Slide 1

Growth and Development

of Children

Theoretical Approaches to Growth

and Development of Children

Slide 2
GROWTH is an increase in the
number and size of
cells.Measured in terms of
QUANTITY.

Slide 3
Growth, Maturation,
Development
 Growth: a physiologic increase in size
through cell multiplication or
differentiation
 Maturation: changes that are due to
genetic inheritance rather than life
experiences, illness, or injury
Slide 4
WHAT IS DEVELOPMENT?

Development is capacity of
functioning or skill. Measured
in terms of QUALITY.

COMPETENCY IN PEDIATRIC NURSING

Slide 5
Growth, Maturation,
Development
 Development: physiological,
psychosocial, and cognitive changes
occurring over one’s life span due to
growth, maturation, and learning;
assumes orderly and specific situations
lead to new activities and behavior
patterns

Slide 6
Principles of Growth and
Development
 Development is orderly and sequential
 Development is directional
 Development is unique
 Development is interrelated
 Development becomes increasingly
differentiated
 Development becomes increasingly
integrated and complex
 Children are competent
 New skills predominate
Slide 7

1. Unique – individualized.
2. Unified – all areas are important: physical ,
social (play).
3. Continuous process.
- Begins at conception
and ends at death.

Slide 8
4. Rate of growth varies:
- rapid stages (growth spurts)
Infancy & Adolescent
- slow periods- (growth gaps)
Toddler, Preschooler, Schooler
5. Directional:
Growth- horizontal and vertical
Development- cephalo-caudal (gross motor)
- proximo-distal (fine motor)

Slide 9
Issues of Human
Development (cont.)
 Passive versus active
 Critical versus sensitive period
 Critical: limited time span
 Sensitive: a time span optimal for
development
 Universality versus context specificity
 Universality: similar developmental
pathways
 Context specificity: differences related to
cultural values, beliefs, and experiences
Slide 10 Assessment of GROWTH:
1. Physiologic loss of
weight a couple of weeks
after birth: 5-10% of
birthweight

2. Most rapid during infancy (Doubles

at 6 mos. Triples at 1 year) and
adolescent stages.

Slide 11

DDST- Denver Developmental Screen Test

MMDST- Metro Manila Developmental Screen
TestAssessed:
Areas
• Gross Motor Skills- skills done by the large
muscles (CEPHALOCAUDAL)
• Fine Motor Skills- skills done by small muscles
(hands) (PROXIMODISTAL)
• Interpersonal-social
• Language

Slide 12
Stages of Human
Development
 Infant: birth–1 year
 Toddler: 1–3 years
 Preschooler: 3–6 years
 School-age child: 6–12 years
 Adolescent: 12–19 years or later
Slide 13
Assumptions about Human
Nature
 Original sin
 Innate purity
 Tabula rasa
 Behavioral consistency

Slide 14 Theories of Human

Development—
Psychoanalytic perspective
 Freud: psychosexual
 Id
 Ego
 Superego
 Stages: oral, anal, phallic, latency, genital

Slide 15
DEVELOPMENTAL
THEORIES
Sigmund Freud considered sexual instincts to
be significant in the development of
PSYCHOSEXUAL DEVELOPMENTAL THEORY personality. At each stage, regions of the body
assume prominent psychologic significance as
sources of pleasure.

Gratification or pleasure shift from one zone of

the body to another. From the mouth to anus
then to the genitals.
Slide 16 Baby’s chief source of pleasure is the MOUTH.

ORAL (BIRTH – 1 YEAR) Infants sucks for the enjoyment as well as

nourishment.

Gains gratification by swallowing, chewing,

Infants sucks for the enjoyment as well as nourishment. biting and eating.
Gains gratification by swallowing, chewing, biting and eating.
Unable to delay gratification.
Unable to delay gratification.

Begins to develop self-concept from the responses of others.

Begins to develop self-concept from the
responses of others

Slide 17 TOILET TRAINING

Readiness is 18-24 months.
ANAL (1-3 YEARS)
Bowel training accomplished before bladder.
Complete night bladder training at 4 or 5-
years-old.
Zone of gratification is ANUS/BUTTOCKS.

