Growth & Development

Growth & Development

Growth: generally used to denote an increase in
physical size (quantitative change) :
Wt = kg or lbs Height = cm or ft
Development: used to denote an increased in
skill or the ability to function (qualitative
change) measured by:
1. observing child’s ability to perform tasks
2. recording parents’ description
3. using standard tests
STAGES OF GROWTH AND DEVELOPMENT
Neonate/Newborn: Birth to 1 month

Infancy: 1 month to 1 year

Early Childhood (Toddlerhood): 1-3 years

Early Childhood (Pre-school Age): 3-6 years

Middle Childhood (School-age): 6-12 years

Late Childhood (Adolescent): 13-18 years

Middle to Late Adulthood (Elderly): 19-65 years

PEDIATRIC NURSING
Stages of Growth & Development
A. First Stage – pre-natal begins from conception to
birth
B. Second stage – from birth to 12 months
1. neonatal – first 28 days or the first 4 weeks of life.
2. Infancy – 1 to 12 months
C. Third Stage – Early Childhood ( 1-6 y/o)
1. Toddler – 1-3 y/o
2. Pre- school – 3-6 y/o
D. Fourth Stage – Late Childhood
1. School age – 6-12 y/o
2. Adolescence – 13 – 18 y/o
 Two Parameters of Growth
• WEIGHT: most sensitive measure of
growth
 2x ----- 6 mos
 3x-------1 yr
 4x--------2-2 ½ yr
• HEIGHT: increases by 1 inch per month
during first 6 months
– Average increase in Ht: 1st yr = 50 %

PEDIATRIC NURSING
 HEIGHT
↑ 1”/mo = 1 – 6 months
↑ 1.5”/mo = 7 – 12 months
↑ 50 % = 1st Year (doubles)

HEIGHT COMPARISON
9 y/o - Male = female
12 y/o - Male < Female
13 y/o - Male > Female
 OTHER PARAMETERS:
3. Bone size

Fig. 1. Changes in body proportions with physical growth

 OTHER PARAMETERS:
4. Dentition
 How to measure development?
1. by simply observing a child doing specific task
2. by noting parent’s description of the child’s
progress
3. by using standardized test:
a)DDST (Denver II
Developmental
Screening Test)
b) MMDST (Metro Manila
Developmental
Screening Test)
 MDDST
4 Main Rated Categories of MDDST
1. Language – for
communication
2. Personal- Social – ability to
interact
3. Fine Motor Adaptive – pre
tensile ability (ability to use
hand movement)
4. Gross Motor Skills – ability to
use large body movement
DENVER II TEST
 DENVER II TEST
This 125 easily administered
developmental test items, with age
norm, presented in a convenient one-
page format
Denver Developmental Screening Test II
 MATURATION

• “maturus” = ripe): the total way in which a person

grows and develops, as dictated by inheritance
(development of traits carried by genes)
• Development that are genetically and organically
programmed
 Maturation could refer to any of the
following:
1. Fetal development/Developmental biology
2. Emotional development
3. Physical maturation of any biological life
form
4. The emergence of personal and behavioral
characteristics through growth processes.
5. The final stages of differentiation of cells,
tissues, or organs
 Principles of Growth and
Development (Pillitteri, 2008)
1.Growth and development are
continuous process from conception
until death.
WOMB to ________)
(Principle: _________ TOMB
 Principles of Growth and
Development (Pillitteri, 2008)
2. Growth and development proceed
in an orderly sequence:
A. Maturation follows a predictable,
universal timetable
B. Developmental changes occur
rapidly during the first year of life
and slow during middle and late
childhood.
 Principles of Growth and
Development (Pillitteri, 2008)
3. Different children pass thru Cephalo-caudal

the predictable stages at

Proximo-distal
different rate Directional trends
Predictable stages Symmetrical

Mass-specific

Locomotion
Sequential
Language
Secular
 Principles of Growth and
Development (Pillitteri, 2008)
a. CEPHALOCAUDAL PATTERN (Head to Toe)

DIRECTIONAL
TREND

b. PROXIMODISTAL PATTERN (from the Center Outward)

