Growth & Development

Introduction
 Growth and Development Extends through out

the life cycle  Principle changes occur from conception to end of Adolescence  Conception period is complex one. i.e. Two cells joins and becomes one  Important for the nurse to understand total life cycle and behaviour to provide care for every individual

A knowledge of growth & development is essential for the nurse for following reasons What to expect from the child according to the age

1.

2. To plan for nursing management & help in formulating plan for total care of each child contd…

3.

Understand the reason for particular conditions and illnesses occur in various age groups To teach the parents how to observe the children & use their knowledge to help the children achieve optimal growth & development

1.

Definitions of Terms
 Growth : Refers to an increase in physical

size of the whole or any parts and can be measured in inches or centimeters and in pounds or kilograms
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It results because of cell division & synthesis of proteins It gives quantitative change contd…

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 Development : Refers to a progressive increase

in skill & capacity to function
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It causes a qualitative change in the child’s functioning Development is orderly not haphazard Direct relation between each & the next contd…

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 Maturation : Refers to the development of

traits carried through the genes It produces an increase in competence, an ability to function at a higher level of depending on the child's heredity
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Concepts of Growth & Development
 The Growth & Development patterns can be

studied in two methods
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Cross Sectional method Longitudinal method contd…

Cross Sectional Method
 Many of the students of same age group studied

to establish the norms of growth and development of specific group  Eg ; Tests / Measurements taken from many children in a particular age range Scores of 3 year old Average of each Scores of 4 year old = group considered Scores of 5 year old as base line

Longitudinal Method
 Individual children of large group are measured

at intervals throughout their stages of growth and development over a period of year  It is more difficult than Cross Sectional method

Characteristics of Growth & Development
 Individual Differences  Critical periods  Rate of Development

Principles of Growth & Development
1. 2. 3. 4. 5.

Continuous, Orderly and Sequential process Growth & Development is Directional Growth & Development is Unique Development is related Development become increasingly differentiated contd…

6. Development becomes increasingly integrated and complex 7. Children are competent 8. New skills predominate 9. Development involves changes 10.Early Development is more critical than latter 11.Development is the product of Maturation & Learning contd...

12. Development pattern is Predictable 13. Development pattern has its own characteristics 14. Development pattern has periods 15. There are social expectations for every developmental periods 16. Every area of development has potential hazards 17. Happiness varies at different periods in development

Stages of Growth & Development
Prenatal period – Conception to Birth a) Embryonic – conception to 8 wks b) Fetal - 8wks to 40 wks  New born - From birth to 2-4 weeks  Toddler - 1 to 3 years  Early child hood – 3 to 6 yrs  Late child hood – 6 to 12 yrs

contd…

 

Adolescence - Puberty to beginning of adult life Early Adult hood - 18 – 25 yrs Middle Adult hood – 25 -40 yrs Late Adult hood – 40 – 60 yrs Old age - After 60 yrs

 

Theories of Growth & Development
Theories classified as 1.Intellectual development – Jean Piaget 2.Moral development - Jean Piaget & Kohl berg 3. Emotional development – Erik H.Erikson 4.Development of sexuality – Freud 5.Spiritual Development – James W.Fowler

Factors influencing Growth & Development
Factors influencing fetus Growth & Development 1. Effects of Maternal infection & Nutrition 2. Placental dysfunction 3. Fetal infection 4. Treatments of infection and drugs 5. Pre –Pregnancy infection 6. Alcohol, Caffeine, Artificial sweetners and Smoking contd…

7. Role of Hormones 8. Genetic Endowment 9. Ratio of surface & volume 10.Structural limitations 11.Diabetes Mellitus 12.Pregnancy Induced Hypertension ( PIH ) 13.Rubella, Toxoplasmosis & Syphilis 14.Rh-Incompatability 15.Maternal Cardiac Diseases 16.Incompetent Cervix

1.Effects of Maternal infection & Nutrition
Maternal Nutrition affects “Fetal Programming” ie “Fetal origin of Adult diseases” - Alterations in fetal nutrition & endocrine status Result in developmental adaptations - Change in structure, physiology & metabolism - Maternal under /over Nutrition Placental – fetal blood flow Stunt growth contd…

