Growth and Development

Definition of Terms:
Growth – increase in size of a structure.
Development – maturation of structures.
Cephalocaudal –head-to-toe progression of
growth and development.
Proximodistal – trunk-to-periphery
progression of growth and development.
Phylogeny – development or evolution of a
species or group; a pattern of development for
a species.
Ontogeny – development of an individual
within a species.
Critical Period – specific time period during
which certain environmental events or stimuli
have greatest effect on a child’s development.
 Growth and Development
 Growing up is a complex phenomenon because of the many
interrelated facets involved. Children do not merely grow taller and
heavier as they get older; maturing also involves growth in their ability
to perform skills, to think, to relate to people, and to trust or have
confidence in themselves.
 The terms “growth” and “development” are occasionally used
interchangeably, but they are different.
 Growth is generally used to denote an increase in physical size or a
quantitative change. Growth in weight is measured in pounds or
kilograms; growth in height is measured in inches or centimeters.
 Development is used to indicate an increase in skill or the ability to
function (a qualitative change). Development can be measured by
observing a child’s ability to perform specific tasks such as how well a
child picks up small objects such as raisins, by recording the parent’s
description of a child’s progress, or by using standardized tests such as
the Denver II.
 Growth and Development
 Maturation is a synonym for development.
 Psychosexual development is a specific type of development that
refers to developing instincts or sensual pleasure (Freudian theory).
 Psychosocial development refers to Erikson’s stages of personality
development.
 Moral development is the ability to know right from wrong and to
apply these to real-life situations. Kohlberg is a theorist who studied
this.
 Cognitive development refers to the ability to learn or understand from
experience, to acquire and retain knowledge, to respond to a new
situation, and to solve problems (Piaget’s theory of cognitive
development). It is measured by intelligence tests and by observing
children’s ability to function effectively in their environment.
  
 Rates of Development
 Infancy and adolescence: fast growth
periods
 Toddler through school-age: slow growth
periods
 Fetal period and infancy: the head and
neurologic tissue grow faster than other
tissues.
 Toddler and preschool periods: the trunk
grows more rapidly than other tissue.
 The limbs grow most during school-age
period.
 The trunk grows faster that other tissue
during adolescence.
 Factors Influencing Growth and
Development
 Genetic inheritance, or whether a child receives healthy genes or
genes that will lead to an illness, and environmental influences,
such as whether the family a child is born into has sufficient
funds to supply adequate food, are two primary factors that
determine a child’s pattern of growth and development.
 Temperament (the typical way a child reacts to situations) is an
example of genetic influence.
 Whether a fetus enjoyed a healthy uterine existence is an example
of environmental influence. Whether a child receives good
nutrition, beginning with being breastfed, is another . A unique
combination of these factors determines how each child grows
and matures.
 Factors Influencing Growth and Development

 Genetics
 From the moment of conception when a sperm and
ovum fuse, the basic genetic makeup of an individual is
cast. Although each child is unique, certain gender-
related characteristics will influence growth and
development.
 In addition to physical characteristics such as eye color
and height potential, inheritance determines other
characteristics such as learning style and temperament.
An individual may also inherit a genetic abnormality,
which could result in disability or illness at birth or
later in life.
 Factors Influencing Growth and Development
 Gender
 On average, girls are born lighter (by an ounce or two) and
shorter (by an inch or two) than boys. Boys tend to keep this
height and weight advantage until prepuberty, at which time
girls surge ahead because they begin their puberty growth spurt
6 months to 1 year earlier than boys. By the end of puberty (14
to 16 years), boys again tend to be taller and heavier than girls.
This difference in growth patterns is reflected in the different
growth charts used for boys and girls.
 Factors Influencing Growth and
Development
 Health
 A child who inherits a genetically transmitted disease may not
grow as rapidly or develop as fully as a healthy child,
depending on the type of illness and the therapy or care
available for the disease.
 Intelligence
 Children with high intelligence do not generally grow faster
physically than other children, but they do tend to advance
faster in skills. Occasionally, children of high intelligence fall
behind in physical skills because they spend their time with
books or mental games rather than with games that develop
motor skills and so do not receive practice in these areas.
 Factors Influencing Growth and
 Temperament
Development
 Temperament is the usual reaction pattern of an individual, or
an individual’s characteristic manner of thinking, behaving, or
reacting to stimuli in the environment.
 Unlike cognitive or moral development, temperament is not
developed by stages but is an inborn characteristic set at birth.
Understanding that children are not all alike—some adapt
quickly to new situations and others adapt slowly, and some
react intensely and some passively—can help parents better
understand why their children are different from each other
and help them care for each child more constructively.
 Principles of Growth and Development

 Growth and development are continuous

processes from conception until death.
 Growth and development proceed in an orderly
sequence.
 Development also proceeds in a predictable order.

 Different children pass through the predictable

stages at different rates.
 Development is cephalocaudal.
 Principles of Growth and Development

 Development proceeds from proximal to distal body

parts.
 Development proceeds from gross to refined skills.