Child derives sensual satisfaction from withholding and expelling feces. SIGNS OF TODDLER’S READINESS FOR
Bladder and bowel training occurs and is a major task. TOILET TRAINING
Sexuality begins to develop. (Sex differences, learned words pertaining to Stays dry for 2 hours with regular bowel
anatomy and elimination.
movements.
Conflict of “Holding On” and “Letting Go” gradually resolves as bowel Can sit, walk and squat.
training progresses. Resolution occurs once bowel control is firmly
established. Can verbalize the desire to void or defecate.
Exhibits a willingness to please parents.
Wants to have soiled diapers changed
immediately.
NOTE: Toilet training should not be
initiated during times of stress, such a
new baby, a move, a divorce, or a
vacation.

Slide 18
PHALLIC (3-6 YEARS)

The child’s pleasure centers on the GENITALIA and masturbation.

Time of “Family Romance”
A. Oedipal Complex
B. Electra Complex

- CASTRATION ANXIETY
Values and rules learned from parents.
Guilt and self-esteem develop.
Desires are repressed and introjection and role identification with parent of
the same sex.
Slide 19 Time of relative sexual indifference/sex
LATENCY ( 6-12 YEARS) instincts relatively quiet.

Time of relative calm between more turbulent

stages.

Development of self-esteem closely linked

with developing sense of worth and value.

Mastery of learning(Uses creative energies to

influence environment)

Relationships with same sex peers develops.

Slide 20 Adolescent focus on the genitals as an

GENITAL ( 12 YEARS & BEYOND)
erogenous zone and engage in masturbation
and sexual relations with others.

Period of sexual maturity directed toward

heterosexual relationships.

Sexual activity increases and sexual identity is

strengthened or attacked.

Periods of renewed sexual drive with conflict

between adolescent’s need for sexual
satisfaction and society’s expectations for
control of sexual expression.

Core concerns are body image development

and acceptance of the opposite sex.

Slide 21 Theories of Human

Development—
Psychoanalytic perspective
 Erikson: Psychosocial
 Trust versus mistrust
 Autonomy versus shame and doubt
 Initiative versus guilt
 Industry versus inferiority
 Identity versus role confusion
Slide 22 Erik Erikson believed that development results
PSYCHOSOCIAL THEORY from social aimsor conflicts arising from
feelings, parent-child interaction, and social
relationships.

At each stage, children confront a crisis that

requires the integration of personal needs and
skills with social and cultural expectations.
Each stage has two components, favorable and
unfavorable.

Slide 23 Foundation of all future psychosocial tasks.

TRUST vs MISTRUST
(BIRTH – 1 YEAR) Baby develops sense whether world can be
trusted.

SIGNIFICANT PERSON: Mother/Caregiver

TRUST
Infants who receive attentive care learn that
life is predictable and that their needs are
promptly meet.

MISTRUST
Infants whose needs are consistently unmet or
who experience significant delays develop a
sense of uncertainty.

Slide 24 PSYCHOSOCIAL VIRTUE: HOPE

TRUST vs MISTRUST
(BIRTH – 1 YEAR)
FEARS: Stranger anxiety; loud noises, falls,
sudden movement in the environment.
PSYCHOSOCIAL VIRTUE: HOPE
PLAY: SOLITARY:reflect development and
FEARS: Stranger anxiety; loud noises, falls, sudden movement in the
environment. awareness ofthe environment.
PLAY: SOLITARY:reflect development and awareness ofthe environment.
AGE APPROPRIATE TOYS AGE APPROPRIATE TOYS
Birth – 3 months: mobiles, mirrors, music boxes, rattles,stuffed animals
without detachable parts
4-6 Months: squeeze toys, busy boxes and play gyms
- safe, no sharp edges, not small, non-
7-9 Months: cloth-textured toys, splashing toys, large blocks and large
balls
detachable parts
10-12 Months: durable books, with large pictures, large building blocks,
nesting cups, and push-pull toys Birth – 3 months: mobiles, mirrors, music
boxes, rattles,stuffed animals without
detachable parts
4-6 Months: squeeze toys, busy boxes and
play gyms
7-9 Months: cloth-textured toys, splashing
toys, large blocks and large balls
10-12 Months: durable books, with large
pictures, large building blocks, nesting
cups, and push-pull toys
Slide 25
AUTONOMY vs SHAME AND DOUBT
(1-3 YEARS)

Psychosocial theme: “HOLD ON OR LET GO”

Struggle of giving self chance to gain independence from the mother and
breaking the symbolic ties/dependence from the mother.

