Growth and Development

GROWTH AND DEVELOPMENT

IMPORTANCE OF KNOWLEDGE ABOUT GROWTH AND
DEVELOPMENT
 Health Promotion and Illness Prevention
o Anticipatory Guidance
o Health teaching BEFORE characteristic behaviors and
concerns occur
o Teach about what child is capable of doing
 Health Restoration and Maintenance

GROWTH –is generally used to denote an increase in size or
shape and can be measured quantitatively.
DEVELOPMENT -is used to indicate an increase in skill or the
ability to function. A qualitative change
 Also known as maturation
 Can be measured by:
o Observing the child’s ability to perform a specific task
o Recording the parent’s description of a child’s progress
o Using standardized test such as Denver II.
 Denver Developmental Screening Test
• Common SCREENING test
• Measures language, personal/social, fine and
gross motor areas
• Easy to administer
• NOT an intelligence test
 Must fail test twice before referral is
considered
 If child uncooperative – test later

PRINCIPLES OF DEVELOPMENT·
 Continuous Process through Life
 Orderly Sequence
 Predictable but Unique Ranges
 Systems Mature At Different Rates
 All Body Systems Do Not Develop At The Same Rate
 Cephalocaudal Pattern
 Proceeds From Proximal to Distal Body Parts
 Gross To Refined Skills
 Sensitive Periods Occur For Learning
 Neonatal Reflexes Need To Be Lost
 Skills Are Learned By Practice

FACTORS INFLUENCING GROWTH AND DEVELOPMENT
1. GENETIC INHERITANCE
 Genetics
 Gender
 Intelligence
 Temperament
 Activity level
 Rhythmicity – refers to the regularity / irregularity in
physiologic functions
 Approach – refers to a child’s response o initial contact
with a new stimulus
 Adaptability – the ability to change ones reaction to a
stimuli over time
 Intensity of reaction
 Distractibility – ability to shift attention to a new
 situation
 Attention span – ability to remain interested in a
project or activity
 Persistence – ability to perform an activity even when
they fail time after time
 Threshold of Response – refers to the intensity level of
stimulation that is necessary to evoke a reaction
 Mood quality
2. ENVIRONMENTAL INFLUENCE
 Socioeconomic level
 Parent-child relationship
 Ordinal position in the family
 Nutrition

Nursing Implications
· Although development follows an order of succession:
· The rate of progress differs among people in certain life stages
· Anticipate regression during crisis periods
· Accept/support the return to progression
· Transition to each stage has no definite beginning or end.
· From each stage to the next is an overlapping process.
· Be knowledgeable concerning various stages of development.
· Be flexible when assessing and caring for people:
· Respect each person’s uniqueness
· Be cognizant of environmental and cultural influences on
development.

GROWTH AND DEVELOPMENT OF INFANTS
Physical growth
 Infants grow more rapidly both size and their ability to
perform tasks.
 More infants double weight by 6 months of age
 Triple by 1 year.
 Height increase at 1 year by 50%
 Head circumference increases due to rapid brain growth
 Body proportion changes to amore typically infant
appearance. Mandible becomes prominent and remain
throughout life.
 Chest is less than the size of the head at birth by about 2 cm.
 Even with the head at 6 months and in most 12 months.
 Cervical, thoracic, and lumbar vertebrae curves develop as
infants hold up their head, sit, and walk.
 Lengtening of the lower extremities during the last 6
months of infancy readies the child for walking and often
changes as “baby like” to “ toddler like”

Teeth
 First baby tooth is the central incisor- erupts at age 6
months followed by a new one monthly
 1 in 2000 may be born with natal teeth
 Or have erupt at first 4 weeks of life called neonatal teeth.
 Deciduous teeth or temporary or baby teeth are essential
for protecting the growth of the dental arch.
 Causes increased saliva and drooling
 Enzyme released with teething causes mild diarrhea, facial
skin irritation
 Slight fever may be associated; not high fever

