Growth and Development.

Growth-increase in physical size of a structure

-quantitative change

Two parameters of Growth:

1. Weight-most sensitive measure of growth
especially low birth weight.

Weight doubles 6 months., triples in a year, quadruples

2 ½ years
Growth and Development.
2. Height- average increase in height for 1st year is 50% of birth height
-increase by 1 inch per month during 1st 6 months
-half inch per month by 7 months to 12 months
Growth and Development.
Development-increase skills or capacity to function
-qualitative

How to Measure Developmentt?

1. By simply observing a child doing specific task.
2. By noting parent’s description of the child’s progress.
3. By DDST or MMDST.
Growth and Development.
DDST measures the following except IQ (which can be measured
through IQ test):
1. Language-communication
2. Personal social-interaction
3. Fine motor skills-ability to use hand movement
4. Gross motor skills-large body movement
Growth and Development.
Maturation
- synonymous with development, readiness

Cognitive Development
- ability to learn and understand from experience
- to acquire and to retain knowledge

IQ Test
- test to determine cognitive development
- IQ = mental age/chronological age x 100
Growth and Development.
Basic Divisions of Life:
1. Prenatal Stage-from conception to birth
2. Period of Infancy
- Neonatal - 1st 28 days of life
- Formal infancy - 29th day to 1 year
3. Early Childhood
- Toddler - 1-3 years old
- Pre school - 4-6 years old
4. Middle Childhood - 7-12 years old
5. Late childhood
- Pre adolescent
- Adolescent
Growth and Development.
Principles of Growth and Development.:
1. Growth and development is a continuous process - womb to tomb principle.
2. Not all parts of the body grow at the same time or at same rate.
Patterns of Growth and Development.:
1. Renal, digestive, musculoskeletal, circulatory-grows sparingly during
childhood

2. Neuromuscular-grows rapidly 1st 2 years of life, achieves adult

proportion by 5th year. Food for the brain is potato.
Growth and Development.
3. Lymphatic system - spleen grows rapidly during infancy and childhood to
provide protection, tonsil achieve adult proportion at 5 years old

4. Reproductive organ-grows rapidly at puberty

Rates of Growth and Development:

1. Fetal & infancy - most rapid growth and development
2. Adolescent - rapid
3. Toddler - slow growth
4. Preschool - alternating rapid and slow
5. School age - slower growth, period of latency
Growth and Development.
3. Each child is unique.
2 Primary Factors affecting Growth & Development
• Heredity
- race, intelligence, sex, nationality
• Environment
- nutrition, socio - economic status, ordinal position in the family, parent-
child relationship
Growth and Development.
4. Growth & Development occurs in a regular direction reflecting a definitive and
predictable pattern or trends.

A. Directional trends - occur in a regular direction reflecting the development of

neuromuscular function; apply to physical, mental, social and emotional development
Cephalocaudal
Proximo distal
Symmetrical

Mass specific differentiation - simple operations before complex functions, gross

motor before fine motor
Growth and Development.
B. Sequential - involves a predictable sequence of growth &
development to which the child normally passes
• Locomotion-creep then crawl, sit then stand, walk then run
• Socio and language skills-solitary game, parallel game, cooperative game

C. Secular - refers to the worldwide trend of maturing earlier and

growing larger as compared to previous generations
Growth and Development.
5. Behavior is the most comprehensive indicator of developmental status. “Act your
age.”
6. Universal language of child is play.
7. Great deal of skills and behavior is learned by practice.
8. There is an optimum time for initiation of experience or learning.
9. Neonatal reflexes must be lost first before one can proceed.
• Plantar reflex-disappear before baby can walk, 9 mos.
• Moro reflex-disappear before baby can roll, 5 mos.
Persistent primitive infantile reflexes-suspect case of cerebral palsy
Theories of Growth & Development

Developmental Tasks
- different from chronological age
- skills or growth responsibility arising at a particular time in the
individual life
- the successful achievement of which will promote a foundation for
accomplishment of the future tasks
Theories of Growth & Devt.
Sigmund Freud-founder and father of psychoanalysis
• Oral phase
• 0 to 18 mos.
• mouth as site of gratification, sucking is release of tension
• provide oral stimulation even if baby was placed on NPO
• Anal phase
• 18 mos. to 3 years
• anus as site of gratification, toilet training, principle of holding on or letting go
enters
Theories of Growth & Devt.
Usual cause of failure of toilet training: unreadiness of child

