Chapter 15

An Overview of Growth,
Development, and Nutrition
 Objectives

• Explain the differences among growth,

development, and maturation.
• Recognize and read a growth chart for
children.
• List five factors that influence growth and
development.
• Discuss the nursing implications of growth
and development.

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 Objectives (cont.)

• Discuss the importance of family-centered

care in pediatrics.
• Recognize the influence of the family and
cultural practices on growth, development,
nutrition, and health care.
• Describe three developmental theories and
their impact on planning the nursing care of
children.

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 Objectives (cont.)

• Discuss the nutritional needs of growing

children.
• Differentiate between permanent and
deciduous teeth, and list the times of their
eruption.
• Understand the characteristics of play at
various age levels.
• Describe the relationship of play to physical,
cognitive, and emotional development.
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 Objectives (cont.)

• Understand the role of computers and

computer games in play at various ages.
• Define therapeutic play.
• Understand the use of play as an
assessment tool.

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 Growth and Development

• Differences between adult and child

– The child is in a continuous process of growth
and development
– Growth spurts followed by plateaus
– The growth is measurable, can be observed
and studied
– Not all parts mature at the same time

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 The Impact of Growth and
Development on Nursing Care
• Developmental needs will have an impact on
a child’s response to illness
• The nurse must know what is normal in order
to recognize any deviations within a given
age group and plan care accordingly
– A child differs in anatomy and physiology as
compared to the adult; therefore, illnesses and
their responses to them, including treatments,
may be different

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 The Nursing Process Applied to
Growth and Development
• Data collection
– Height and weight, plot standard growth chart
– Record developmental milestones achieved
related to age of child
– Observe infant; interview parents
• Analysis/nursing diagnosis
– Determine appropriate nursing diagnoses
related to parenting, coping skills, and unmet
developmental needs
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 The Nursing Process Applied to
Growth and Development (cont.)
• Planning
– Offer guidance and teaching to family, school
personnel, and child to meet developmental
needs
• Implementation
– Interventions that foster growth and
development in the hospital setting can include
encouraging age-appropriate self-care
– Anticipatory guidance may be given to parents
so they understand changes in behavior, eating
habits, and play for the growing child
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 The Nursing Process Applied to
Growth and Development (cont.)
• Evaluation
– Ongoing evaluation of growth and
development of the child and follow-up of
teaching and guidance offered at prior
clinic/home visits are essential

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 Key Terms in Child Development

• Development
– A progressive increase in the function of the
body
• Growth
– An increase in physical size, measured in feet
or meters and pounds or kilograms
• Maturation
– The total way in which a person grows and
develops, as dictated by inheritance
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 Directional Patterns

• Fundamental to all
humans
– Cephalocaudal
• Proceeds from head to
toe
– Proximodistal
• From midline to
periphery

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 Some Developmental Differences
Between Children and Adults
• Height • Kidney function
• Weight • Nervous system
• Body proportions • Sleep patterns
• Metabolic rates • Bone growth
• Respirations • Critical periods
• Cardiovascular • Integration of skills
system
• Immunity

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 Growth Standards

• Measured in • Standardized
dimensions – Compare the
– Height measurement of a child
– Weight to others of the same
age and sex
– Volume
– Compare the child’s
– Tissue thickness
present measurements
with the former rate of
growth and pattern of
progress

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 Growth Charts

• Children who are in

good health tend to
follow a consistent
pattern of growth
• At any age, there
are wide individual
differences in
measured values
• There are separate
charts for boys and
girls
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 Developmental Screening

• Denver Developmental Screening Test

– Assesses the developmental status of children
during the first 6 years of life in four categories
• Personal-social
• Fine motor-adaptive
• Language
• Gross motor
– Purpose is to identify children unable to
perform at an age-appropriate level
– Not an intelligence test
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 Influencing Factors

• All of the following factors are closely related

and dependent on one another in their effect
on the growth and development of the child
– Heredity
– Nationality and race
– Ordinal position within the family
– Gender
– Environment

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 Types of Families

• Nuclear • Dual career

• Extended • Blended
• Single parent • Polygamous
• Foster parent • Homosexual
• Alternative • Cohabitation

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 Family Apgar

• Used to assess family function

– Adaptation
– Partnership
– Growth
– Affection
– Resolve
• Enables the nurse to develop interventions
that aid the family to achieve a healthier
adaptation to the child’s health needs
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 Family as Part of a Community