An internal struggle for self-identity: LOVE vs HATE

Ritualism, negativism and independence predominate social interaction.

Temper tantrums, seeks security blankets/objects

Starts to delay gratification

Slide 26 AUTONOMY vs SHAME AND DOUBT

(1-3 YEARS)

PSYCHOSOCIAL VIRTUE: WILL

FEARS: Separation anxiety, loud noises, going to sleep, large animals
SIGNIFICANT PERSON: Family
PLAY: Parallel, enhance locomotion skills (push-pull toys)
AGE APPRPRIATE TOYS
- safe, non-detachable, no small parts
Dolls and housekeeping toys
Play phones and cloth books
Appropriate rocking horses and “riding” trucks, finger paints, play clay,
large-piece wooden or plastic puzzles, and large blocks

Slide 27
INITIATIVE vs GUILT
(3-6 YEARS)

Child learns the ability to try new things and learns how to handle failure.
Period of intensive activity, play and consuming fantasies
Child interjects parent’s social consciousness
Child develops initiative when trying out new things and is not
overwhelmed by failure.
Slide 28 PSYCHOSOCIAL VIRTUE: PURPOSE
INITIATIVE vs GUILT
(3-6 YEARS) FEARS: Dark, being left alone esp. at bedtime,
large animals(large dogs) Ghosts, body
PSYCHOSOCIAL VIRTUE: PURPOSE
FEARS: Dark, being left alone esp. at bedtime, large animals(large dogs)
mutilation, pain and objects and people
Ghosts, body mutilation, pain and objects and people associated
with painful experiences associated
SIGNIFICANT PERSON: Family, grandparents, siblings and preschool
experiences with painful experiences
PLAY: Associative, enhance gross and fine motor development
AGE APPROPRIATE TOYS
Tricycle, big wheels, gym sets, wading pools and sandboxes
SIGNIFICANT PERSON: Family,
Large blocks, puzzles, crayons, paints and simple crafts
Dress-up clothes and dolls, housekeeping toys, play tents,puppets, doctor
grandparents, siblings and preschool
and nurse kits to imitative play and imagination.
experiences
PLAY: Associative, enhance gross and fine
motor development
AGE APPROPRIATE TOYS
Tricycle, big wheels, gym sets, wading pools
and sandboxes to enhance gross
motor skills.
Large blocks, puzzles, crayons, paints and
simple crafts to enhance fine motor skills
Dress-up clothes and dolls, housekeeping
toys, play tents,puppets, doctor and nurse
kits to imitative play and imagination.

Slide 29
INDUSTRY vs INFERIORITY
(6-12 YEARS)

Child learns how to make things with others and strives to achieve success.
Child must learn skills of the culture or face feelings of inferiority.
PSYCHOSOCIAL STRENGTH: SKILL
FEARS: Failure at school, bullies, intimidating teachers
SIGNIFICANT PERSON: Teacher
PLAY: Cooperative, competitive and complex
Complex puzzles, collections, quiet board games, reading
AGE APPROPRAITE TOYS
Increasing complex board and card games
Book and crafts
Music and art
Athletic activities( swimming), team activities, video games
Slide 30
IDENTITY vs IDENTITY CONFUSION
(12-18 YEARS)

ADOLESCENCE
Adolescent determines own sense of self.

Development of who, what, and where they are going become focus

(SELF-CONCEPT)

Period of rebellion and uncertainty.

PSYCHOSOCIAL VIRTUE: FIDELITY

SIGNIFICANT PERSON: Peers

PLAY: Sports, camping, fishing gear, video and video games, computer
games, radios and compact disk players, personal telephone

Slide 31 INTIMACY vs ISOLATION

(20-45 YEARS)

(YOUNG ADULTHOOD)

Person make commitments to another.

Isolation and self-absorption occur if unsuccessful.

Independent from parents, possible marriage/partnership.

Major goals to accomplish in career and family.

“Sandwich Generation” (35-45 years)

PSYCHOSOCIAL VIRTUE: LOVE

SIGNIFICANT PERSON:Spouse/Partner

Slide 32 GENERATIVITY vs STAGNATION

(45-65 YEARS)

MIDDLE ADULTHOOD

Mature adult is concerned with establishing and guiding the next

generationor else feels personal impoverishment or incompleteness.