Signals to Start Toilet Training:

• Can stand, walk, squat alone
• Can communicate need to go
• Can make himself dry for 2 hours
Theories of Growth & Devt.
• Phallic phase-4 to 6 yrs. Old
• genitals as site of gratification, Oedipus and Electra complexes
• right age to introduce sexuality
• Latent phase-7 to 12 yrs. Old
• period of suppression, no obvious development.
• helps child to achieve (+) experience to face conflict of adolescence
• Genitals phase-12 to 18 yrs. Old
• achieve sexual maturity and satisfaction
• gives an opportunity to relate to opposite sex
Theories of Growth & Devt.
Eric Erickson - stresses importance of culture and society
to development of one’s personality
• Trust vs. Mistrust - 0 to 18 mos.
• satisfy needs on time
• care must be consistent and adequate from both parents
• Autonomy vs. shame and doubt - 18 mos. to 3 yrs.
• give an opportunity of decision making like offering choices
• set limits
Theories of Growth & Devt.
• Initiative vs. Guilt - 4 to 6 yrs.
• give opportunities to explore new places & events (i.e., parks, zoos)
• modeling clay, finger painting will enhance imagination and creativity
• Industry vs. inferiority - 7 to 12 yrs.
• child learns how to do things well
• give opportunity for short assignments and projects
Theories of Growth & Devt.
• Identity vs. Role Confusion - 12 to 18 yrs.
• learns who he/she is or what kind of person he/she will become by adjusting
to new body image
• seeks emancipation from parents
• Intimacy vs. Isolation -18 to 30 yrs.
• career focus, looking for lifetime partner
Theories of Growth & Devt.
• Generativity vs. Stagnation - 30 to 60 yrs.
• passing on to the next generation
• Ego integrity vs. Despair - 60 yrs. Above
• retirement
Theories of Growth & Devt.
Jean Piaget - developed reasoning power known as cognitive development
• Sensory motor-0 to 2 yrs.
• child communicates through senses and reflexes
• Preoperational thought - 2 to 7 yrs.
a. preconceptual
- concept of time is now
- concept of distance is as far as they can see
- concept of animism
- not aware of concept of reversibility
b. intuitive - 4 to 7 yrs.
- beginning of causation
Theories of Growth & Devt.
• Concrete Operational - 7 to 12 yrs.
- have concept of reversibility
- have concept of conservation
- activity recommended: collection of stamps, stationaries
• Formal Operational - 12 and up
- cognition achieved final form
- can deal with past, present, future
- have abstract and mature thoughts
- activity recommended: talk time
Theories of Growth & Devt.
Kohlberg - theory of moral development closely approximate cognitive stages of
development
• Preconventional-2 to 7 yrs.
a. Stage 1 - punishment/obedience orientation
b. Stage 2 - individualism/will do something if that person does something for the
child
• Conventional - 7 to 12 yrs.
a. Stage 3 - child follows rules to be “good” person in own eyes and others
b. Stage 4 – follows rules to keep the system working
• Post conventional-12 years old up
a. Stage 5 - follows standards of society for good of all people
b. Stage 6 - follows internalized standards of conduct
- only few can reach this stage
Development Milestones
Milestones - major markers of growth & development
• Period of Infancy
Play - solitary
-rattles, mobiles, teeters, music box (facilitate motor and sensory
development)
Fear - stranger anxiety
- begins at 6 to 7 months, diminishes 9 months
Development Milestones
Neonate - largely reflex, complete head lag, cry without tears
1 month - alert to sound, follows object to midline
2 months – social smile, baby coos “doing sound”, closure of posterior
fontanel, recognizes parents, follows object past midline
3 months - holds head and chest up when prone, hand regard,
reaches for familiar people or objects
4 months - turns from front to back, head control complete, laugh
aloud, bubbling sound
Development Milestones
5 months - turn both ways/”roll over”, moro reflex disappears,
handles rattle well
6 months - sits with support, 1st temp teeth (lower central incisor),
uses palmar grasp
7 months - beginning fear of strangers, transfer object hand to hand
8 months - sits without support, peak of stranger anxiety, plantar
reflex disappears
9 months - creeps or crawls, neat finger grasp reflex, “mama” and
“dada”
Development Milestones
10 months - pulls self to stand, responds to own name, peek a boo,
pat a cake as games
11 months - cruises, stands with assistance
12 months - stands alone, walks with assistance, says 2 words other
than “mama” and “dada”, drinks from cup, cooperate in dressing
Development Milestones
• Toddler
Play - parallel play
- squeaky frog to squeeze, waddling duck to pull, truck to push-
pull
Fear - separation anxiety begins when stranger anxiety disappears
- begins 9 months, peak at 18 months