 Principles of Growth and
Development (Pillitteri, 2008)
c. SYMMETRICAL
(general to specific)

d. MASS-SPECIFIC
(Differentiation)
 Principles of Growth and
Development (Pillitteri, 2008)
SEQUENTIAL TREND
Involves a
predictable
sequence of
growth and
development to
which the child
normally passes.
1.Locomotion
2.Language and
Social skills
 Principles of Growth and
Development (Pillitteri, 2008)
 This refers to the worldwide
SECULAR trend of maturing earlier and
TREND growing larger as compared
to succeeding generations.
 Principles of Growth and
Development (Pillitteri, 2008)
4. All body systems do not develop the
same rate
Patterns of Growth and Development
1. Renal, digestive, circulatory, musculoskeletal
(childhood)
2. Neurologic Tissue
- Grows rapidly during 1 – 2 years of life
- Brain (achieve to its adult proportion by 5
years)
- Central Nervous System
 Principles of Growth and
Development (Pillitteri, 2008)
4. All body systems do not develop the
same rate
3. Lymphatic System
- Lymph nodes, Spleen, Thymus
- Grows rapidly during infancy and childhood (to
provide protection against infection)
- Tonsils is achieved in 5 years
4. Reproductive Organ – grows rapidly during
puberty
 Principles of Growth and
Development (Pillitteri, 2008)
5. Development proceeds from gross to
refined skills (Becomes Increasingly
Differentiated)
 Responses become more specific and, skillful
as the child gets older.
6. There is an optimum time for initiation
of experiences or learning
 Children have a strong drive to practice and
perfect new abilities, especially when they are
young and not capable coping with several
new skills simultaneously.
 Principles of Growth and
Development (Pillitteri, 2008)
7. Neonatal reflexes must be lost before
development can proceed
 Persistent Primitive Infantile Reflex (suspect
Cerebral Palsy)
 Principles of Growth and
Development (Pillitteri, 2008)
8. A great deal of skill and behavior is
learned by practice (Becomes
Increasingly Integrated and Complex)
 As new skills are gained, more complex
tasks are learned.

9. Play is the 10. Behavior is a

universal most comprehensive
indicator of
language of a developmental
child. status
 Principles of Growth and
Development (Pillitteri, 2008)
11. Development Is Unique
 Every child has a unique timetable for
physiological, psychosocial, cognitive,
and moral development

12. Development Is Interrelated

 Physiological, psychosocial,
cognitive, and moral aspects of
development affect and are affected
by one another.
 Principles of Growth and
Development (Pillitteri, 2008)
13. Children are Competent
They possess qualities and abilities
ensuring their survival and promoting their
development.
14. New Skills Predominate
Children have a strong drive to
practice and perfect new abilities,
especially when they are young and
not capable coping with several new
skills simultaneously.
 Why developmental changes
come out?
Factors Influencing Growth and
Development
1) Genetics
2) Environment
3) Culture
4) Nutrition
5) Health Status
6) Family (Parental Attitudes & Child-
Rearing Philosophies)
CRITICAL PERIOD: specific time period
during which certain environmental
events or stimuli have greatest effect on a
child's development.
Theories of Development
• Freud, Sigmund Psychosexual
development
• Piaget, Jean Cognitive
development
• Erikson, Erik Psychosocial
development
Moral
• Kohlberg, Lawrence development

PEDIATRIC NURSING
PSYCHOSEXUAL DEVELOPMENT:
FREUD’S THEORY
PSYCHOSEXUAL DEVELOPMENT:
FREUD’S THEORY
PSYCHOSOCIAL DEVELOPMENT:
ERIKSON’S THEORY
 PSYCHOSOCIAL DEVELOPMENT:
ERIKSON’S THEORY
INFACNY
TODDLER
PRESCHOOL
 PSYCHOSOCIAL DEVELOPMENT:
ERIKSON’S THEORY
SCHOOL AGE
ADOLESCENCE
 PSYCHOSOCIAL DEVELOPMENT:
ERIKSON’S THEORY
YOUNG ADULT
MIDDLE ADULT