Relates to older and younger generations

Become “Pillars of Community”

Prepares for retirement

PHYSICAL CHANGES: graying hair, wrinkling skin, pains and muscle

aches, menopause

PSYCHOSOCIAL VIRTUE: CARE

Slide 33
INTEGRITY vs DESPAIR
(65- OLD AGE)

OLD ADULTHOOD
Achieves sense of acceptance of own life, adapts to triumphs and
disappointments with a certain ego integrity.
Accepts inevitability of death or else falls into despair.
Appraisal of life and changing social roles
Self-concern and withdrawn
PHYSICAL CHANGES: increasing physical decline, increasing
forgetfulness, changes in lifestyle with modification on physical limitations,
appearance of chronic diseases
PSYCHOLOGICAL VIRTUE: WISDOM

Slide 34 Swiss psychologist Jean Piaget proposed four

COGNITIVE DEVELOPMENT major stages of cognitive Development.
COGNITIVE DEVELOPMENT
- the growth in thought processes that
enables one to acquire and use knowledge
about the world.
Piaget believed that the core of intelligent
behavior is an inborn tendency for people to
adapt to their environment.

Slide 35 Infant changes from a being who responds

PIAGET’S SENSORIMOTOR primarily through reflexes to one who can
STAGE OF COGNITIVE DEVELOPMENT
organize activities in relation to the
environment.
SENSORIMOTOR STAGE(BIRTH-2 YEARS) Uses sensory and motor abilities to
Infant changes from a being who responds primarily through reflexes comprehend world.
to one who can organize activities in relation to the environment.
Uses sensory and motor abilities to comprehend world.
Slide 36 REFLEXIVE STAGE
SUBSTAGE 1 ( BIRTH- 1 MONTH)
This period is marked by the use of innate and
REFLEXIVE STAGE predictable survival reflexes.
NO OBJECT PERMANENCE
No coordination from their senses, do not
grasp an object they are looking at.

NO OBJECT PERMANENCEn
- the realization that an object or person
continues to exist even when out of sight.

Slide 37 PRIMARY CIRCULAR REACTIONS

SUBSTAGE 2 ( 1-4 MONTHS )
• Marked by stereotyped repetition and
PRIMARY CIRCULAR REACTIONS the infant’s focus on his own body as the
FOCUS: Infant’s body center of interest.(e.g. infant discovers own
• Hand-mouth and ear-eye coordination develop.
body parts)
• Enjoyable activity for this period: a rattle or a tape of parent’s voice.
FOCUS: Infant’s body
• NO object permanence.
• Hand-mouth and ear-eye coordination
develop.
• Development of primary circular
reaction to acquired adaptation then finally
organization.
• Enjoyable activity for this period: a
rattle or a tape of parent’s voice.
• NO object permanence.

Slide 38 SECONDARY CIRCULAR REACTIONS

SUBSTAGE 3 ( 4-8 MONTHS ) Infants learns to initiate, recognize and repeat
pleasurable experiences from environment.
SECONDARY CIRCULAR REACTIONS Coincides with new interest to manipulate
objects in the environment.
Infants learns to initiate, recognize & repeat pleasurable experiences from
environment.
Coincides with new interest to manipulate objects in the environment.
Begin to show PARTIAL OBJECT PERMANENCE.
Good toy for this period: mirror Memory traces are present; infant’s anticipates
Good game: peek-a-boo
familiar events.

Actions intentional but not initially goal-

directed.

Begin to show partial object permanence.

Good toy for this period: mirror

Good game: peek-a-boo

Slide 39 COORDINATION OF SECONDARY
SUBSTAGE 4 ( 8-12 MONTHS) SCHEMES

COORDINATION OF SECONDARY SCHEMES Behavior is more deliberate and purposeful as

Behavior is more deliberate and purposeful
infant’s coordinate previously learned schemes
Can anticipate events.
(e.g. looking and grasping a rattle) and use
Begin to develop object permanence
previously learned behaviors to attain their
Recognize shapes and sizes of familiar objects.
goals (e.g. crawling across the room to get
Good toy: nesting toys (colored boxes)
desired toy).
Can anticipate events.
Begin to develop object permanence. (first
hiding place even being moved).
Recognize shapes and sizes of familiar objects.
Good toy: nesting toys (colored boxes)

Slide 40 TERTIARY CIRCULAR REACTIONS

SUBSTAGE 5 ( 12-18 MONTHS ) Infants show curiosity as they purposely vary
their actions to see results.
TERTIARY CIRCULAR REACTIONS
Infants show curiosity as they purposely vary their actions to see results.
Child is able to experiment to discover new
Try new activities and use trial and error in solving problems. properties of objects and events.
Object permanence developed further. (Follow series of displacements and
look in last place rather than first.)