How to prevent anxiety - don’t prolong goodbye, say goodbye firmly,

say when you will be back
Development Milestones
15 months - walk alone (if late in walking, suspect mental
retardation), holds spoon well, 4 to 6 words
18 months - height of possessiveness, favorite word “mine”, bowel
control achieved, 7-20 words, walks up and down stairs holding on to
person’s hand or railing
24 months - terrible 2, 50-200 words, daytime bladder control
achieved
30 months - knows full name, copy a circle, temp teeth complete,
beginning of toothbrush, right time to bring to dentist
Development Milestones
3 years - draw a +, learns how to share, knows full name and sex,
nighttime bladder control achieved, 300-900 words, ride a tricycle

Characteristic Traits of Toddler:

• Negativistic - modify question to statement, offer options
• Rigid, ritualistic - for mastering of concepts
• Temper tantrums - head banging, screaming
- ignore behavior
• Food jag or food fad - offer finger foods
Development Milestones
• Pre schoolers
Play - associative or cooperative play
- ”bahay bahayan”
Fear - body mutilation or castration
- fear of dark places
- fear of ghosts, witches
Development Milestones
4 years - furious four (noisy, aggressive), copy a square, lace shoes, can button
buttons, vocabulary is composed of 1,500 words
5 years - copy a triangle, vocabulary of 2,100 words, jumps over low obstacles

Characteristics Traits of Preschooler:

• Curious-2 favorite words “why” & “how”
• Creative/imaginative
• Identification to parent of same sex and attachment to parent of opposite sex
• Death - sleep only
• Imaginary friend - way to release tension and anxieties
Development Milestones
• School age
Play - competitive play
Fear - school phobia, fear of death, loss of privacy

Significant Developments:
• Boys prone to greenstick fracture
• Mature vision-20/20 vision
Development Milestones
6 years - permanent tooth appear (1st molar), recognize all shapes, 1st grade
teacher becomes authority figure
7 years - assimilation age, copy a diamond, enjoys teasing and playing alone,
quieting down period
8 years - expansive age, loves to collect objects
9 years - tells time correctly, hero worship, takes care of body needs completely
10 years - age of special talent, considerate and cooperative, well mannered with
adults, joins girl scouts, boy scouts
11-12 years - full of energy and constantly active, secret language common, social
and cooperative
Development Milestones
Characteristic Traits of School Age:
• Industrious
• Modest
• Loves collecting
• Can’t bear to lose
Development Milestones
Signs of Sexual Maturity:
Girls - widening of hips, appearance of pubic, axillary hair,
menarche
Boys - appearance of pubic, axillary hair, deepening of
voice, development of muscles, increase in size of penis and
testes, production of viable sperm
Development Milestones
• Adolescent
Fear - acne, obesity, homosexuality, replacement from friends, death
Significant person - peer of the opposite sex
Significant Developments:
• Change of body image and acceptance of opposite sex
• Nocturnal emission - wet dream (hallmark of adolescent)
• Distinctive odor - due to stimulation of apocrine glands
• Sperm is viable by 17 years
Development Milestones
Characteristic Traits of Adolescents:
• Idealistic
• Rebellious
• Conscious with body image
• Adventuresome
Problems:
• Vehicular accident
• Smoking
• Alcoholism
• Drug addiction
• Premarital sex
Immediate Care of Newborn
The 8 Priorities of the Newborn in the First Days of Life:
• Initiation and maintenance of respiration
• Establishment of extra uterine circulation
• Control of body temperature
• Intake of adequate nourishment
• Establishment of waste elimination
• Prevention of infection
• Establishment of an infant-parent relationship
• Developmental care that balances rest and stimulation for mental development
Immediate Care of Newborn
Initiation and Maintenance of Respiration:
• Happens on the 2nd stage of labor
• Crucial among the newborn
• Most neonatal deaths within the first 24 hrs is primarily caused by
inability to initiate airway
• Lung function begins only after birth-when baby cries
Immediate Care of Newborn
How to initiate airway?
1. Remove secretions with bulb syringe
2. Proper suctioning with a catheter
• Place head to side to facilitate drainage of secretion
• Suction mouth 1st before nose. Neonates are mouth breathers.
• 5-10 seconds suctioning, gentle and quick. Prolonged suctioning can lead to
hypoxia, laryngo spasm and bradycardia due to stimulation of vagal nerve
• Evaluate for patency-cover one nostril and when baby struggles, need for
additional suctioning
Immediate Care of Newborn
If ineffective, an endotracheal tube can be inserted and oxygen can be
administered by a (+) pressure bag and mask with 100% oxygen at 40-
60 bpm.
Nursing Alert:
• No smoking for it can facilitate combustion
• Humidify to prevent drying of mucosa
• Over dosage of oxygen can lead to scarring of retina leading to
blindness (retrolental fibroplasia)
• When meconium stained, never administer oxygen with pressure to
prevent atelectasis
Immediate Care of Newborn
Establishing Extra Uterine Circulation
Nursing Alert: circulation is initiated by lung expansion or pulmonary ventilation
and completed by cutting of cord

