NCM 107 A___(CARE OF MOTHER, CHILD AND ADOLESCENTS (WELL CLIENT)

GROWTH AND DEVELOPMENT

Desdimona C. Sakandal, MN, RN, RM

Course Facilitator

Table of Contents

A. Theoretical approaches to the growth and development of children.

B. Nursing process for promotion of normal growth and development.

1. The family with an infant

2. The family with a toddler

3. The family with a preschooler.

4. The family with a school aged child.

5. The family with an adult adolescent.

LESSON 1 : Principles and Theoretical Approaches to the Growth and Development of
Children.

INTRODUCTION :

Growth and development is a lifelong process. It is a continuum

that involves the different concepts and theories which applies to the child’s
growth and development pattern. It highlights the psychosocial, cognitive and
moral aspects as well as the physical growth and maturation in various stages
from newborn to adolescence. It provides relevant information which will guide
us in understanding the different changes that occurs as the child moves along
the life stages and specific nursing implications in dealing with these changes.

OBJECTIVES : At the end of this module, you should be able to;

1. Differentiate growth from development.

2. Explain the general principles of growth and development.
3. Describe the different theoretical approaches of the child’s
psychosocial, cognitive and moral development across stages.
4. Apply these theoretical approaches in the care of the child in
various stages of growth and development

Try this!

Read and understand the following statements. Indicate which of the general principles of
growth and development best describe the statements.

5. Growth is from small to big and follows a certain sequence or

order.
 Growth
___________________________________________
and development proceeds in an orderly sequence.

6. Development begins with the head ending with the tail.

 ________________________________________________
Development is Cephalocaudal.

7. Systems of the body vary in their period of development and

functioning.
All body systems do not develop at the same rate.
 _______________________________________________
 8. Tasks are learned at the appropriate time.
 There
________________________________________________
is an optimum time for initiation of experiences or learning.

9. New skills are learned and new cell grow continuously.

 Growth and development are continuous processes from conception until
________________________________________________
death.
10. A child learns to hold before he/she can write.
Development proceeds from gross to refined skills.
 _______________________________________________

11. Two children may both learn to walk at different time range.
 Children pass through predictable stages at different rates.
________________________________________________

12. A child learns to hold things once the grasp reflex disappears.
 _______________________________________________
Neonatal reflexes must be lost before development can proceed.

13. A child attempts to take a few steps, walk and may fall several
times in order to accomplish the skill of walking.
 ________________________________________________
A great deal of skill and behavior is learned by practice

Think ahead!

A. Think of at least three (3) factors which may influence a child’s growth and development
and support your answer by providing an example.

FACTORS EXAMPLES
1. Genetics  Our parents' genes influence everything from our height, eye
color, hair color, and other physical characteristics to our
intelligence, behavioral patterns, and personality traits,
including diseases or disabilities. Our genetic background, as
well as environmental influences, shape who we are today.

2. Health A child's current health condition influences its growth and

development in such a way that the presence of illnesses may
interfere with the child's growth and development processes.

3. Gender In the processes of growth and development, characteristics

of boys and girls differ, particularly in their physical
appearance, whereas height and weight patterns are different
considering that girls are shorter and lighter than boys as
puberty ends. Moreover, they also differ in their personality
traits and behavioral patterns as a result of gender roles,
norms, and practices expected of them.

B. Complete the table below by indicating the appropriate answers based on Freud’s and
Erikson’s Theories of Personality Development.
 STAGE DEVELOPMENTAL TASK PSYCHOSEXUAL STAGE

Infant Trust vs. Mistrust Oral Stage

Toddler Autonomy vs. Shame and Doubt Anal

Preschooler Initiative vs. Guilt Phallic

School-Age Child Industry vs. Inferiority Latency

Adolescent Identity vs. Role Confusion Genitals

C. Identify the appropriate moral development based on Kohlberg’s Theory being

described in the following sentences.