· Vision
· Newborn prefers bright moving
· Fixation by 6 weeks
· Depth perception by 2-3 months
· Acuity 20/100 to 20/50
· Taste
· Prefers sweet
· 2-3 months expresses displeasure
· Hearing
· Newborn prefers mother’s voice
· Turns at 4 months localizes sound
· 6 months responds to name
· Tactile
· Pain response
· 1 week – general
· 3 months – specific withdraw
· Integumentary
· Adipose tissue insulates infant
· Epidermis easily separates
· Cardiovascular
· Fetal hemoglobin present first 5 months
· Maternal iron stores 5-6 months
· GI
· Small, round stomach
· Rapid peristalsis and transit
· Predisposed to spitting up, diarrhea, vomiting and
dehydration
· Respiratory
· Number of alveoli increases first year
· Predisposed to respiratorY infections
· Closeness of trachea and bronchi
· Short, straight Eustachiantubes
· Immature, mucosal lining
· Renal
· Immature nephrons
· Decreased filtration and absorption
· Less ability to concentrate urine
· Predisposed to dehydration
· Neurological
· No new nerve cells appear after 6 months of fetal age

0-1 month
- Largely reflexes- motor
- Keeps hand fisted: able to follow object to midline- fine
- Play: Enjoys watching of primary caregiver: listening to
soothing sounds
2 month
- Holds head up when prone- motor
- Has social smile- fine
- Makes cooing sounds- socialization and language
- Play: Enjoys bright colored mobiles
3 month
- Holds head and chest up when prone
- Follows object past midline- fine
- Socialization and language- Laughs out loud
- Spends time looking at hands or uses them as toy during the
month ( hand regard)

4 month
- Grasp, stepping, tonic-neck reflexs are fading- motor
- Play: needs space to turn
5month
- Turns from front to back- motor
- No longer head lag
- Bears Partial weight when upright
- Play- Handles rattles well
6 month
- Turn both ways
- Moro reflex fading- motor
- Uses palmar grasp- fine
- May say vowel (oh-oh)-socialization and language
- Play- Enjoys bathtub toys, rubber ring for teething
7 months
- Reaches out in anticipation of being picked up first tooth
central incisor)- motor
- Sits unsteadily or with support- motor
- Transfers objects hand to hand- fine
- Shows beginning fear of strangers- socialization and play
- Play- likes objects that are good size for transferring
8 months
- Sits securely without support-motor
- Socialization and language- Has peak fear of strangers (
ability to tell known from unknown people)
- Play- Enjoys manipulation, rattles and toys of different
textures
9 months
- Creeps or crawls- motor( abdomen off floor)
- Socialization and language- Says first word ( da- da)
- Play- needs space for creeping
10 months
- Pulls self to standing- motor
- Uses pincer grasp- socialization and language
- Play- Plays like patty cake and peek-a-boo
11 months
- Cruises “ Walks with support”- motor
- Play- Cruises
12 months
- Stands alone: some infants take first step- motor
- Holds cup and spoon well:
- Helps to dress( pushes arm into sleeve)
- Says to word da-da or ma- ma
- Play- likes toys that fit inside each other, nursery rhyme

PROMOTING INFANT SAFETY
 Accidents are leading cause of death from 1 month through
24 years of age.
 They are only second to acute infections as a cause of
morbidity
 Most accidents in infants occur due to underestimation or
overestimation of child’s ability.
Aspiration Prevention
 Round and cylindrical objects are dangerous because it can
obstruct the airway( hotdog and carrots)
 Educate the parents of the infant not to prop the bottles
 Educate the parents to secure that the infant will not even
reach a small object to be put into the mouth
 When solid foods are introduced, encourage parents to
offer a small pieces of food.
Fall prevention- second major cause of infant accidents
 As a preventive measure, no infant, should be left
unattended on a raised surface.
 Be sure that the crib sides are raised and secure before
anyone walks away from the crib.
Motor vehicle
 Never transport unless the infant is buckled into an infant
car seat in the back seat of the car
 Do not be distracted while driving
 Do not leave the infant unattended in the car park
Suffocation
 Allow no plastic bag’s within the reach of the infant
 Do not use pillows in the crib
 Store unused appliances with the doors removed
 Remove constricting clothing such as bib at bedtime
Drowning
 Do not leave infant alone in the bath tub or unsupervised
near water
Animal Bites
 Do not allow an infant to approach a strange dog
Poisoning
 Never present medication as candy
 Never take medications in front of a child
 Place all medications in a secure cabinets
 Never leave the medications on a pocket or handbag
 Hang plants or set on a high surfaces
Burns
 Test warmth formula and food before feeding
 Do not smoke or drink hot liquids while holding the infant
 Buy flame or retardant clothing
 Use sunscreen on a child over6 months when out in direct
or indirect sunlight
 Turn handles of pans toward back of the stove
 Monitor infants carefully near candles
 Donot allow infants to blow matches
 Keep electric wires out of reach