Shunts:
Ductus Venosus - shunt from liver to inferior vena cava
Foramen Ovale - shunt between 2 atrias
Ductus Arteriosus - from artery to aorta
What will sustain 1st breath? Decreased pulmonary artery pressure
What will initiate lung circulation? Lung expansion
What will complete circulation? Cutting of cord
Immediate Care of Newborn
2 Ways to Facilitate Closure of Foramen Ovale:
1. Tangential foot slap - slap foot of baby to make baby cry
• Never stimulate baby to cry if not fully drained with secretions to prevent
aspiration
• Check characteristics of cry
2. Proper positioning - right side lying position
• Will increase pressure on left side of the heart thus causing closure. Begins
to close within 24 hours
Immediate Care of Newborn
• Foramen ovale must have complete closure in 1 year. Failure to close:
atrial septal defect
• Ductus arteriosus must have complete closure in 1 month. Failure to
close: patent ductus arteriosus
• Ductus venosus must have complete closure in 2 months

Position of Infant After Birth:

NSD - trendelenburg to promote drainage
CS - supine or crib level position
Immediate Care of Newborn
Temperature Regulation
• Goal is to maintain it not less than 36.5 C
• Maintenance of temp is crucial on preterm and SGA. Prone to hypothermia or
cold stress
Factors Leading to Development of Hypothermia:
• Preterms are born poi kilo thermic - easily adopt to temp of
environment due to immaturity of thermo regulating system of body
• Inadequate subcutaneous tissue
• Newborn not capable of shivering
• Babies are born wet
Immediate Care of Newborn
Process of Heat Loss:
1. Evaporation - body to air
2. Conduction - body to cold solid object (i.e., TSB)
3. Convection - body to cooler surrounding (i.e., aircon)
4. Radiation - body to cold object not in contact with body (i.e., body
to crib, crib to wall)
Immediate Care of Newborn
Effects of Hypothermia:
• Hypoglycemia - 45-55 mg/dl normal with 40 mg/dl as borderline
• Metabolic acidosis - breaking down of brown fats leading to ketones
formation
• High risk for kernicterus - bilirubin in brain leading to irreversible
brain damage
• Additional fatigue to a stressful heart
Immediate Care of Newborn
Prevent Hypothermia:
1. Dry and wrap baby
2. Use of mechanical radiant warmer-pre heated isolette
3. Prevent unnecessary exposure-cover the areas not being examined
4. Cover baby with tin foil or plastic
5. Embrace the baby known as kangaroo care