• Factors to consider
– Housing
– Access to public transportation
– City services
– Safety
– Health care delivery system
– Assessment of community is important in
creating discharge plans for family

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 Homeless Family

• Has an impact on the growth and development

of a child
• Support system and financial resources often
lacking
• School or emergency department nurse may be
the only contact with health care or may be the
first to identify the status of the family
• Community referrals for food, housing,
education, and financial assistance are essential

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 Personality Development

• Personality is the result of interaction

between biological and environmental
heritages
• Unique organization of characteristics that
determine the individual’s typical or recurrent
pattern of behavior

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 Developmental Theorists

• Erikson
• Freud
• Kohlberg
• Sullivan
• Piaget
• Maslow

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 Maslow’s Hierarchy of Needs

• The needs at the

bottom of the
pyramid must be
met before one
can fulfill needs
at the next
higher level

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 The Growth and Development of a
Parent
• First prenatal trimester
– Child’s tasks
• Growth
– Parent’s task
• Develop attitude toward newborn. Happy? Parent of
disabled child? Unwed mother? These factors and
others affect the developing attitude of the mother.
– Nursing intervention
• Develop positive attitude in both parents concerning
expected birth of child. Use referrals and agencies as
needed.
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 The Growth and Development of a
Parent (cont.)
• Second prenatal trimester
– Child’s task
• Growth
– Parent’s task
• Mother focuses on infant because of fetal movements
felt. Parents picture what infant will look like, what
future he or she will have, and other ideas.
– Nursing intervention
• Parents on child care and needs and providing
physical environment for expected infant. Information
about newborn care should be given at this time.
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 The Growth and Development of a
Parent (cont.)
• Third prenatal trimester
– Child’s task
• Growth
– Parent’s task
• Mother feels large. Attention focuses on how fetus
is going to get out.
– Nursing intervention
• Detailed information should be presented at this
time concerning the birth processes, preparation for
birth, breastfeeding, and care of sibling at home.

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 The Growth and Development of a
Parent (cont.)
• Birth
– Child’s task
• Adjust to external environment.
– Parent’s task
• Elicit positive responses from child and respond by meeting child’s
need for food and closeness. If parents receive only negative
responses (e.g., sleepy infant, crying infant, difficult feeder,
congenital anomaly), parental development will be inhibited.
– Nursing intervention
• Encourage early touch, feeding, and other practices. Explain
behavior and appearance of newborn to allay fears. Help parents
to identify positive responses. (Use infant’s reflexes, such as
grasp reflex, to identify a positive response by placing mother’s
finger into infant’s hand.)
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 The Growth and Development of a
Parent (cont.)
• Infant
– Child’s task
• Develop trust.
– Parent’s task
• Learn “cues” presented by infant to determine
individual needs.
– Nursing intervention
• Help parents assess and interpret needs of infant
(avoid feelings of helplessness or incompetence). Do
not let grandparents take over parental tasks. Help
parents cope with problems such as colic.

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 The Growth and Development of a
Parent (cont.)
• Toddler
– Child’s task
• Autonomy
– Parent’s task
• Try to accept the pattern of growth and
development. Accept some loss of control but
maintain some limits for safety.
– Nursing intervention
• Help parents cope with transient independence of
child (e.g., allow child to go on tricycle but don’t yell
“Don’t fall” or anxiety will be radiated).
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 The Growth and Development of a
Parent (cont.)
• Preschool
– Child’s task
• Initiative
– Parent’s task
• Learn to separate from child.
– Nursing intervention
• Help parents show standards but “let go” so child
can develop some independence. A preschool
experience may be helpful.

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 The Growth and Development of a
Parent (cont.)
• School-age
– Child’s task
• Industry
– Parent’s task
• Accept importance of child’s peers and learn to accept some
rejection from child at times.
• Patience is needed to allow children to do for themselves, even
if it takes longer. Do not do the school project for the child.
Provide chores for child appropriate to his age level.
– Nursing intervention
• Help parents understand that child is developing his or her own
limits and self-discipline. Be there to guide child, but do not
constantly intrude. Help child get results from his or her own
efforts at performance.
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 The Growth and Development of a
Parent (cont.)
• Adolescence
– Child’s task
• Establishing identity
• Accepting pubertal changes
• Developing abstract reasoning
• Deciding on career
• Investigating lifestyles
• Controlling feelings