GROWTH AND DEVELOPMENT OF TODDLERS
 Toddler- great strides
 developmentally but growth are slow
 Speaks in two word sentences
 20 deciduous teeth present at 2.5 years
 Chest circumference becomes bigger than the head
circumference at 2 years
 Heart ate 90- 110 bpm
 “ pouchy” abdomen from weak abdominal muscles
 Noticeable lordosis
 “ baby fat” begins to disappear
 Wide based gait

 15months
 Puts a small pellets into small bottles- fine
 Scribbles voluntarily with a pencil or a crayon and holds a
spoon well but may still turn upside down- fine
 Walks alone well: can seat self in chair: can creep upstairs-
gross
 4-6 words
 Play- can stack 2 blocks enjoys being read to; drop toys for
adult to recover ( exploring sense of permanence)

 18 months
 No longer rotates a spoon to bring it to mouth-fine
 Can run and jump in place. Can walk up and down stairs
holding onto a person’s hand or railing.
 Typically places both feet on one step before advancing-
gross
 7-20 words, uses of jargoning:
 Names 1 body part- language
 Play- Imitates household chores, dusting etc.
 Begins parallel play (playing beside but not with another
child)

 24 months
 Can open doors by turning doorknobs, unscrew lids- fine
 Walks up stairs alone still using both feet on same step at
the same time
 50 words, 2 word sentences( such as noun, pronoun, verb)
“Daddy go” “me come”
 Parallel play evident

 30 months
 Makes simple lines or strokes for crosses with a pencil- fine
 Can jump down from chairs- gross
 Verbal language increasing steadily. Knows full name: can
name one color and holds up finger to show age
 Play- Spends time playing house, imitating parents actions;
play is “ rough- housing” or active

Problem Concerns Associated With The Toddler Period:
Toilet training
- It should begin when the infant is ready to accomplish it
- They must have the control of rectal and urethral spinchter
- They must have a cognitive understanding of what it means
to hold urine and stools- so they can release it on time and
proper place
- They must have the desire to delay immediate gratification
for a more socially accepted action
Ritualistic Behavior
- They will use their spoon at meal time
- They will not go outside unless mother locates his cap
- You need more guidelines and rule”
NEGATIVISM
- They always say “no”
- Just make a staement not a question
- Example: Are you ready for dinner?
- Instead tell come to table its dinnertime
DISCIPLINE-means setting rules or road signs so children know
what is expected of them
Punishment- is a consequence that results from a breakdown in
discipline
A. Parents need to be consistent
B. rules are learned best if correct behavior is praised than
wrong nehavior is punished
“timeout:”- help children that their actions have consequences
SEPARATION ANXIETY
6 mos persists up to preschool period
Inform the child before leaving
But they will still cry if they don’t see their parents
Sneaking can prevent crying but increases abandonment
TEMPER TANTRUMS
Child may kick, scream, stamp, shout
No no no and lie on the floor
Sometimes they are holding their breath, true breath holding is a
neurologic problem in wc children under stress
Just ignore!
Approaching the Toddler
• Position sitting/lying on parent’s lap
• Ignore/avoid eye contact initially
• Introduce equipment slowly
• Remove clothing as examined
• Shine “light” on hand before using otoscope
• Use restraints as necessary

