Pediatric Nursing: Principles of Growth & Development

1. Continuous process
Growth and Development 2. Predictable Sequence

through Life Span 3. Don't progress at the same rate (↑ periods of GR in

Growth
✔Growth refers to an increase in physical size of the
whole body or any of its parts.
✓The best index of GROWTH is WEIGHT!
✓Growth takes place in the first 20 years of life
✓MOST RAPID - INFANCY
early childhood and adolescents & ↓ periods of GR in
middle childhood)- Each individual grows in his own
rate or pace.
4. Not all body parts grow in the same rate at the same
time.
5. Each child grows in his/her own unique way.
6. Each stage of G&D is affected by the preceding types
of development.

✔GROWTH SPURT - ADOLESCENCE

Development
✓Changes that mark increase in function and
complexity and progression of skill
✔Structural, emotional or social environment
✔Qualitative continues after 20 years, even after growth
stops
✔Growth & Development are independent and
interrelate processes.
Maturation
•Intrinsic processes of development that are genetically
and organically programmed depends of
ENVIRONMENTAL FACTORS at its normal progress
•Development of traits carried by the genes.
● Each child is competent and equipped with
capacity for growth and development.
● Development is continuous throughout life.
Knowledge and new skills can be acquired at
each stage of development if the basic potential
is present.
● Upper limits of growth and development exist
and cannot be surpassed, but their attainment
many be hampered at any age
G&D proceed in regular related directions:
-Cephalo-caudal(head down to toes) - Proximodistal
(center of the body to the peripheral)
-The child's pattern of growth is in a head-to-toe
direction, or cephalocaudal, and in an inward to outward
pattern called proximodistal.
- General to specific

Factors affecting growth and development:

Developmental Task
• Hereditary
• Is a specific task that arises at or about a certain period
in the life achievement of future tasks. • Environmental factors
•Failure in achieving developmental tasks results in
unhappiness, difficulty with later tasks and disapproval
to society( Havighurst, 1972).

Critical Period is a specific time period during which a

certain environmental stimuli give the greatest effect/s
on the child development.
Pre-natal environment Types of growth and development
Factors related to mothers during pregnancy: Types of growth:
-Nutritional deficiencies - Physical growth (Ht, Wt, head & chest circumference)
-Diabetic mother - Physiological growth (vital signs..)
-Exposure to radiation
-Infection with German measles Types of development:
- Smoking -Motor development
-Use of drugs -Cognitive development
-Emotional development
2-Factors related to fetus -Social development
• Mal-position in uterus
• Faulty placental implantation Importance of Psychosocial Development
•The biologic equipment with which a child is born is
modifiable.
Post-Natal Environment
•All behavior has meaning.
External environment:
• Theories explain the behavior
-socio-economic status of the family
- child's nutrition
Methods for Assessing Physical Growth and
-climate and season
Development
- child's ordinal position in the family
> Skeletal Age
- Number of siblings in the family
● Bone age- general index of growth status
-Family structure (single parent or extended family.) ● Assessed through x-ray
● Bone age is based on the number and size of
epiphyseal center
Internal environment ● Girls are more advance than boys skeletal
development at all ages
Child's intelligence
Hormonal influences
Emotions
 Methods for Assessing Physical Growth and Denver Developmental Screening Test (DDST)/
Development MMDST
>Dental age
● 5th to 7th months eruption of first deciduous
teeth, the lower central incisors (mandibular)
● 6th to 8th months eruption of upper incisors
(maxillary)
● 7th months old infant begins calcification of
teeth
● 1st year: 4 sets of primary or deciduous teeth
(central & lateral incisors)
● 2 ½ years: complete primary deciduous teeth (10
pairs)
● 6th years: eruption of the first permanent teeth(
molars) which stabilize the dental arch and
shape of the jaw and arrangement of the teeth.
● Shedding of the first deciduous teeth; lower
central incisor
● -dancing teeth
● 17th to 22 year - eruption of the 3rd permanent
molars

WOMB TO WOMB
Major Issues regarding Health Promotion
S-stress mgt
P-physical activity
I - interpersonal relationships
N-nutrition
E - environment safety
Denver developmental screening test (DDST) evaluates
in 4 areas: personal-social, fine motor, language, gross
motor

Normal Newborn Infant

Physical growth
Weight most rapid physical growth in infancy, best
measure of growth
- first gain to 1 to 1%½ lb/ month during the 1" 6 months
-Double the weight at 6 months
-Triple birth weight in 1 year