Conventional Development (3) 1. The focus of behavior is not what is right or wrong but what
is “nice”.

Postconventional Development (6) 2. Internalizes standards of conduct, doing what he or she

thinks is right

regardless of an existing social rule.

Preconventional Development (2) 3. The child tries to imitate doing gestures or behaviors only
for gestures in

return.

Preconventinal Development (1) 4. Punishment-obedience orientation, easily governed by

parental authority.

D. Matching Type : Match Column A (Piaget’s Stages of Development) with Column B

(description of Piaget’s Stages), write the letter corresponding to your answer on the
space provided.

COLUMN A COLUMN B

_C__ 1. Sensorimotor A. Thinking in terms of what could be

than what currently exist

__E__ 2. Preoperational thought B. Inductive reasoning, from specific to

general

__D___ 3. Intuitive thought C. Development of the concept of

permanence and goal-directed
behavior

__B___ 4. Concrete operational thought D. Object viewed as having only one

characteristics

__A__ 5. Formal operational thought E. Symbolic thought, egocentric and static

thinking
 Read and Ponder

 Growth – refers to a quantitative change; an increase in height and weight. Process of

physical maturation resulting to an increase in body size and various organs.
 Development – denotes a qualitative change; one’s maturation or skills development;
an increase in one’s ability to perform tasks.

GENERAL PRINCIPLES OF GROWTH AND DEVELOPMENT :

1. Growth and development are continuous processes from conception until death.
2. Growth and development proceeds in an orderly sequence.
3. Children pass through the predictable stages at different rates.
4. All body systems do not develop at the same rate.
5. Development is cephalocaudal.
6. Development proceeds from proximal to distal body parts.
7. Development proceeds from gross to refined skills.
8. There is an optimum time for initiation of experience or learning.
9. Neonatal reflexes must be lost before development can proceed.
10. A great deal of skill and behavior is learned by practice

Factors Influencing Growth and Development :

1. Genetics – eye color and height potential are determined in one’s genetic make-up upon
conception. This may also include disabilities and diseases.

2. Gender – There are differences in height and weight patterns among boys and girls.
e.g. girls are shorter and lighter in weight than boys as puberty ends.

3. Health – illnesses may interfere with the child’s growth and development process.

4. Intelligence – Children with high intelligence tend to grow and develop their physical skills
slower since they spend much of their time reading or with mind games.

5. Temperament – how a child responds to his environment or situation is innate or congenital.

Categories of Temperament :

A. The EASY child – has predictable rhythmicity, approach and adapts to new situations readily,
have a mild to moderate intensity of reaction and have an overall positive mood quality.
B. The Intermediate Child – some characteristics of both easy and difficult groups are present
C. The Difficult Child – irregular in habits, have a negative mood quality, and withdraw rather
than approach new sitations.
D. The Slow-to-Warm-Up Child – fairly inactive, respond only mildly and adapts slowly to new
situations, and have a general negative mood
6. Environment – Child’s growth and development can be influenced by the following;
A. Socio-economic level
B. Parent-Child relationship
C. Ordinal position in the family
D. Health
E. Nutrition

Theoretical Approaches to Growth and Development of Children :

 Theory – a systematic statement of principle that provides a framework for explaining a

phenomenon.
 Developmental Theories – provides road maps for explaining human development.
 Developmental Tasks – are skill or a growth responsibility arising at a particular time in
an individual’s life, in which achievement will provide a foundation for the
accomplishment of future tasks.

BASIC DIVISION OF CHILDHOOD :

STAGE AGE PERIOD

Neonate First 28 days of life
Infant 1 month to 1 year
Toddler 1-3 years
Preschooler 3-5 years
School-Age child 6-12 years
Adolescent 13-17 years
Late Adolescent 18-21 years

1. FREUD’S PSYCHOANALYTIC THEORY

 Sigmund Freud (1856-1939) – an Austrian neurologist and founder of psychoanalysis.