GROWTH AND DEVELOPMENT OF PRESCHOOLERS

PRESCHOOL CHILD
Physical Growth
-Definitive changes in the body contour- ectomorphic( slim)
endomorphic( large)
- Vocabulary increases
- Tonsils appear enlarged
- Growth is only 2- 3.5 inches a year
- Pulse rates decreases to about 85bpm
- Genu valgus (knock knees) may be evident
- Increase coordination makes bicycle riding, running, kicking
if possible
 Weight gain- child gains only about 4.5lb (2kg)
 Height gain- only 2 to 3.5 in (6-8cm)
 Teeth- generally have 20 deciduous teeth by 3 years of age.
 Oedipus complex- strong emotional attachment a preschool
boy demonstrates toward his mother
 Electra complex- preschool girl to her father
DEVELOPMENTAL MILESTONES
3 years old
Undresses self; stacks tower of blocks; draws a cross-fine motor
Runs; alternate feet on stairs; rides tricycle; stand on one foot-
gross
Vocabulary of 900 words
Play- Able to take turns; very imaginative
4 years old
Can do simple buttons- fine
Constantly in motion jumps; skips- Gross
Vocabulary of 1500 words- language
Play: Pretending is major activity
Ex: imaginary friends are normal
5 years
Draws a 6 part man, can lace shoes- fine motor
Throws overhead- gross
Vocabulary of 2100 words- language
Play: likes games with numbers or letters

PARENTAL CONCERNS ASSOCIATED WITH PRESCHOOL
PROBLEMS
COMMON FEARS OF THE PRESCHOOLER
Fear of darkness- sleep with the child
Fear of mutilation-which involves the loss of, or incapacity to
use, a bodily member
- need of good explanation
Separation abandonment- explain on the time and place that a
child can relates
Ex: television shows, or a friends house
Preparing for new sibling
Eliminate the sibling rivalry by explaining that the preschool is
already big boy
Tell the preschool child in advance
Allow the child to visit in the hospital
SEX EDUCATION
Why does james looks differ from mine?
Answer: “boys look different from girls”
The different part is penis
Where does the babies come from?
Answer: “Babies grow in a special place in a mothers body called
uterus.”

Approaching the Preschooler
• Position on table
• Allow to inspect equipment
• Compliment on appearance
• Use positive statements for instructions
• Fun games

GROWTH AND DEVELOPMENT OF SCHOOL AGE
CHILDREN

SCHOOL AGE DEVELOPMENT
6 years
A year of constant motion, skipping is a new skill- physical
Teacher becomes authority figure- psychosocial
Define words by their use- cognitive
Ex: a key is to unlock a door not a metal object

7 years
Central incisor erupt-permanent
Play: video games and dolls- quiet play
A quiet year: striving for perfection leads to this year being
called an eraser year.
Can tell time, can make simple changes

8 years
Coordination definitely improved;
playing with gang becomes important; eyes become fully
developed
Best friends develop
Whispering and giggling begins
Can write as well as print
Can tell the present, past and future



9 years
All activities done with a gang
Gang age- secrets
All boys or all girls
If gang disband and reform quickly

10 years
Coordination improves
Ready to camp away from home
Ready for competitive games

11 years
Active but awkward and ungainly
Insecure with members of the opposite sex, repeats off color
jokes

12 years
Coordination improves
A sense of humor is present: is social and cooperative