OLDER ADULT
 OVERVIEW OF ERIKSON’S DEVELOPMENTAL TASKS THROUGHOUT THE
LIFESPAN
Age Stage Erikson’s Positive Outcome Negative Outcome
Task
Birth to Infancy Trust vs. Trusts self and others Demonstrates an
18 mos Mistrust inability to trust;
withdrawal, isolation
18 mos Toddler Autonomy Exercises self-control and Demonstrates defiance
to 1 y vs. Shame influences the and negativism
and Doubt environment directly
3 to 6 y Preschool Initiative vs. Begins to evaluate own Demonstrates fearful,
Guilt behavior; learns limits on pessimistic behaviors;
influence in the lacks self-confidence
environment
6 to 12 y School age Industry vs. Develops a sense of Demonstrates feelings
Inferiority confidence; uses of inadequacy,
creative energies to mediocrity, and self-
influence the doubt
environment
12 to 20 Adolescen Identity vs. Develops a coherent Demonstrates inability
y ce Role sense of self; plans for a to develop personal
confusion future of work/education and vocational identity
COGNITIVE DEVELOPMENT:
PIAGET’S THEORY
MORAL DEVELOPMENT:
KOHLBERG’S THEORY
 Significant Persons
INFANCY Mother, mother substitute (Primary Caregiver)
Toddler Parents
Pre-schooler Members of the Basic Family
Schooler  Teacher
 Peer of Same Sex: Neighborhood and
classmates
 Adults other than parents are “HERO
worshiped”
Adolescent  Peers- greatest determined of his behavior;
 Models of leadership
 Sexual models
 Adults other than parents are Idolized
 Partners of the same and opposite Sex
(establish close relationship with the opposite
sex)
 Summary of Theories
THEORY Infancy Toddler Preschool School age Adolescence
(0-1y) (1-3y) (3-6y) (6-12) (12-20y)

FREUD Oral Anal Phallic Latency Genital

Psychosexual
Oedipal
PIAGET Sensori- Sensori- Preoperational Concrete Formal operation
Cognitive motor motor

ERIKSON Trust Autonomy Initiative vs. Industry vs. Identity vs. role
Psychosocial vs vs. Shame guilt inferiority confusion
mistrust & doubt

KOHLBERG Pre- Pre- Pre-conventional Conventional/ Post-conventional/

Moral conventional conventional (Intuitive phase) Concrete Formal operation
(Sensori- (Pre- Operational (Deductive and
motor) conceptual (inductive Abstract
phase) reasoning, Thinking)
beginning logical
thinking)
PEDIATRIC NURSING
SPIRITUAL DEVELOPMENT:
FOWLER’S THEORY
Stage ‘0’: Undifferentiated

Stage ‘1’: Intuitive Projective

Stage ‘2’: Mythical Literal

Stage ‘3’: Synthetic Convention

Stage ‘4’: Individuating Reflexive

LANGUAGE DEVELOPMENT THEORY
THEORY ON DEVELOPMENT OF
TEMPERAMENT
 THEORY ON DEVELOPMENT OF
TEMPERAMENT
Temperamental Qualities: Type of
1.Activity level Temperament:
2.Sensitivity and reactions A.Easy Child
to external stimuli B.Difficult Child
3.Adaptability C.Slow-to-
Warm-Up
4.Level of Intensity
Child
5.Distractibility
6.Approach/Avoidance &
Withdrawal
7.Persistence
8.Regularity & organization
9.Mood
 REFERENCES
• Butkus, S.C. (2015). Maternal-neonatal nursing made incredibly
easy! Third edition. Copyright 2015. Wolters Kluwer Health |
Lippincott Williams & Wilkins.
• Carley, Jerry (2011). Nursing Growth and Development Overview.
Accessed from: http://nursing--growth-and-
development.pbworks.com/w/page/10228855/G%20and%20D--
General%20Overview
• Kendra, Cherry (2020). Erik Erikson’s Psychosocial
Development. Theories: Psychosocial Psychology. VeryWell Mind
Website. https://www.verywellmind.com/erik-eriksons-stages-of-
psychosocial-development-2795740
• Pillitteri, Adele. (2010). Maternal and child health nursing: Care of
the childbearing and childrearing family; 6th edition.
• Tabangcora, Iris Dawn (2017). Maternal and Child Health Nursing
– Development Milestones: Normal Pediatric Development
Milestones. Last updated on January 19, 2017. Retrieved from:
https://nurseslabs.com/normal-pediatric-developmental-milestones/