 Described adult behavior as being the result of instinctual drives of a primarily sexual
nature (libido)
 Child development is a series of psychosexual stages in which a child’s sexual
gratification becomes focused on a particular body part at each stage.

https://it3psychproject.wordpress.com/2014/07/19/part-1-1-reaction-on-freuds-
theory/
Nursing Implications :

1. Infant – provide oral stimulation by giving pacifiers; do not discourage thumb sucking

2. Toddler – help children achieve bowel and bladder control without undue emphasis on its
importance.

3. Preschooler – Accepts children sexual interest such as fondling his or her own genitalia, as a
normal area for exploration

4. School-age Child – help children have positive experiences with learning so their self-esteem
continue to grow.

5. Adolescent – Provide appropriate opportunity for the child to relate with opposite and own
sex relationship.

2. ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT :

 Erik Erikson (1902-1996)

 Stresses the importance of culture and society in development of the personality.
 The person’s social view of self is more important than instinctual drives in determining
behavior.
 Described eight (8) developmental stages across life span which are conflicting or
opposing to each other, wherein resolution of each conflict will allow the individual to
progress to the next phase.
Nursing Implications :

1. Infant - provide a primary caregiver and experiences that add to security.

2. Toddler – provide opportunities for independent decision-making, such as choosing own

clothes.

3. Preschooler – provide opportunities for exploring new places or activities. Allow free-form
play

4. School-age Child – provide opportunities such as allowing child to assemble and complete a
short project.

5. Adolescent – provide opportunities to discuss feelings about events important to him or her.
Offer support and praise for decision-making.

3. PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

 Jean Piaget (1896 – 1980), a Swiss psychologist,

 Introduced how children learn and think
 Defined four (4) stages where children progress from one period to the next; children
reorganize their thinking process to bring them closer to adult thinking.

https://philocyclevl.wordpress.com/13th-lesson-211-stages-in-personality-development/

Nursing Implications :

A. Birth to 2 years

1 month - stimuli are assimilated into beginning mental images; entirely reflexive

1 – 4 months – hand-mouth and ear-eye coordination develop; rattle or tape of parents voice

4 – 8 months – infant learns to initiate, recognize and repeat pleasurable experiences from
environment; good toy-mirror; good play – peek-a-boo

8 – 12 months – infant can play activities to attain specific goals; good toy – nesting toys (e.g.
colored boxes)
12 – 18 months – Child is able to experiment to discover new properties of objects and events;
good game-throw and retrieve

18 – 24 months – Transitional phase to the preoperational thought period; good toys – things
with several uses ( blocks or colored plastic rings)

B. Preoperational Thought
 Thought becomes more symbolic; can arrive at answer mentally instead of through
physical attempt.
 Centering or focusing on a single aspect of an object causes distorted reasoning
 No awareness of reversibility (for every action there is an opposite action) is present
 Unable to state cause and effect relationships, categories or abstraction
 Good toy – items that require imagination (e.g. modeling clay)

C. Concrete Operational Thought

 Systematic reasoning; uses memory to learn broad concepts (fruits) and subgroups
(apple, banana)
 Classification involves sorting objects according to attributes (e.g. color), seriation
(increasing or decreasing measures like weight) and multiplication.
 Awareness of reversibility (retraces steps); understands conservation (able to discern
truth, even though physical properties change)
 Good activity – collecting and classifying natural objects (e.g.native plants or sea shells)
 Expose child to other view points by asking questions ( e.g. “How do you think you’d feel
if you are a nurse and had to tell a boy to stay in bed?”)

D. Formal Operational Thought

 Can solve hypothetical problems with scientific reasoning
 Good activity – “talk time” to sort through attitudes and opinions

4. KOHLBERG’S THEORY OF MORAL DEVELOPMENT

 Lawrence Kohlberg (1927 – 1987), a German psychologist

 Developed the theory on the way children gain knowledge of right or wrong and moral
reasoning.
Nursing Implications :

2 – 3 years old – child needs help to determine what are right actions; give clear instructions to
avoid confusion.

