NUR244 TOPIC 5 LECTURE

Growth and Development

Learning Objectives

  • Differentiate between the terms growth and development.

  • Describe essential principles related to growth and development.

  • List factors that influence growth and development.

  • Outline developmental theorists.

  • Be introduced to the ways in which children, young people, and their families respond to disruptions in health.

  • Explore the relationship between responsive nursing and psychosocial development of children and young people.

  • Examine cultural factors that influence the ways in which children, young people, and their families respond to disruptions in health.

  • Consider child behaviour and child development, and the impact of nursing practice on responses to experiences of illness.

Growth vs Development

Growth

  • Defined as the quantitative aspect of an individual’s progression in physical measurements.

  • Measurable growth indicators include:

    • Height

    • Weight

    • Teeth

    • Skeletal structures

    • Sexual characteristics

Development

  • Refers to the progressive and continuous process of change leading to a state of organized and specialized capacity occurring over time.

  • Characterized as cumulative, a function of increasing age and mastery of skills.

  • Behavior reflected through abilities that enable individuals to be self-regulating.

Factors Influencing Growth and Development

  • Genetic Factors

  • Temperament

  • Family Environment

  • Nutrition

  • General Environment

  • Health

  • Cultural Background

Major Components of Growth and Development

  • Commonly understood as having five major components:

    • Biophysical

    • Psychosocial

    • Cognitive

    • Moral

    • Spiritual

Biophysical Theory

  • focus on the development of the physical body, how it grows and changes.

  • Arnold Gesell's Theory:

    • Development is directed by genetics.

    • Norms for typical age at which children reach developmental milestones.

    • Maturation has a fixed developmental sequence in humans that cannot be accelerated.

    • Unhealthy environments can impede the timing and quality of development.

Physical Growth

  • Children’s physical growth can indicate their overall health and development.

  • Growth patterns:

    • Vary among children yet typically follow a consistent pattern over time.

    • Influenced significantly by genetics and environment.

  • Growth Charts:

    • Used to show changes in children's length, height, weight, and head circumference over time.

    • Lines reflect typical growth ranges for different ages, based on World Health Organization (WHO) standards.

Example of Weight-for-age Growth Chart (Girls, Birth to 2 years)

  • Percentiles include the following:

    • 14extkg=85thextpercentile14 ext{ kg} = 85^{th} ext{ percentile}

    • 13extkg=50thextpercentile13 ext{ kg} = 50^{th} ext{ percentile}

    • 12extkg=15thextpercentile12 ext{ kg} = 15^{th} ext{ percentile}

    • 11extkg=3rdextpercentile11 ext{ kg} = 3^{rd} ext{ percentile}

Developmental Milestones

Birth to Six Months
Gross (Large) Motor Skills

  • Lifts head and chest while lying on stomach.

  • Rolls side to side and completely over.

  • Sits with support.

  • Holds head in an upright position when held or on tummy.

Fine (Small) Motor Skills

  • Reaches for and holds objects briefly.

  • Touches and plays with fingers, hands, and toes.

Six to Twelve Months
Gross Motor Skills

  • Progresses from sitting with support to sitting independently.

  • Crawls on hands and knees; pulls to stand; learns to walk.

Fine Motor Skills

  • Reaches for and transfers objects between hands.

  • Improves eye-hand coordination.

Twelve to Eighteen Months
Gross Motor Skills

  • Stands and walks independently; runs stiffly.

  • Climbs stairs; performs controlled movements (e.g., throwing a ball).

Fine Motor Skills

  • Turns several pages of a book at once; scribbles on paper; begins to build a tower of blocks.

Eighteen to Twenty-Four Months
Gross Motor Skills

  • Continues to run, jump, and climb.

  • Walks up stairs one step at a time.

Fine Motor Skills

  • Can manage a spoon; beverages from a straw.

  • Enjoys creative activities like drawing and building.

Two to Three Years
Gross Motor Skills

  • Constantly in motion; jumps off low surfaces; rides wheeled toys.

Fine Motor Skills

  • Manages simple tasks (e.g., zips jackets, turns knobs).

Three to Four Years
Gross Motor Skills

  • Hops, skips, and performs jumping actions.

  • Climbs playground equipment.

Fine Motor Skills

  • Draws simple shapes and uses scissors.

Four to Five Years
Gross Motor Skills

  • Climbs large structures and performs somersaults.

  • Hops on one foot and catches a ball.

Fine Motor Skills

  • Can write their name; constructs complex structures with blocks.

Five to Six Years
Gross Motor Skills

  • Continues refining jumping and landing techniques; climbs more challenging structures.