 There is an optimum time for initiation of experiences

or learning.
 Neonatal reflexes must be lost before development can
proceed.
 A great deal of skill and behavior is learned by
practice.
Stages of Growth and
Development
 Stage – Neonatal
 Age – Birth to 28 days

 Significant Characteristics – Behavior

is largely reflexive and develops to
more purposeful behavior.
 Nursing Implications – Assist the
parents to identify and meet unmet
needs.
 Stage – Infancy
 Age – 1 month to 1 year

 Significant Characteristics - Physical

growth is rapid.
 Nursing Implications – Control the
infants environment so that physical
and psychologic needs are met.
 Stage – Toddlerhood
 Age – 1 to 3 years

 Significant Characteristics – Motor

development permits increased
physical autonomy. Psychosocial skills
increased.
 Nursing Implications – Safety and risk-
taking strategies must be balanced to
permit growth.
 Stage – Preschool
 Age – 3 to 6 years

 Significant Characteristics – The

preschooler’s world is expanding. New
experiences and the preschooler’s social
role are tried during play. Physical growth
is slower.
 Nursing Implications – Provide
opportunities for play and social activity.
 Stage - School age
 Age – 6 to 12 years

 Significant Characteristics – Stage includes

the preadolescent period (10 to 12 years).
Peer group increasingly influence
behavior. Physical, cognitive, and social
development increases, and
communication skills improve.
 Nursing Implications – Allow time and
energy for the school age child to pursue
hobbies and school activities. Recognize
and support child's achievements.
 Stage – Adolescence
 Age – 12 to 20 years

 Significant Characteristics – Self-

concept changes with biologic
development. Values are tested.
Physical growth accelerates. Stress
increases, especially in face of conflicts.
 Nursing Implications – Assist
adolescents to develop coping
behaviors. Help adolescents develop
strategies for resolving conflicts.
 Stage – Young Adulthood
 Age – 20 to 40 years

 Significant Characteristics – A personal

life style develops. Person establishes a
relationship with a significant other and
a commitment to something.
 Nursing Implications – Accepts adult’s
chosen lifestyle and assists with
necessary adjustments relating to
health. Recognize the person’s
commitments. Support change as
necessary for health.
 Stage – Middle Adulthood
 Age – 40 to 65 years

 Significant Characteristics – Lifestyle

changes due to other changes; for
example, children leave home,
occupational goals change.
 Nursing Implications – Assists clients
to plan for anticipated changes in
life, to recognize the risk factors
related to health, and to focus on
strengths rather than weaknesses.
 Older Adulthood
 Stage – Young-old
 Age – 65 to 74 years

 Significant Characteristics –
Adaptation to retirement and
changing physical abilities is often
necessary. Chronic illnesses may
develop.
 Nursing Implications – Assists clients
to keep physical and social active and
to maintain peer group interactions.
 Stage – Middle-old
 Age – 75 to 84 years

 Significant Characteristics –
Adaptation to decline in speed of
movement, reaction time, and
increasing dependence on others may
be necessary.
 Nursing Implications – Assist clients
to cope with loss (e.g. hearing,
sensory abilities and eyesight, death
of loved one). Provide necessary
safety measures.
 Stage – Old-old
 Age – 85 and over

 Significant Characteristics –
Increasing physical problems may
develop.
 Nursing Implications – Assists
clients with self-care required,
and with maintaining as much
independence as possible.
 Freud’s Five Stages of
Development
 Stage – Oral
 Age – Birth to 1½ year

 Characteristics – Mouth is the center

of pleasure (major source of
gratification and exploration).
 Implications – Feeding produces
pleasure and sense of comfort and
safety. Feeding should be pleasurable
and provided when required.
 Stage – Anal
 Age - 1½ to 3 years

 Characteristics – Anus and bladder are the

sources of pleasure (sensual satisfaction,
self-control). Major conflict: toilet training
 Implications – Controlling and expelling
feces provide pleasure and sense of
control. Toilet training should be
pleasurable experience.
 Stage – Phallic
 Age – 4 to 6 years
 Characteristics – The child’s genitals are the
center of pleasure. Masturbation offers
pleasure. Other activities include fantasy,
experimentation with peers and questioning
adults about sexual topics. Major conflict: the
Oedipus or Electra complex, which resolves
when the child identifies with parent of same
sex. (The Oedipus complex refers to the male
child’s attraction for his mother and hostile
attitudes towards his father. The Electra
complex refers to the female’s attraction for her
father and hostile attitudes toward her mother.)
 Implications – The child identifies with the
parent of the opposite sex and later takes on a
love relationship outside the family. Encourage
identity.
 Stage – Latency
 Age – 6 to puberty

 Characteristics – Energy is directed

to physical and intellectual activities.
Sexual impulses tend to be
repressed. Develop relationships
between peers of the same sex.
 Implications – Encourage child with
physical and intellectual pursuits.
Encourage sports and other activities
with the same sex peers.
 Stage – Genital
 Age – Puberty and after