CONCERNS OF PROBLEMS DURING SCHOOL AGE
Common:
- Attention deficit hyperactivity disorders
- Fears
- Language
- Responsibility
Language
Articulation- the child is difficult in saying
S,z, th,l r, and w substitutes for “westroom” or “radies room”
Fears
- Anxiety related to beginning school- adjusting to the
environment
- School refusal or phobia- resist to attend school just like
agoraphobia
- Cause: bully harsh teacher, showering in the gym class
- Manage by counseling or transferring to another room
-
Sex Education
- Reproductive organ function
- Secondary sexual characteristics-aware of their body
- Physiology of reproduction-understand menstruation
- Explanation of the physiology of pregnancy and the
possibility that comes with sexual maturity for unplanned or
unwanted pregnancies
- Social and moral implications sexual maturity
Stealing- during early age it is normal- around 7 yrs old
Tell your child that the money is missing
Not pointing that the child steal the money
The importance of money is reviewed\
Mother and father is theirs
Child;s money is the childs money

Violence and tourism- such as shooting or reports of terrorism
COMMON RECOMENDATIONS
- Assure children they are safe;
- Assure children their parents are actively involved in keeping
them safe.
- Observe for signs of stress- sleep disturbance, fatigue, lack of
pleasure,
- Not allow children or adolescents to view footage of
traumatic events over and over
- Watch news programs with children so they can explain that
the situation.
- Explain there are bad people in the world, and bad people do
bad things. But encourage not to see only one side of it.
- Prepare a family disaster plan
BULLYING
- Tell the child that it should be reported
- School age child bullying has long term effects on mental
health

SCHOOL AGE CHILD
Chronological Devt of secondary characteristics

Age Boys GIrls
9-11 Prepubertal weight gain
Breasts: elevation of papilla with breast bud formation, areolar
diameter enlarges
11-12
Sparse growth of straight, downy
slightly pigmented hair at base of penis
Scrotum become textured
Growth of penis and testes
Perspiration increases
Straight hair along the labia, vaginal epithelium cornified
Perspiration also increases
12-13
Pubic hair present across pubis
Penis lengthens
Dramatic linear growth spurt
Breast enlargement occurs
Pubic hair grows darker; spreads all over pubis
Breast enlarges, still no protrusion of nipples axillary hair is
present
Menarche occurs


Approaching the School Age Child
 Position on table
 Give simple explanations and teaching
 Talk to distract and relax
 Respect privacy
 Examine genitalia last and quickly

GROWTH AND DEVELOPMENT OF ADOLESCENTS

ADOLESCENTS

 Puberty- is the time at which an individual first become
capable of sexual reproduction
 Range 11- 14years
 Girls- < 13 years- menstruation
 Boys- begins producing spermatozoa

Play or recreation
- Change from more adults forms of recreation such as:
listening to music, chatting on computers, following a sports
teams wins or losses.
Emotional devt: identity vs. role confusion
Four main areas to achieve a sense of identity
1. Accepting a change or body image
2. Establishing a value system or what kind of person they
want to be
3. Making a career decision
4. Becoming emancipated from their parents

13 years old
feel self doubt than self confidence
Because they still look children but want to grown up
14 years old
Becoming used of their body changes and quieter- have more
self confidence
15 years old
Fall in love 5 to six times a year
Based on physical features
16 years
Becoming sexually mature- trust their own bodies
17 years
Left behind the childish behaviors they used in early adolescence
Shoving and punching- to get the attention of the opposite sex

Approaching the Adolescent
• Needs privacy
• Use a gown and sheet
• Talk as a professional
• Do not use slang
• Give honest answers to questions

SECONDARY SEX CHARACTERISTICS


Age Males Females
13-15
Growth spurt continues
Pubic hair is abundant and curly
Testis, scrotum and penis enlarging further
Facial hair, voice changes
Pubic hair is thick and curly- triangular
Menstruation is ovulatory
Pregnancy is possible
15-16
Genitalia adult
Scrotum dark and heavily rugaeted
Facial and body hair is present
Sperm production is mature
Pubic hair abundant
Areolas no longer project as separates
ridges from the breast
Facial acne
16-17
Pubic hair curly and abundant may extend to the
medial aspect of the thigh
Facial acne
Gynecomastia – enlarged breast tissue
End of skeletal growth
17-18 End of skeletal organ
NURSING CARE FOR OLDER ADULTS

Gerontological Nursing
 nursing specializing in the care of older adults. These standards include practice guidelines fro health promotion, health
maintenance, diease prevention, and self-care, with a goal of restoring and maintaining optimal physical psychological and
social functioning among the elderly population.