Impaired placental blood flow Impaired placental synthesis of nitric oxide & Polyamines IUGR Promoting optimal nutrition ensure optimal fetal growth & risk of chronic diseases in adults contd…

The impact of Malaria, Diarrhea, AIDS,PID, Severe Reproductive tract infections and UTI Affect chemical messengers – Cytokines Suppress appetite centre in the brain Anorexia (intake ) Malnourishment of mother Fetal Malnutrition

Intestinal Parasites – Ascaris Absorption energy, Protein, Micro Nutrients (iron, Vit-A) Infection Body temperature Metabolic stress for mother itself (10%) Fetal inadequacy

Profound changes in the distribution of Micronutrients ( Zinc, Iron ) Transfer of nutrients affected Defect in fetal development Hook worm infestation Severe loss of iron & protein Affects intra uterine growth

Consequences of impaired maternal nutrition
Reproduction doesn’t occur properly Conceptus material cannot grow & develop normally & possibly die LBW baby Placental size Brain cell & head size Size of other organs ced contd…

Alterations in normal cell constituents & biochemical processes Depend on timing, severity and duration of Malnutrition reversible hypertrophy & irreversible hyperplasia

2. Placental dysfunction
 Specific

Infections

Alter structure of placenta Impaired nutrient transfer
 Malarial

infection of mother delivers

LBW babies contd…

 Ascending infections from Vagina

Attacks amniotic sac Organisms reach maternal blood  Placental functions -Endocrine -Respiration -Digestion -Excretion -Protection

3. Fetal infection
Syphilis & HIV Transmitted across the placenta Decreased birth weight Herpes infection associated with IUGR Toxoplasmosis and Cytomegalovirus infections impact on fetal growth is not known

4.Treatments of infection and drugs
Treatments of infection by Teratogenic drugs Cross the Placenta Fetal growth & development affected

5. Pre - Pregnancy infection
Under nourishment before pregnancy due to LSEB, Poor etc. Chance of chronic infection in child hood & adolescent Malnutrition deficiency of Iron, Folate, Zinc & Vit A IUGR

6. Alcohol, Caffeine, Artificial sweetners and Smoking
a) Alcohol –Ethanol ( Primary Teratogen )

Depress the CNS Interference with cardio pulmonary adaptation in newborn Fetal Alcohol Syndrome (FAS) contd…

Chronic Alcoholic woman Deliver the babies with Microcephaly, Short palpebral fissure, Small cheek bones, Congenital heart defects, Pre & Post natal growth deficiency, Congenital heart defects, Congenital Hip dislocations and other joint anomalies and altered palmar crease pattern.

b) Caffeine - High levels can cause limb defects - Alter blood flow through uterus and placenta - Stimulate AMP pathways in cells contd…

Artificial sweetners - No clear results - Saccharin may be carcinogenic in high levels - Use in moderate level will not give problem contd…

Smoking – Nicotine Placental blood flow & Plasma volume Vasoconstriction of uterine circulation Insufficient nutrition to fetus LBW babies contd…

Smoking increase the risk of -Spontaneous Abortion -Placenta Previa -PROM -Sudden Infant Death Syndrome (SIDS) -Pneumonia -Respiratory infections -interfere with absorption / metabolism of Calcium, Vit B12, A, B6 and B1

7. Role of Hormones

Hormone in the body affect the growth some manner

The Hormones are 1. Somatotrophic Hormone 2. Thyroid Hormone 3. Gonad Stimulating Hormone

contd…

1.

