetite centre in the brain

Anorexia (intake )

Malnourishment of mother

Fetal Malnutrition

Intestinal Parasites Ascaris

Absorption energy, Protein, Micro Nutrients
(iron, Vit-A)

Infection

Body temperature

Metabolic stress for mother itself (10%)

Fetal inadequacy

Profound changes in the distribution of
Micronutrients ( Zinc, Iron )

Transfer of nutrients affected

Defect in fetal development
Hook worm infestation

Severe loss of iron & protein

Affects intra uterine growth

Consequences of impaired maternal
nutrition
Reproduction doesnt occur properly
Conceptus material cannot grow & develop
normally & possibly die
LBW baby
Placental size
Brain cell & head size
Size of other organs ced
contd

Alterations in normal cell constituents &
biochemical processes

Depend on timing, severity and duration of
Malnutrition reversible hypertrophy &
irreversible hyperplasia

2. Placental dysfunction
Specific Infections

Alter structure of placenta

Impaired nutrient transfer

Malarial infection of mother
delivers
LBW babies
contd
Ascending infections from Vagina
Attacks amniotic sac
Organisms reach maternal blood
Placental functions
-Endocrine
-Respiration
-Digestion
-Excretion
-Protection
3. Fetal infection
Syphilis & HIV

Transmitted across the placenta

Decreased birth weight
Herpes infection associated with IUGR
Toxoplasmosis and Cytomegalovirus
infections impact on fetal growth is not known

4.Treatments of infection and drugs
Treatments of infection by Teratogenic drugs

Cross the Placenta

Fetal growth & development affected
5. Pre - Pregnancy infection
Under nourishment before pregnancy due to
LSEB, Poor etc.

Chance of chronic infection in child hood &
adolescent

Malnutrition deficiency of Iron, Folate, Zinc &
Vit A

IUGR

6. Alcohol, Caffeine, Artificial
sweetners and Smoking
a) Alcohol Ethanol ( Primary Teratogen )
Depress the CNS

Interference with cardio pulmonary adaptation in
newborn

Fetal Alcohol Syndrome (FAS)
contd

Chronic Alcoholic woman Deliver the babies
with Microcephaly, Short palpebral fissure,
Small cheek bones, Congenital heart defects,
Pre & Post natal growth deficiency, Congenital
heart defects, Congenital Hip dislocations and
other joint anomalies and altered palmar crease
pattern.
b) Caffeine
- High levels can cause limb defects
- Alter blood flow through uterus and
placenta
- Stimulate AMP pathways in cells
contd
Artificial sweetners
- No clear results
- Saccharin may be carcinogenic in high levels
- Use in moderate level will not give problem
contd
Smoking Nicotine

Placental blood flow & Plasma volume

Vasoconstriction of uterine circulation

Insufficient nutrition to fetus

LBW babies
contd

Smoking increase the risk of
-Spontaneous Abortion
-Placenta Previa
-PROM
-Sudden Infant Death Syndrome (SIDS)
-Pneumonia
-Respiratory infections
-interfere with absorption / metabolism of
Calcium, Vit B12, A, B6 and B1
7. Role of Hormones
Hormone in the body affect the growth some
manner

The Hormones are
1. Somatotrophic Hormone
2. Thyroid Hormone
3. Gonad Stimulating Hormone

contd
1. Somatotrophic Hormone

- Stimulates skeletal and protein
anabolism

- Excess gigantism

- Lack Dwarfism

2. Thyroid Hormone
- Thyrotrophic Hormone (TH),
Triiodothyronine (T3) and Thyroxine (T4)
stimulate general metabolism
- Excess liner growth
- Deficiency cretinism MR
3. Gonad stimulating Hormone
Hypothalamus

LHRH

Anterior Pituitary

In Male

Stimulate interstitial
cells of testes

Testosterone

Hypothalamus

LHRH

Anterior Pituitary

In Female

FSH LH

Ovarian Follicle Corpusluteum

Estrogen Progesterone
contd

Excess in Gonad stimulating Hormone
Precocious Puberty
Less in Gonad stimulating Hormone
Delayed Sexual Development