STRUCTURAL and FUNCTIONAL CHANGES and COMMON HEALTH PROBLEMS in OLDER ADULTS
SYSTEM NORMAL CHANGES ASSOCIATED WITH AGING COMMON HEALTH PROBLEMS
Cardiovascular  contractility, impaired coronary artey flow, 
atherosclerotic plaques
Hypertension, Ischemic Heart Disease, Heart Failure,
Peripheral Vascular Disease, Varicose veins, DHN,
Stroke / TIA
Neurologic /
Behavioral
 speed of neural conduction,  number of brain
cells,  neurotransmitters,  cerebral circulation, 
REM sleep
Parkinsonism, Alzheimer’s Disease or dementia,
depression, sleep disturbance
Respiratory  rigidity of thoracic cage,  elasticity,  vital
capacity,  cough efficiency,  ciliary action
Pneumonia, COPD, dyspnea
Gastrointestinal  secretion of gastric acid, delayed gastric emptying,
 GI motility, altered nutrient digestion, altered
bowel function
Diverticula or Diverticulitis, constipation, GERD, fecal
incontinence, colorectal CA, anorexia
Genitourinary  badder capacity, concentrating and diluting
abilities,  creatinine clearance,  prostate size
Renal insufficiency, urinary incontinence, UTI,
Prostate Ca, sexual dysfunction
Endocrine /
Metabolic
 basal metabolism, altered pancreatic function, 
testosterone, estrogen, progesterone
DM, hyperthyroidism and hypothyroidism,
hyperlipidemia
Musculoskeletal  Bone density,  muscle size and strength,
degenerated joint cartilage
Paget’s disease, osteoporosis, osteomalacia, RA,
osteoarthritis, fractures, falls
Autonomic
Nervous System
 reaction time and coordination,  temperature
regulation,  sensitivity to baroreceptors
Falls, accidental injuries orthostatic hypotension,
impaired body temperature regulation
Hematologic and
immune function
 erythropoietin production,  T and B cellsand
monocytes,  intrinsic factor
Iron Deficiency Anemia, pernicious anemia, Cancer,
autoimmune disorders
Oral  salivary secretion, loss of teeth Periodontal disease, problems with speech, chewing
and swallowing
Sensory  accomodation,  visual acuity,  hearing of high
pitched frequencies
Visual impairment, hearing impairment,  smell or
taste
Dermatologic  elasticity,  secretion of natural oil and
perspiration,  heat regulation,  epidermal renewal,
 inflammatory response
Pressure sores, dermatitis, pruritus, hypothermia
Reproductive Female: vaginal mucosal thinning, atrophy,  breast
tissue, sexual dysfunction
Male:  sexual desire
Female: Cervical Ca, Breast Ca
Male: Prostate Ca, impotence
GUIDELINES FOR EFFECTIVELY TEACHING OLDER ADULTS
1. VISION
a. Provide large, easy-to-read typeface
b. Emphasize contrasting colors: black and white
c. Avoid blue and greens
d. Write short and simple paragraphs
e. Make sure eyeglasses are in place and clean
2. HEARING
a. Speak slowly
b. Enunciate clearly
c. Lower the pitch of your voice
d. Eliminate background noise
e. Face the learner
f. Use non-verbal cues
g. Make sure client’s hearing aid is in place ad is working
properly

3. ENERGY LEVEL / ATTENTION
a. Use short teaching sessions
b. Offer liquid refreshment and bathroom breaks
c. Promote comfort
4. INFORMATION PROCESSING AND MEMORY
a. Present most important information first
b. Clarify information with use of examples that the client can
relate to
c. Motor skills: teach one step at a time, demonstrate, allow for
return demonstration
d. Be concrete and specific
e. Eliminate distractions
f. Encourage verbal interactions
g. Correct wrong answers and reinforce correct answers
h. Offer praise and encouragement