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 The Growth and Development of a
Parent (cont.)
– Parent’s task – Nursing intervention
• Parents must learn to let • Help parents adjust to
child live his or her own changing role and
life and not expect total relationship with
control over the child. adolescent.
• Expect, at times, to be • Expose child to varied
discredited by teenager. career fields and life
• Expect differences in experiences. Help child
opinion and respect to understand
them. Guide but do not emerging emotions
push. and feelings brought
about by puberty.
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 Erikson’s Stages of Development

• Tasks must be mastered at each stage to

achieve optimum maturity
• Each builds on the successful completion of
the previous stage
• Parents must interact with their child to assist
the child to master the various stages

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 Piaget’s Theory of Cognitive
Development
• Intellectual ability • Ages for each stage
• Intellectual maturity is are approximate
attained through four and each builds
orderly and distinct upon the others
stages of development, • Consists of
all are interrelated interactions and
– Sensorimotor coping with the
– Preoperational environment
– Concrete operations
– Formal operations
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 Kohlberg’s Theory of Moral
Development
• Sequential
• Theory is based upon Piaget’s
• Three levels
– Preconventional
– Conventional
– Postconventional
• Each level contains two stages
• Emphasis on the conscience of the individual
within society
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 Parent Teaching

• Experiences in dealing with challenges and

disappointments prepare the child to function
independently in adulthood
• Encourage child to deal with successes and
failures, provide socially acceptable outlets,
and intervene only if the frustrations become
overwhelming
• Parent’s task is to provide the child with skills
and tools appropriate for each age level to
deal with current events
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 Nutrition

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 Nutritional Heritage

• Some families do not consider food a priority

• A lack of adequate nutrition can lead to
mental retardation
• The obese child may be subject to decreased
motor skills and peer rejection
• The nurse identifies children at risk and
assists the family in modifying eating habits
to ensure adequate nutrition is provided for
growth and development
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 Family Nutrition

• USDA dietary guidelines

– Intended to help families make informed
decisions about what they eat
• A well-balanced diet supplies all essential
nutrients in the necessary amounts

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 Food

• Provides heat and energy

• Builds and repairs tissues
• Regulates body processes
• Is given in a mixture of elements
– Minerals
– Compounds
– Water

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 Children’s Food Pyramid

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 Vegetarian Diet Pyramid

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 Infant Nutritional Needs

• Require more
– Calories
– Protein
– Minerals
– Vitamins
– Higher fluid requirements

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 Fiber Needs of the Young Child

• The American Academy of Pediatrics

recommends 0.5 g of fiber/kg of body weight
in childhood, gradually increasing to adult
levels of 20 to 35 g/day by the end of
adolescence
• High-fiber foods can fill the small stomach
capacity and provide few of the nutrients and
calories needed by the active, growing child

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 Nutrient Digestion

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 Nutritional Care Plan

• Can be used in
– Hospital
– Home
– Outpatient departments
• Provides information and stores it in one
place

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 Nutrition and Health

• Digestive system of the newborn

– Immature and functions minimally for the first
3 months of life
– Saliva is minimal
– Hydrochloric acid and rennin in the stomach
and trypsin found in the intestines aid in the
digestion of milk
– The physiology of the digestive tract is the
basis for introduction of various foods in the
first year of life
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 Nutrition and Health Promotion

• To help prevent some illnesses, it is not

recommended to significantly restrict fat and
cholesterol as they are needed for calories
and the development of the central nervous
system
• Nutritional needs may be changed due to the
severity of illness
– Total parenteral nutrition and enteral feedings
allow children who need nutritional support to
be cared for at home
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 Feeding the Healthy Child: Infant
• Symptoms of • High-fat diets cause
underfeeding – Delayed gastric
– Restlessness emptying
– Crying – Abdominal distention
– Failure to gain weight • High carbohydrates
• Symptoms of – Abdominal distention
overfeeding – Flatus
– Regurgitation – Excessive weight gain
– Mild diarrhea • Constipation
– Too rapid weight gain – Too much fat or protein
– Deficiency in “bulk”
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 Nursing Tip

• Whole milk should not be introduced before 1

year of age
• Low-fat milk should not be introduced before
2 years of age

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 Feeding the Healthy Child: Toddler

• Can feed themselves by end of second year

– Important in order to develop a sense of
independence
• Parent should be present at mealtimes
• Difficulties may arise from parental anxiety
and/or a lack of time during meals

