GROWTH & DEVELOPMENT infants can lift both the head and chest off the
, homelessness
(NCM – 107 Finals)
Definition of Terms:
Growth - quantitative measurement or the
increase in size of the whole or any of the body
parts.
Development- qualitative measurement of
increasing capacity to function at more
advanced levels.
Growth - Physical change and increase in size.
-Generally takes place during the first 20 years
of life. Indicators:
 Height
 Weight
 Bone size
 dentition
-Increase in the Complexity of function and skill
progression.
-Behavioral aspect of growth.
Principles of Growth and Development
1.Growth and development are continuous
processes from Conception until death.
Although there are highs and lows in terms of
the rate at which growth and development
proceed, at all times a child is growing new cells
and learning new skills.
2. Growth and development proceed in an
orderly sequence.
Growth and development proceed in an orderly
sequence. - Growth in height occurs in only one
sequence-from smaller to larger. - Development
also proceeds in a predictable order. For
example, the majority of children sit before
they creep, creep before they stand, stand
before they walk, and walk before they run.
3.Different children pass through the
predictable stages at different rates
- All stages of development have a range of time
rather than a certain point at which they are
usually accomplished.
-Two children may pass through the motor
sequence at such different rates, for example,
that one begins walking at 9 mos, another only
at 14 mo. Both are developing normally.
- They are both following the predictable
sequence; they are merely developing at
different rates.
4. All body systems do not develop at the
same rate.
-Certain body tissues mature more rapidly than
others.
-For example, neurologic tissue experiences its
peak growth during the first year of life,
whereas genital tissue grows little until puberty.
5. Development is cephalocaudal.
Cephalo is a Greek word meaning "head";
caudal means "tail." Development proceeds
from head to tail
-Newborns can lift only their head off the bed
when they lie in a prone position. By age 2 mo,
e.g.
bed; by 4 mo, the head, chest, and part of the
abdomen; by 5 mo, infants have enough control
to turn over; by 9 mos, they can control legs
enough to crawl; and by 1 yr., children can
stand upright and perhaps walk. Motor
development has proceeded in a cephalocaudal
order-from the head to the lower extremities
DEVELOPMENT PROCEEDS FROM
PROXIMAL TO DISTAL BODY PARTS.
DEVELOPMENT PROCEEDS FROM GROSS TO
REFINED SKILLS.
THERE IS AN OPTIMUM TIME FOR
INITIATION QE EXPERIENCES OR LEARNING.
Neonatal reflexes A great deal of skill
must be lost before and behavior is
development can learned by practice
proceed.
FACTORS INFLUENCING GROWTH AND
DEVELOPMENT
1.Genetics
-genetic inheritance of an individual is
established at conception.
-remains unchanged throughout life and