Fine Motor Skills

  • Forms detailed shapes and colors with improved control and dexterity.

School Age (Six to Nine Years)

  • Growth rate slows; requires about eleven hours of sleep.

  • Establishes hand dominance.

  • Develops coordination and engages in sports and organized activities.

  • Self-care abilities become more pronounced.

Adolescence (Twelve to Fifteen Years)

  • Puberty brings rapid growth; development of secondary sexual characteristics.

  • Body image concerns become prominent; comparison with peers begins.

Adolescence (Fifteen to Eighteen Years)

  • Physical growth slows in girls; continues for boys.

  • Completion of puberty; 95% of adult height reached; increased personal identity exploration.

Psychosocial Theories of Development

Erik Erikson's Stages of Development

  • Trust vs. Mistrust (Infancy: Birth to 1 year)

  • Autonomy vs. Shame and Doubt (Early Childhood: 1–3 years)

  • Initiative vs. Guilt (Preschool: 3–6 years)

  • Industry vs. Inferiority (School Age: 6–11 years)

  • Identity vs. Role Confusion (Adolescence: 11–20 years)

  • Intimacy vs. Isolation (Young Adults: 20–40 years)

  • Generativity vs. Stagnation (Middle Age: 40–60 years)

  • Integrity vs. Despair (Old Age: 60 years until death)

Details of Conflict and Outcomes

  • Trust vs. Mistrust: Children develop trust through reliable care. Negative results in mistrust.

  • Autonomy vs. Shame and Doubt: Encouragement in making choices fosters independence. Too much control breeds shame.

  • Initiative vs. Guilt: Children should explore and take charge. Failure brings guilt.

  • Industry vs. Inferiority: Success in managing social demands leads to confidence; failure generates feelings of inferiority.

  • Identity vs. Role Confusion: Successful identity formation leads to stability; poor outcomes yield confusion.

  • Intimacy vs. Isolation: Building close relationships fosters connection. Failure results in isolation.

Nursing Implications for Developmental Stages

Trust vs. Mistrust: Nursing Actions

  • Allow ongoing caregiver interactions.

  • Maintain routines to reduce anxiety.

Autonomy vs. Shame and Doubt: Nursing Actions

  • Provide choices to empower.

  • Ensure excellent pain management.

Initiative vs. Guilt: Nursing Actions

  • Engage children in interactive play.

  • Acknowledge parental anxiety to alleviate child fears.

Industry vs. Inferiority: Nursing Actions

  • Encourage self-care responsibilities.

  • Provide positive feedback to boost confidence.

Identity vs. Role Confusion: Nursing Actions

  • Create spaces for social interaction.

  • Provide privacy and encourage peer support during hospital experiences.

Cognitive Development

  • Refers to learning methods, reasoning, and language usage.

  • Key theorist: Jean Piaget, who described cognitive development as orderly and sequential through five stages:

    • Each stage has unique characteristics.

  • This framework is crucial for developing educational strategies in nursing.

Moral Development

  • Describes the process of distinguishing right from wrong; involves ethical reasoning.

  • Key theorist: Lawrence Kohlberg with six stages of moral reasoning relevant for children:

    1. Obeying rules (Toddler to 7 years): avoidance of punishment.

    2. Conformity (Preschool to School Age): driven by ego-centric needs.

    3. Approval needs (School Age to Adulthood): concern for others’ reactions.

    4. Law and Order (Adolescence and Adulthood): respect for authority and duty.

Cultural Influences on Child Development

  • Culture shapes values, language, belief systems, and identity from birth, affecting overall development.

  • Transmission of cultural values through family, environment, and media affects children's behavior and self-identification.

  • Conflicts between socio-cultural environments and home cultures can lead to developmental issues.

  • Key for parents:

    • Cultural values guide child-rearing practices—discipline and boundary setting play a crucial role.

Key Points for Pediatric Nursing

  • The welfare of children and families during health disruptions is crucial for pediatric nurses.

  • Relevant strategies include family advocacy, disease prevention, health education, and coordinated care.

  • Cultural factors significantly influence health responses in children and families.

  • Health care must embrace cultural awareness and provide support for diverse values and practices.

References

  • Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (2019). Potter and Perry’s Fundamentals of Nursing (5th ed.). Elsevier.

  • Fraser, J., Waters, D., Forster, E., & Brown, N. (2022). Paediatric Nursing in Australia and New Zealand (3rd Ed). Cambridge University Press.

  • Harvey, N. (2021). Concepts of Growth and Development. In A. Berman, et al. (Eds.), Kozier and Erb's Fundamentals of Nursing: Concepts, Process and Practice (5th Australian ed., Vol. 1, pp. 367–384). Pearson.