Good game: throw and retrieve

Try new activities and use trial and error in
solving problems.

Object permanence developed further. (Follow

series of displacements and look in last place
rather than first.)

Good game: throw and retrieve

Slide 41 MENTAL COMBINATIONS

SUBSTAGE 6 ( 18-24 MONTHS )

Toddler have developed a primitive symbol

MENTAL COMBINATIONS
Toddler have developed a primitive symbol system (language) to system (language) to represent events.
(Symbolic thought)
represent events. (Symbolic thought)
Basic understanding of cause and effect. No longer confined to trial and
error.
Develops of insight.
Object permanence fully developed.
Good toys: blocks, colored plastic rings
Basic understanding of cause and effect. No
longer confined to trial and error.

Develops of insight.

Object permanence fully developed.

Good toys: blocks, colored plastic rings

Slide 42 Child develops a representational system and
PREOPERATIONAL ( 2 – 7 YEARS ) uses symbols such as words to represent
people, places and events.
Child develops a representational system
and uses symbols such as words to Comprehend simple abstractions but thinking is
represent people, places and events.
Comprehend simple abstractions but
thinking is basically concrete and literal.
basically concrete and literal.
SYMBOLIC FUNCTION SYMBOLIC FUNCTION
- is the ability to learn by using symbols.

SYMBOL
- is the ability to learn by using symbols.
- is a mental representation to which
consciously or unconsciously, a person SYMBOL
has attached meaning.
- is a mental representation to which
consciously or unconsciously, a person has
attached meaning.

Slide 43 1. PRECONCEPTUAL PHASE ( 2-4 years )

PREOPERATIONAL STAGE

The child forms concepts that are less

1. PRECONCEPTUAL PHASE ( 2-4 years )
Child forms concepts; less complete & logical than adult concepts.
complete and logical than adult concepts.
- Centration, conservation of matter(height & weight)
- reversibility & animism (confuse reality and fantasy)
- Centration, conservation of matter(height &
The child makes simple classifications. ( to form design or figure) weight), reversibility and animism (confuse
The child associates on event with a simultaneous one.
(TRANSDUCTIVE REASONING) reality and fantasy).
The child exhibits egocentric thinking. The child makes simple classifications. ( to
Good toys: items that require imagination such as modeling clay. form design or figure)
The child associates on event with a
simultaneous one.
(TRANSDUCTIVE REASONING)
The child exhibits egocentric thinking.
Good toys: items that require imagination such
as modeling clay.

Slide 44 2. INTUITIVE PHASE ( 4-7 YEARS)

PREOPERATIONAL STAGE

The child becomes capable of classifying,

2. INTUITIVE PHASE ( 4-7 YEARS)
The child becomes capable of classifying, quantifying, and relating objects quantifying, and relating objects but remains
unaware of the principles behind these
but remains unaware of the principles behind these operations.
The child exhibits intuitive thought process.
The child is egocentric.
The child uses many words appropriately but lacks real knowledge of their
operations.
meaning.

The child exhibits intuitive thought process.

The child is egocentric.

The child uses many words appropriately but

lacks real knowledge of their meaning.
Slide 45 Marked by inductive reasoning, logical
CONCRETE OPERATIONS STAGE
(7-12 YEARS)
operations and reversible concrete thought.
Uses memory to learn broad concept and
Marked by inductive reasoning, logical operations and reversible concrete
thought. subgroup of concepts.(Fruit and apple)
Uses memory to learn broad concept and subgroup of concepts.(Fruit
and apple) Classifies according to attributes such as color
Classifies according to attributes such as color and seriation.
Understands reversibility, conservation of matter.
and seriation.
Transition from egocentric to objective thinking.
Typical activities: collecting and sorting objects, ordering items according
Understands reversibility, conservation of
to size, shape, weight and other criteria. matter.
Transition from egocentric to objective
thinking.
Typical activities: collecting and sorting
objects, ordering items according
to size, shape, weight and other
criteria.