determines such characteristics as gender,
physical characteristics (e.g., eye color,
potential height), and, to some extent,
temperament.
2. Temperament
-(i.e., the way individuals respond to their
external and internal environment) sets the
stage for the interactive dynamics of growth
and development.
-Temperament may persist throughout the life
span, though caution must be taken not to
irrevocably "label or categorize infants and
children
3. Family
-Purpose of a family: provide support and safety
for the child.
-Family is the major constant in a child's life.
-Families are involved in their children's physical
and psychological well-being and development.
Children are socialized through family dynamics.
The parents set expected behaviors and model1
appropriate behavior.
4. Nutrition
Adequate nutrition is an essential Component
of growth and development.
For example, poorly nourished children: more
likely to have infections than are well-
nourished children.
Poorly nourished children may not attain their
full height potential
5. Environment
-A few environmental factors that can influence
growth and development include living
conditions of the child
socioeconomic status (e.g, poor versus
financially stable) climate, and community (e.g,
provides developmental support versus exposes
the child to hazards)
6. Health Illness
- injury, or congenital conditions (e.g, congenital
cardiac conditions) can affect growth and
development. Being hospitalized is stressful for
a child and can affect coping mechanisms of the
child and family. Prolonged or chronic illness
may affect normal developmental processes.
7. Culture
-Cultural customs can influence a child's growth
and development.
-Nutritional practices may influence the rate of
growth for infants.
-Child-rearing practices may influence
development.
Child Developmental Theorists
A PSYCHOSEXUAL DEVELOPMENTAL THEORY:
Sigmund Freud
PSYCHOSOCIAL THEORY: Erik Erikson
COGNITIVE THEORY: Jean Piaget MORAL
DEVELOPMENT: Lawrence Kohlberg
Psychosexual Development - Sigmund Freud
developing instincts or sensual pleasure
-described adult behavior as the result of
instinctual drives
 that have a primarily sexual nature
(libido) that arise from within the
person and
 the conflicts that develop between
these instincts (represented in the
individual as the (id), reality (the ego),
and society (the superego).
-described child development as being a series
of psychosexual stages in which a child's sexual
gratification becomes focused on a particular
body part
Infancy (1 Toddlerhood
month-1-year (1-3 years):
Oral stage Anal stage
School-age Preschool
(6-12 years) (3-5 years):
Latency stage Phallic Stage
Adolescence
(13 years -21
years) Genital
stage
INFANCY
Freud termed the infant period the "oral phase"
because infants are so interested in oral
stimulation or pleasure during this time.
According to this theory, infants suck for
enjoyment or relief of tension, as well as for
nourishment.