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 Feeding the Healthy Child:
Preschool
• Likes finger-foods
• Dawdling and regression common in this age
group
• More vulnerable to protein-calorie
deficiencies

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 Feeding the Healthy Child:
School-age
• Attitude toward food unpredictable
• Intake of protein, calcium, vitamin A, and
ascorbic acid tends to be low
• Intake of sweets decreases appetite and
provides “empty” calories

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 Feeding the Healthy Child:
Adolescent
• Grow rapidly and expend large amounts of
energy
• Important to involve adolescent in food
selections that are nutritious and appetizing
• Fad food drives a lot of food selections
• Fatigue is common in this age group

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 Childhood Obesity

• One-third of all children in the U.S. are

overweight
– 30% to 40% of those are considered obese
• Related to obesity in adulthood
• Most often related to diet and inactivity
• Basal metabolic index (BMI) percentile
Weight in pounds
Height in inches2 × 705

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 Feeding the Ill Child

• Many hospitalized • Nurse should assess

children have poor – Does child have any
appetites teeth?
• Causes vary – Are there any lesions
in the mouth?
depending on
– Can child eat
illness/disease
independently or is
• May also refuse food assistance needed?
as a means of
manipulating parents

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 Feeding the Ill Child (cont.)

• A tablespoonful of food for each year of age

is a good guide to follow when feeding a child
• Sweet drinks and snacks should not be
served just before meals
• Infants who are placed on NPO status should
be provided with a pacifier to meet their
sucking needs

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 Food-Drug Interactions
• Drug-drug: nurse needs to know the side effects
of each drug prescribed and administered
• Drug-environment: involves interaction of the
effects of a drug on the response of the patient
to the environment (i.e., certain antibiotics
cause pronounced photosensitivity)
• Drug-food: nurse needs to know if any foods are
contraindicated when child is receiving certain
drugs (i.e., Coumadin and foods containing high
levels of vitamin K)

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 The Teeth

Permanent and deciduous teeth and age of eruption.

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 The Teeth (cont.)

• Important not to neglect baby teeth

• Deciduous teeth serve not only in the
digestive process but also in the
development of the jaw
• If these teeth are lost too early, the
permanent teeth can come in poorly aligned
• Delayed or early eruption can be indicative of
certain endocrine disorders or other
pathologic conditions
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 Oral Care in Health and Illness

• Sticky foods have more • Recommended

potential to cause snack foods
dental caries than do – Cheese, milk, sugarless
gum, raw vegetables
sugared drinks
• Brushing after each
• Snack foods to avoid
– Sugared gum, dried fruits,
meal/snack
sugared soft drinks, cake, and • Eating a healthy,
candy
balanced diet
enhances tooth
development

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 Dental Caries

• Occurs when infant

falls asleep while
breastfeeding or is
put to bed with a
bottle of milk or
sweetened juice
• Sugar pools in the
oral cavity
• Most often seen in
children 18 months to
3 years of age
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 Education on Tooth Hygiene

• Starts with first tooth • Replace toothbrush

eruption every 3 months or
• Brush before bedtime after a viral illness
– Protective bactericidal • Avoid rinsing bristles
effects of saliva decrease in hot water
during sleep
• Do not use a closed
• Fever is not associated container for
with teething; therefore, toothbrush storage
cause should be • Avoid sharing
assessed
toothbrushes
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 Play

• Play is the “work” of • Nursing interventions

children should focus on
• Hospital playrooms are – Encouraging optimal
used by children who do play activities that are
age-appropriate
not have communicable
– Helping parents select
illnesses (e.g., measles
age- and illness-
or a draining wound) appropriate toys
• Art allows for creative • An asthmatic child should
expression not be given a stuffed
animal to play with
• Computer games
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 Medical Problems and Dental
Health
• Health problem • Effect on teeth
– Asthma – Sucrose content of
– Hemophilia medications can cause
– decay
Seizure disorders
– – Can cause oral bleeding,
Bulimia
impaired healing
– Causes decreased saliva;
gingival overgrowth
– Erosion of teeth from acid
content during vomiting

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 Question for Review

• Why is introduction of solid foods to infants

delayed until 4 to 6 months of age?

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 Review

• Objectives
• Key Terms
• Key Points
• Online Resources
• Critical Thinking Question
• Review Questions

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