 Characteristics – Energy is directed

toward full sexual maturity and
function and development of skills
needed to cope with the
environment.
 Implications – Encourage separation
from parents, achievements of
independence and decision making.
 Erikson’s Eight Stages of
Development
 Stage – Infancy
 Age – Birth to 18 months

 Central Task – Trust versus mistrust

 Indicators of Positive Resolution –

Learning to trust others
 Indicators of negative Resolution –
Mistrust, withdrawal, estrangement
 Stage – Early childhood
 Age – 18 months to 3 years

 Central Task – Autonomy versus

shame and doubt
 Indicators of Positive Resolution –
Self-control without loss of self-
esteem. Ability to cooperate and to
express oneself
 Indicators of negative Resolution –
Compulsive self-restraint or
compliance. Willfulness and defiance
 Stage – Late childhood
 Age – 3 to 5 years
 Central Task – Initiative versus guilt
 Indicators of Positive Resolution –
Learning the degree to which
assertiveness and purpose influence
the environment. Beginning ability to
evaluate one’s own behavior
 Indicators of negative Resolution –
Lack of self-confidence. Pessimism,
fear of wrongdoing. Over control and
over restriction of own activity
 Stage – School age
 Age – 6 to 12 years

 Central Task – Industry versus

inferiority
 Indicators of Positive Resolution –
Beginning to create, develop, and
manipulate. Developing sense of
competence and perseverance
 Indicators of negative Resolution –
Loss of hope, sense of being
mediocre. Withdrawal from school
and peers
 Stage – Adolescence
 Age – 12 to 20 years

 Central Task – Identify versus role

confusion
 Indicators of Positive Resolution –
Coherence of self. Plans to actualize
one’s abilities
 Indicators of negative Resolution –
Feelings of confusion, indecisiveness,
and possible antisocial behavior.
 Stage – Young adulthood
 Age – 18 to 25 years

 Central Task – Intimacy versus

isolation
 Indicators of Positive Resolution –
Intimate relationship with another
person. Commitment to work and
relationships
 Indicators of negative Resolution –
Impersonal relationships. Avoidance
of relationship, career, or lifestyle
commitments
 Stage – Adulthood
 Age – 25 to 65 years

 Central Task – Generality versus

stagnation
 Indicators of Positive Resolution –
Creativity, productivity, concern
for others
 Indicators of negative Resolution
– Self-indulge, self-concern, lack
of interest and commitments
 Stage – Maturity
 Age – 65 to Death

 Central Task – Integrity versus

despair
 Indicators of Positive Resolution –
Acceptance of worth and uniqueness
of one’s life. Acceptance of death
 Indicators of negative Resolution –
Sense of loss, contempt for others.
 Jean Piaget (Cognitive Theory)

 0-2 years: sensorimotor (reflexes , repetition of acts)

 2-4 years: preconceptual (no cause and effect
reasoning; egocentrism; use of symbols; magical
thinking)
 4-7 years: intuitive/preoperational (beginning of
causation)
 7-11 years: concrete operations
 11-15 years: formal operations (reality, abstract
thought)
 Assessment

 Developmental Tasks
 Developmental tasks are accomplishments normally
occurring at one stage and having an effect on the
development of subsequent stages.
 3 Categories
 Physical tasks

 Psychosocial tasks

 Cognitive tasks
 Measurement Tools
A. Chronologic Age : assessment of developmental task related to birth date.
B. Mental Age: assessment of cognitive development
 Measured by variety of standardized intelligence tests (IQ)
 Uses toys and language based on mental rather than chronologic age
 C. Denver Developmental Screening Test (DDST)
 General assessment tool; measures gross motor, fine motor, language, and
personal-social development from newborn – 6 years.
 Does not measure intelligence
 D. Growth Parameters
 Bone Age: X-ray of tarsals and carpals determines degree of ossification
 Growth charts: norms are expressed as percentile of height, weight, and
head circumference for age.
 
 Development Stages
 Infant
Play (Solitary)
Fears : Stranger Anxiety
 Toddler ( 12 months to 3 years)

Play : Parallel Play

Fears: Separation Anxiety
 Preschooler ( 3 to 5 years)

Play: Associative Play

Fears
 Fears concerning body integrity are common

 Magical thinking allows children to develop many illogical

fears ( fear of inanimate objects, the dark, ghosts)
 Development Stages
 School-age ( 6 to 12 years)
Play: Cooperative Play
Fears
 More realistic fears than younger children; include death, disease or
bodily injury, punishment; school phobia may develop, resulting in
psychosomatic illness.
 Adolescent ( 12 to 18 years)
Activities
 Group activities predominate ( sports are important); activities involving opposite sex by
middle adolescence
Fears
 Threats to body image: acne, obesity, homosexuality
 Injury or death
 The unknown