Somatotrophic Hormone - Stimulates skeletal and protein anabolism - Excess - Lack gigantism Dwarfism

2. Thyroid Hormone - Thyrotrophic Hormone (TH), Triiodothyronine (T3) and Thyroxine stimulate general metabolism - Excess liner growth - Deficiency cretinism MR

(T4)

3. Gonad stimulating Hormone Hypothalamus LHRH Anterior Pituitary In Male Stimulate interstitial cells of testes Testosterone

Hypothalamus LHRH
Anterior Pituitary In Female FSH Ovarian Follicle Estrogen contd… Corpusluteum Progesterone LH

Excess in Gonad stimulating Hormone – Precocious Puberty  Less in Gonad stimulating Hormone – Delayed Sexual Development

8. Genetic Endowment
a)

Hexogenes: Gives floor plan for growth and development Gene Control rate of critical metabolic processes Fetus size and shape determined

9. Ratio of surface & volume
Food ingested Metabolized into protoplasm Remainder excreted as wasted - The Ratio of Surface and Volume influence the growth and development

10.Structural limitations
-The

structural limitations depends on gene Engineering

11.Diabetes Mellitus
Type I Diabetic mothers Maternal Blood glucose levels Fetus gets the glucose Fetal islets of langerhans produce insulin To utilize available glucose Excessive growth “macrosomia” and fat deposits contd…

Mothers with advanced diabetes Vascular changes Efficiency of placental perfusion IUGR contd…

Level of fetal insulin Surfactant enzymes secretion Respiratory distress syndrome contd…

Diminished ability of glycosylated Hb in mothers blood to release O2 Polycythemia ( RBC )  Glucose level leads to anomalies in Heart, CNS & Skeletal system  Sacral agenesis Incomplete development of lower extremities

12.Pregnancy Induced Hypertension ( PIH )
 PIH

Maternal vasospasm & Hypovolemia Fetal hypoxia Malnutrition SGA / Premature baby

13.Rubella, Toxoplasmosis & Syphilis
a)

Rubella infection in mother Causes fetal problems like

Congenital heart diseases, IUGR, Cataract, Petechial rash, Hepatosplenomegaly, Hyperbilirubinemia, MR or Cerebral palsy in infancy contd…

b) Toxoplasmosis -Caused by protozoan –Toxoplasma Gondii -Complications like Abortion, Prematurity, Still births, Newborn deaths & Severe congenital anomalies, Retinochoroiditis -Neonatal disorders associated with congenital infection include Convulsion, Microcephaly, Coma & Hydrocephalus -Survivors are often blind, deaf & severely retarded contd…

 Syphilis

- Caused by the Bacterium - Treponema palidum - It results in Spontaneous abortion, Preterm birth, Still birth, Neonatal death, Morbidity - Treponema infection( afetr 4 mon) Cross the Placenta Infect the fetus

14.Rh-Incompatability
Rh-ve mother Rh-ve baby No problem + Rh+ve father Rh+ve baby for 1st pregnancy placenta act as a barrier Good outcome

 But during pregnancy any chance for FMH or

During delivery mixing of Feto Maternal blood Reaction of immune system Anti-D antibodies Kill the fetus/In subsequent pregnancies Contd…

In subsequent pregnancies

Maternal antibody cross the placenta Destroy fetal erythrocytes Erythroblastosis Fetalis

15.Maternal Cardiac Diseases
 1. 2. 3.

Morbidity and Mortality with Maternal Cardiac Diseases depends on 3 factors Nature of cardiac lesion Affect on the functional capacity of the heart The development of pregnancy related complications – PIH, Infection, Thrombosis and Haemorrhage contd…

 CCF

Altered haemodynamic state Systemic circulation to fetus O2 nation Abortion, IUGR, Fetal hypoxia And Preterm birth fetal death

16.Incompetent Cervix
 Cervical Incompetence is painless dilatation of

the cervix 2nd or 3rd trimester allowing bulging membranes through the cervical os into the vagina
 Causes- Trauma, D&C, Induced abortion  Treatment- Cervical Cerclage

Developmental Vulnerability Time Table
Weeks since conception 3 4 Malformation Ectromelia, Ectopia cordis Omphalocele, Tracheoesophageal fistula, Hemi vertebra Nuclear Cataract, Microphthalmia, Facial clefts

5

6

Gross septal or aortic abnormalities. Cleft lip, Agnathia Interventricular septal defects, Pulmonary stenosis, Epicanthus, Cleft palate, Brachyaphalism, Mixed sexual characteristics Persistent ostium primum, Digital stunting

7

8

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