Infancy
Nursing Implication
- Provide oral stimulation by giving pacifiers; do
not discourage thumb sucking
- Breastfeeding may provide more stimulation
than formula feeding because it requires the
infant to expend more energy.
Toddler
Freud described the toddler period as an "anal
phase" because during this time, children's
interests focus on the:
- anal region as they begin toilet training.
Elimination takes on new importance for them.
- Children find pleasure in both the retention of
feces and defecation.
- This anal interest is part of toddlers':
1. self-discovery,
2. a way of exerting independence, and
3. probably accounts for some of the difficulties
parents may experience in toilet- training
children of this age.
Nursing Implication:
-Help children achieve bowel and bladder
control without undue emphasis on its
importance.
-If at all possible, continue bowel and bladder
training while child is hospitalized.
Preschooler
-During the preschool period, children's
pleasure zone appears to shift from the anal to
the genital area.
- Freud called this period the "phallic phase."
Child learns sexual identity through awareness
of genital area.
-Masturbation is common during this phase.
-Children may also show exhibitionism,
suggesting they hope this will lead to increased
knowledge of the two sexes
Nursing Implication:
Accept children's sexual interest, such as
fondling their own genitals, as a normal area of
exploration.
Help parents answer child's questions about
birth or sexual differences.
School-Age
- Freud saw the school-age period as a "latent
phase, a time in which children's libido appears
to be diverted into concrete thinking.
- He saw no developments as obvious as those
in earlier periods appearing during this time.
Nursing Implication:
Help children have positive experiences with
learning so their self-esteem continues to grow
and they can prepare for the conflicts of
adolescence.
Adolescent
– Freud termed the adolescent period the
"genital phase”.
Freudian theory considers the main events of
this period to be the establishment of new
sexual aims and the finding of new love objects.
Adolescent develops sexual maturity and learns
to establish satisfactory relationships with the
opposite sex.
Nursing Implication:
Provide appropriate opportunities for the child
to relate with opposite sex; allow child to
verbalize feelings about new relationships.
PSYCHOSOCIAL
DEVELOPMENT - ERIK
ERIKSON - STAGES OF
PERSONALITY
-stresses the importance of culture and society
in development of the personality.
-One of the main tenets of his theory, that a
person's social view of self is more important
than instinctual drives in determining behavior,
allows for a more optimistic view of the
possibilities for human growth.
INFANCY
: Trust vs mistrust
Toddlerhood
: autonomy vs shame and
doubt
Preschool
: initiative vs guilt
School age
: industry vs inferiority
Adolescents
: Identity vs role confusion
Young adult
: intimacy vs isolation
Middle Adult
: Generativity vs stagnation
Late adult
: ego integrity vs
Cognitive
Development- Jean
Piaget -intelligence
1 month to 24 months: Sensorimotor
2 to 7 years: Preoperational (preqenceptual)
thought
7 to 12 years: Concrete operational thought
12 years: Formal operational thought
3 Sensorimotor Neonatal reflex (1 month)
-Stimuli are assimilated into beginning mental
images.
Primary circular reaction (1-4 mo)
-Hand-mouth and ear-eye coordination
develop.
-Beginning intention of behavior is present
1 month to 24 months:Sensorimotor
Secondary Circular Reaction (4-8 mo)
-Infant learns to initiate, recognize, and repeat
pleasurable experiences from environment.
-Memory traces are present; infant anticipates
familiar events
1 month to 24 months: Sensorimotor
Coordination of Secondary Reactions (8-12 mo)
-Infant can plan activities to attain specific
goals.
- Can search for and retrieve toy that disappears
from view.
1 month to 24 months: Sensorimotor
Tertiary Circular Reaction (12-18 mo)
-Child is able to experiment to discover new
properties of objects and events.
-Capable of space perception and time
perception as well as permanence
1 month to 24 months: Sensorimotor
Invention of new means through mental
combinations (18-24 mo)
-Transitional phase to the preoperational
thought period.
-Uses memory and imitation to act.
-Can solve basic problem
2 to 7 years: Preoperational (preconceptual)
thought
-Thought becomes more symbolic.
-Comprehends simple abstractins but thinking is
basically concrete and literal.
-Child is egocentric.
-Displays static thinking.
7 to 12 years: Concrete operational thought
-Concrete operations includes systematic
reasoning.
-Classifications involve sorting objects according
to attributes.
-Child is aware of reversibility.
-Understands conservation.
12 years: Formal operational thought
- Can solve hypothetical problems with scientific
reasoning.
-understands causality and can deal with the
past, present, and future
-Adult or mature thought.
MORAL DEVELOPMENT LAWRENCE KOHLBERG
Lawrence Kohlberg (1927-1987), a
psychologist.
- Studied the reasoning ability of boys and, to grasp, large goal and not that he is forced to do what the
based on Piaget's development stages. enough or safety adult wishes.
6 – 9 months Large toys with
- developed a theory on the way children gain bright colors, Temper tantrums
knowledge of right and Wrong or moral movable parts - occurs when the child cannot integrate his
reasoning. 9 – 12 months Books with large internal impulses by the demands of reality.
pictures, push – pull
toys, Teddy bears Nursing care:

Preconventional Conventional  Do not give extra attention- ignore

Infants: Accident Prevention  Do not restrain- prevents expression of
(Level 1) (Level 2) anger .
a) Falls- always raise crib rails, when in doubt
 Do not punish
about where to place child use the floor
 Do not yield to the child- be firm and
b) Suffocation- keep all plastic bags stored away consistent
from infanë' s reach, discard large plastic  Do not give emotional or material
garment bags. After tying in a knot, do not tie bribes Divert attention
Postconventional pacifier on string around infant's neck.  Ensure safety
(Level 3)  Tell the child simply that you
c) Aspiration- inform parents of dangers form
disapprove of the behavior
baby powder.
Toilet training
d) Burns- check bath waters and warmed
Preconventional (Level 1) formula and food, place plastic guards over -Do not introduce morality into toilet training-
electrical outlets keep hanging table clothes out child may view himself as worthless and may
Stage 1 (2-3 years ) of reach. begin to think that all physical functions are
-Punishment/obedience orientation distasteful.
e) Poisoning- make sure that paint for furniture
("heteronymous morality) or toys does not contain lead - place toxic -Do not flush toilet while child is sitting down-
substinces on high shelf and/or locked cabinet - has poor sense of space.
Stage 2 (4-7 years)
administer medications as a drug, not as a
Individualism. candy. -Do not wake during the night to void- it
conditions child to void every so often instead
-Carries out actions to satisfy own needs rather f) Motor Vehicles- transport infant in a specially of retaining urine for 12 hours while they sleep
than society's. constructed rear-facing car seat with
appropriate restraints. Separation Anxiety
Conventional (Level 2)
Develpmental Problems  Say goodbye firmly
Stage 3 (7-10 years old)  Assure child that you'll be back- ex.
Teething "After family TV show..." because child
- Orientation to interpersonal relations of
mutuality. s/S: irritability, rubbing of gums, crying has poor concept of time
 Do not sneak out- cause fear of
Stage 4 (10-12 years old) -Nursing care abandonment
- Maintenance of social order, fixed rules, and -Give teethers, teethin foods Speech
authority.
Thumb sucking Learned by imitating adults
Postconventional (Leve 3)
-Nursing care: Allow thumb suck during the 1st Causes of delayed speech:
Stage 5 (Older than 12 years old) year
 Intelligence
- Social contract, utilitarian law- making - Use pacifiers  Deafness Social and cultural
perspectives. environment
Constipation
Stage 6  Sex
Nursing care:  llness
- Universal ethical principle orientation.  Learning 2 or more languages at the
-Give fruits/fluids in between feedings Colic
Expected Stages of Play Development same time
-Nursing care: Avoid giving gas-forming foods,  Poor models
a) Age Characteristics place on knee-chest position  Negativism
1. Exploratory (holding toys: age 0- 1year) Miliaria ("Prickly Heat") Rules to promote language development: -
Speak- clearly, correctly progressively (do not
2. Toys as adult toys (imitation: age 1-7 years -Nursing care: Bath often
cut sentences), often, dramatically
3. Games and Hobbies (age 8-12 years) Developmental Problems
-Listen attentively
Dawdlıng /Dilly dallying
-Read regularly to a child with picture -
b) Social Characteristics S/S: child fins it difficult to perform task Stimulate often
1. Solitary Play-alone, but enjoys presence of Nursing care: Simplify task, Give one item at a -Reward communication
others, interest centered on own activity. (0-18 time when dressing up
Play During Preschool Years
months)
Ritualistic Behavior
-Cooperative Play
2. Parallel Play plays alongside, not with,
Nursing care: Allow child to master skill
another; characteristic of toddlers, but can  Organized, rules, leader/ follower
occur in other age groups. (18 months - 3 years) Negativism relationship established.
3. Associative Play- no group g3l; often follows  Through lay, the child deals with reality,
a leader. (3-6 years) Nursing care:
learns control of feelings and expresses
-Do not use opposition in a child because it emotions more through words than
4. Cooperative Play -organized, rules, leader/
increases the child's drive to slow his through actions.
relationship established. (6-12 years
independence  Age appropriate toys and activities,
offer playground materials,
-Eliminate asking questions that require a "yes" housekeeping toys coloring books,
Birth – 2 months Mobile or "no" answer tricycles with helmet.
2-4 months Rattles, Cradle Gym
4-6 months Brightly – colored -Give physical care- allow toddler to feel that he
toys ( small enough and the adult are working towards a common
 Health Problems Most Common in
Preschoolers

-Fears about body image are now greater than

fear of separation Fears include:

a. Intrusive experiences; needles, thermometer,

otoscope

b. Punishment and rejection

c. Pain

d. Castration and mutilation

Developmental Problems

Fear of the dark

 Because child is highly imaginative,

assure child this is normal
 Urge parents to turn off the light in
child's room and look at the room in the
child's perspective
 Help determine reality from fiction/
fantasy.

Fear of mutilation (Castration Anxiety)

 Do not use the word cut" but "prepare"

 Postpone circumcision to later years