8. Genetic Endowment
a) Hexogenes: Gives floor plan for growth and
development
Gene

Control rate of critical metabolic processes

Fetus size and shape determined
9. Ratio of surface & volume
Food ingested

Metabolized into protoplasm

Remainder excreted as wasted

- The Ratio of Surface and Volume influence the growth
and development
10.Structural limitations
-The structural limitations depends on gene
Engineering

11.Diabetes Mellitus
Type I Diabetic mothers

Maternal Blood glucose levels

Fetus gets the glucose

Fetal islets of langerhans produce insulin

To utilize available glucose

Excessive growth macrosomia and fat deposits
contd
Mothers with advanced diabetes

Vascular changes

Efficiency of placental perfusion

IUGR

contd
Level of fetal insulin

Surfactant enzymes secretion

Respiratory distress syndrome

contd
Diminished ability of glycosylated Hb in mothers
blood to release O
2

Polycythemia ( RBC )
Glucose level leads to anomalies in Heart,
CNS & Skeletal system
Sacral agenesis Incomplete
development of lower extremities

12.Pregnancy Induced Hypertension
( PIH )
PIH

Maternal vasospasm & Hypovolemia

Fetal hypoxia

Malnutrition

SGA / Premature baby
13.Rubella, Toxoplasmosis & Syphilis

a) Rubella infection in mother
Causes fetal problems like

Congenital heart diseases, IUGR, Cataract,
Petechial rash, Hepatosplenomegaly,
Hyperbilirubinemia, MR or Cerebral palsy in
infancy
contd

b) Toxoplasmosis
-Caused by protozoan Toxoplasma Gondii
-Complications like Abortion, Prematurity, Still
births, Newborn deaths & Severe congenital
anomalies, Retinochoroiditis
-Neonatal disorders associated with congenital
infection include Convulsion, Microcephaly,
Coma & Hydrocephalus
-Survivors are often blind, deaf & severely
retarded
contd
Syphilis
- Caused by the Bacterium - Treponema palidum
- It results in Spontaneous abortion, Preterm birth,
Still birth, Neonatal death, Morbidity
- Treponema infection( afetr 4 mon)

Cross the Placenta

Infect the fetus

14.Rh-Incompatability
Rh-ve mother + Rh+ve father

Rh-ve baby Rh+ve baby

No problem for 1
st
pregnancy
placenta act as a
barrier

Good outcome


But during pregnancy any chance for FMH or
During delivery mixing of Feto Maternal blood

Reaction of immune system

Anti-D antibodies

Kill the fetus/In subsequent pregnancies

Contd
In subsequent pregnancies

Maternal antibody cross the placenta

Destroy fetal erythrocytes

Erythroblastosis Fetalis
15.Maternal Cardiac Diseases
Morbidity and Mortality with Maternal
Cardiac Diseases depends on 3 factors
1. Nature of cardiac lesion
2. Affect on the functional capacity of the heart
3. The development of pregnancy related
complications PIH, Infection, Thrombosis
and Haemorrhage
contd
CCF

Altered haemodynamic state

Systemic circulation to fetus

O2 nation

Abortion, IUGR, Fetal hypoxia

And Preterm birth fetal death
16.Incompetent Cervix

Cervical Incompetence is painless dilatation of
the cervix 2
nd
or 3
rd
trimester allowing bulging
membranes through the cervical os into the
vagina

Causes- Trauma, D&C, Induced abortion

Treatment- Cervical Cerclage
Developmental Vulnerability Time Table
Weeks since
conception
Malformation
3 Ectromelia, Ectopia cordis
4 Omphalocele,
Tracheoesophageal fistula,
Hemi vertebra
5 Nuclear Cataract,
Microphthalmia, Facial clefts
6 Gross septal or aortic abnormalities.
Cleft lip, Agnathia
7 Interventricular septal defects,
Pulmonary stenosis, Epicanthus, Cleft
palate, Brachyaphalism, Mixed
sexual characteristics

8 Persistent ostium primum, Digital
stunting