Slide 46 FORMAL OPERATIONS

Develops abstract reasoning which include
(12 YEARS – ADULTHOOD) inductive and deductivereasoning, the ability to
connect separate events and the ability to
understand later consequences.
Adolescent thinks beyond the present and
Develops abstract reasoning delights in “that which is not.”
Adolescent thinks beyond the present and delights in “that which is not.” Development of : Idealism (perfect word)
Development of : Idealism (perfect word)
Egocentism
Egocentism (“Everyone is
watching me and concerned about me.”)
(Personal fable)

Slide 47 • Lawrence Kohlberg was

MORAL DEVELOPMENT developmental psychologist and then moved to
the field of moral education.
• Kohlberg believed and was able to
•Lawrence Kohlberg was demonstrate to studies that people progressed
developmental psychologist
and then moved to the field of
moral education.
in their moral reasoning through a series of
•Kohlberg believed and was
stages.
able to demonstrate to studies
that people progressed in their
moral reasoning through a
series of stages.
Slide 48 Emphasis in this level is on external control.
I. PRECONVENTIONAL MORALITY
( 4-10 YEARS) This standards are those of others, and they
are observed either to avoid punishment or to
reap rewards.
STAGE 1. OBEDIENCE AND PUNISHMENT
STAGE 1. OBEDIENCE AND PUNISHMENT
STAGE 2. INSTRUMENTAL EGOISM AND SIMPLE EXCHANGE - “Whatever is rewarded is good; whatever is
punished is bad.”
- Individual obeys rules to avoid punishment.
- They ignore the motives of an act but on
the consequences of the act.

STAGE 2. INSTRUMENTAL EGOISM AND

SIMPLE EXCHANGE
- “You scratch my back, and I’ll scratch
yours.”
- “I’ll do something good for you if you do
something good for me.”
- Children conform to rules out of own self-
interest and consideration for what others can
do for them in return.

Slide 49 • The individual perceives the

II. CONVENTIONAL MORALITY
( 10 – 13 YEARS)
maintenance of the expectations of his family,
group, or nation as valuable in its own right,
STAGE 3. INTERPERSONAL CONCORDANCE
- “Am I a good boy or a good girl?” regardless of immediate and obvious
consequences.
- Good behavior is what pleases others and approved by them.
- Behavior is judged by intention.
- One earns approval by being nice.

STAGE 4. LAW AND ORDER

-
-
“What if everybody did it?”
Oriented to abiding by law and responding to the obligations of duty.
• Children want to please other people.
- operates on social system and conscience.
- Good is defined by laws of society, by doing one’s duty. A law should
be obeyed even if its unfair.
• They want to be considered “good” by
those opinions that matter to them.
Slide 50 III. POST-CONVENTIONAL MORALITY
( 13 YEARS,OR UNTIL YOUNG
ADULTHOOD, OR NEVER )

•This level marks the attainment of true morality.

•The person acknowledges the possibility of two conflict
between two socially accepted standards and tries to decide
between them.
•The control of conduct is now internal both in the standards
observed and reasoning in right and wrong.
•Stages 5 and 6 may be alternative levels of the highest level
of moral reasoning.

Slide 51 III. POST-CONVENTIONAL MORALITY

• This level marks the attainment of
( 13 YEARS,OR UNTIL YOUNG true morality.
ADULTHOOD, OR NEVER )

STAGE 5. SOCIETAL CONSENSUS/SOCIETAL CONTRACT

- People think in rational terms, valuing the will of the majority and the
• The person acknowledges the
welfare of society.
- While they recognize that there are times when human need and law possibility of two conflict between two socially
accepted standards and tries to decide
conflict, they believe that society in the long run should obey the
law.

STAGE 6. PRINCIPLED CONSCIENCE between them.

- People do what they think is right regardless of legal restrictions or
the opinions of others.
- They act in accordance with internalized standards, knowing that they
would condemn themselves if they did not. • The control of conduct is now internal
both in the standards observed and reasoning
in right and wrong.

• Stages 5 and 6 may be alternative

levels of the highest level of moral reasoning.