4 – 7 years old – child is unable to recognize that like situations require like actions; unable to
take responsibility for self-care because it interferes with meeting own needs.

7 – 10 years old – child enjoys helping others because this is nice behavior; praise for desired
behavior and allow in helping with activities (e.g. house chores).

10 – 12 years old – child often ask what the rules are and if something is right; may have
difficulty modifying a procedure because one method may not be right. Follows self-care
measures only if someone is there to enforce them.

Older than 12 – adolescents can be responsible for self-care because they view this as a
standard of adult behavior

Adulthood – universal ethical principle orientation; many adults do not reach this level of moral
development.

The Metro Manila Developmental Screening Test (MMDST)

- a screening test to note for normalcy of the child’s development and to determine any delays
as well in children 6 ½ years old and below. 

- Modified and standardized by Dr. Phoebe Williams from the original Denver Developmental
Screening Test (DDST) by Dr. William K. Frankenburg

MMDST evaluates 4 sectors of development:

• Personal-Social – tasks which indicate the child’s ability to get along with people and to
take care of himself

• Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands
to pick up objects and to draw

• Language – tasks which indicate the child’s ability to hear, follow directions and to
speak

• Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump

Explaining the Procedure :

 It has to be emphasized that this is not a diagnostic test but rather a screening test only

 When conducting the test, the parents or caregivers of the child under study should be
informed that it is not an IQ test as it may be misinterpreted by them.

 The nurse should also establish rapport with the parent and the child to ensure
cooperation.
Considerations :

• Manner in which each test is administered must be exactly the same as stated in the
manual, words or direction may not be changed

• If the child is premature, subtract the number of weeks of prematurity.  But if the child
is more than 2 years of age during the test, subtracting may not be necessary

• If the child is shy or uncooperative, the caregiver may be asked to administer the test
provided that the examiner instructs the caregiver to administer it exactly as directed in
the manual

• If the child is very shy or uncooperative, the test may be deferred

See if you can do this!

A. Complete the concept map of “I, Me and Myself”

Latrelle Mae S. Bernaldez

Overthinker

18 years old,
Young Adult/ Intimacy vs.
Adolescent Isolation

Post-Conventional Level--
is capable of internalizing
standards of conduct and able to relate well with other
is responsible of self-care
Formal Operational Thought people, and was able to form
(Reasoning Abstractly) a sense of identity vs role
confusion.

B. Case Study :

You are providing care to a 3-year old child who is admitted due to diarrhea with mild
dehydration and requires an intravenous therapy.
1. Give a description of the typical characteristics of your client’s psychosocial development.

According to Erik Erikson's Theory of Psychosocial Development, the patient is a toddler who is
learning Autonomy vs. Shame or Doubt. Since the patient is gaining a sense of autonomy, he or
she will tend to do things independently, recognizing the need to exercise his or her ability, and
is able to say yes or no in certain situations. In some instance, the patient might resist or say no
when introduced with the treatment if he/she does not conform to the procedure, especially
when he/she thinks of the possibility of getting hurt. On the other hand, the toddler might also
choose what he/she wants to eat or drink along the treatment.

2. Based on Piaget’s Cognitive development, what would you expect to observe from your
client?

According to Piaget’s Cognitive Development Theory, a toddler can comprehend simple

abstractions but thinking is basically concrete and literal. Child is egocentric (unable to see the
viewpoint of another). Displays static thinking (inability to remember what they started to talk
about so that at the end of a sentence children are talking about another topic). Therefore, the
patient may result to resist as they draw conclusion based on what they see. Since the
treatment requires intravenous therapy, you as a nurse would have to inject IV cannula to
introduce the IV fluid as a treatment. Given that he/she might experience pain upon doing the
treatment procedure, it is inevitable that the patient might get scared when he/she will see you
again as he/she will think that you would hurt him/her again with the procedure you’ve done.