Length-increase 50% by 1 year

Head circumference- HC 33-35 cm greater than the chest

Fontanels:
● Posterior fontanels-(lambda) triangular shape
closes 2- 3 months
● Anterior fontanels- (bregma) diamond shape
closes 12 18 months
Vision:
● newborns see only gross patterns of light and
dark ormbright colors
● At 3 months- can follow moving objects 180'
● at 4 months- can recognize the mother and
familiar objects
● At 6 months-infants can perceive colors
● After 9 months- can recognize facial
characteristics, smile in response to familiar face
● At 12 months-depth perception e.g. edge of the
bed
Teething:
● at 6 to 8 months-erupt of temporary or milk te
Lower central incisors (first deciduous)
● at 12 months-complete incisors (2 lower central,
2 upper central, 2 upper lateral and 2 lower
lateral)
Stage Based on Developmental Theories
1. Psychosocial Theory (Erik Erikson) - TRUST vs
MISTRUST -
Consistently promotes trust by consistent primary
caregiver and meet the infant NEEDS right away and
consistently
Newborn Senses Hearing
● The newborn infant usually makes some
response to sound from birth.
● Ordinary sounds are heard well before 10 days
of life.
● The newborn infant responds to sounds with
either cry or eye movement, cessation of activity
and/or startle reaction.
● hearing test done at birth
● Ability to hear correlates with ability enunciate
words properly
● Always ask about history of otitis media - ear
aiding devices.
● Early referral to MD to assess for possible fluid
in ears (effusion)
● Repeat hearing screening test
● Speech therapist as needed
Taste
Well developed as bitter and sour fluids are resisted
while sweet fluids are accepted.
Smell
Only evidence in newborn infant's search for the nipple,
as he smell breast milk.
Psychosocial Skills of Infants
1 month-smiles indiscriminately
2 months-social smile
3 months-show interest in the environment
4 months-demands attention, recognizes mother or SO,
engage in social interaction and show excitements
5-6 months-recognize parents, enjoy play
7-8 months-FEAR OF STRANGERS and cries in there
presence (peak 8th months)
9-10 months-shows BEGINNING of SEPARATION
ANXIETY
10-12 months-shows emotion and begin to explore
environment

Cognitive Stage (Jean Piaget)-Sensorimotor phase
Stage 1 Reflexive act
Stage 2 Primary circular reaction (1-4 months)
Discover own body parts, recognizes familiar faces,
turns to sounds, visually follows object to 180'
Stage 3 Secondary circular reaction (4-8 months)
Recognize external environment, imitation begins, object
permanence begins and smile at self in the mirror
Stage 4 Coordination of secondary schema
Searches hidden objects and recognize objects by name
Newborn/Infant
Moral(Lawrence Kohlberg)- premoral
Spirituality (Fowler's theory) primal.
Sleep pattern - influenced by belief and custom
● Total time of sleep/day - 17-18 hours or 22 hours
per day. Awakes every 3 to 4 hours for feeding.
● 3 months- has nocturnal patterns
● 4 months- sleep at night and pattern of daytime
naps
● 6,8-9 and 12 months- establish night sleep
(10-12 hours/ 14 hours per day) and daytime nap
Indicator of good sleep- normal activity during waking
hours normal pattern of growth
Play-Solitary
✓play with own body, 3 months discover the hands and
7 months discover the feet 10 months-game
"peek-a-boo" (hide and seek)
✔Gross motor, fine motor, language,
personal-social-MMDST/DDST
Toys-washable and no small removal parts
Stimulating the senses
● Crib mobiles-birth to 2months
● Rattles-2-4 months
● Brightly colored toys-grasp by 4-6 months
● Teethers-5-7 months
● Musical boxes, squeeze toys, soft large cuddly
toys and noise makers-6-9 m
● Large wooden beads, activity box for playpen,
books with large picture-9-1
Health Maintenance
1. Nutrition-breast milk may be given until 12 months to
2 years old.
2. Weaning
- 6 months from breast to bottle (optional)
-12 months bottle to cap
-Avoid weaning during stress - illness hospitalization,
parental separation
3. Daily caloric need - 1200 kcal (100-115 kcal/kg/day)
Supplemental foods
● Introduce 4 to 6 months if fading extrusion and
sucking reflexes, ability to sit with support, Iron
is required because fetal iron reserve in liver
usually consumed by 4 to 6 months
● First solid foods = cereals
● 5 to 6 months teething
● 9-12 months chapped table foods
4. Simple rules to follow when introducing
supplementary/solid foods:
● Introduce one food at a time
● Give small amount (1tsp) each time -Do not mix
with formula
● Feed when newborn is hungry after few sucks of
milk to increase his patience for a new food
● Allow an interval of 4 to 7 days between new
foods
● Do not bribe, plead, threaten or force the infant
Safety
● Common accidents: aspirations, falls,
suffocation, burns (scalds from hot water) and
poisoning (lead-from old house paint)
● Avoid feeding infant lying supine and avoid
propping feeding bottle in order to prevent
regurgitation, vomiting and aspiration
● To prevent suffocation avoid giving pillows in
the crib. Avoid plastic lined bibs, remove bibs
before sleeping. Do not tie the pacifier to the
infants neck. Keep out of reach plastic bag.
● To prevent falls: Keep crib rails up all times, use
stair guards,. Never leave the infant alone in a
high chair. Use restraints properly as indicated.
● Remove all objects that the infants may choke
on. Avoid sma with removable parts
Safety
Care safety - use infant sear properly, rear-facing
position (9 kg/20 lbs)
To prevent burns-check temperature of bath water, keep
electrical outlet covered.

Immunization
PD 996 (1976)-Compulsory immunization against
tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis
and measles
RA 7846 (1994)- Compulsory immunization against
Hepatitis

Red Flags in infant development

• Unable to sit alone by age 9 months

• Unable to transfer objects from hand to hand by age 1
year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.