Developmental Stages: Infancy Through Middle Adulthood
CHAPTER 5 Life Span: Infancy Through Middle Adulthood
Learning Outcomes
After completing this chapter, you should be able to:
Discuss the principles of growth and development.
Compare and contrast developmental task theory, psychoanalytic theory, cognitive theory, and psychosocial theory of growth and development.
Outline the major principles involved in moral and spiritual development.
Identify conditions that influence growth and development at all ages.
Discuss the cognitive and psychosocial challenges for each age-group from infancy through middle age.
Identify common health problems seen in each stage of development.
Describe special assessments unique to each age-group.
Discuss age-appropriate interventions for each age-group.
Incorporate developmental principles into nursing care.
Key Concepts
Growth
Development
Stages
Related Concepts
See the Concept Map at the end of this chapter.
Example Client Conditions
Abuse, Neglect, and Violence
Substance Abuse
Meet Your Patients
Reflecting on experiences from the pediatric unit where care for three children diagnosed with pneumonia was provided:
#### Tamika (3 years old):
Lives with her grandparents.
Grandmother is only available during afternoon visiting hours as she cares for her ailing husband.
#### Miguel (2 months old):
Lives with his mother, who is 17 years old and has remained by his side during hospitalization, showing high concern for his health.
#### Carrie (13 years old):
Lives with both parents, who can visit only in the evenings after work.
Notable differences in needs and nursing care stem from developmental stages.
Throughout human life, continuous physical, cognitive, and emotional changes occur, visible or not.
Theoretical Knowledge
Understanding principles and theories of growth and development can form a solid foundation for planning and delivering patient care.
Basic foundations cover primarily infant and child development. For in-depth knowledge, refer to relevant child development or pediatric nursing textbooks.
About Key Concepts
Development: A process of adapting to one’s body and environment over time, featuring skill progression and increasing complexity of function.
Examples include:
A child recognizing right from wrong.
An adolescent making vocational choices.
An older adult acknowledging mortality.
Growth: Refers to physical changes over time, such as increases in height, sexual maturation, weight, and muscle tone.
Growth represents the physical aspect of development; behavioral development encompasses other aspects.
Stages
As the chapter unfolds, the concept of stages will interrelate with growth and development concepts.
How Does Development Occur?
Themes of change resonate through all life stages, as illustrated by physical, cognitive, and emotional progress over time.
Key Point: Change is constant across the life span.
The debate on nature versus nurture:
Nature: Refers to genetic endowment.
Nurture: Encompasses environmental influences.
Comparison example: The growth of a flowering tulip from a bulb depends on genetic factors and environmental conditions.
Principles of Growth and Development
Growth and development follow an orderly, predictable pattern but vary by individual.
Example: Some children sit at 6 months and walk at 10 months; others may sit at 7 months and walk at 15 months—but all are developing normally.
Growth proceeds in a cephalocaudal pattern (head to toe).
Example: Infants initially grow head, chest, and trunk before showing noticeable leg growth.
Development follows a proximodistal pattern (center outward).
Example: Infants first focus eyes, then lift their heads, roll over, crawl, and walk.
Simple skills develop separately and integrate into complex skills.
Example: Self-feeding requires locating the mouth, grasping the spoon, controlling the spoon, and coordinating everything to eat.
Body systems grow at varying rates:
Notable changes occur dramatically in certain systems (e.g., the cardiovascular system) while reproductive systems change minimally until puberty.
Body system functions become increasingly differentiated with time; newborn responses evolve to be more focused with maturation (e.g., initial startle reflex versus refined responses).
Theories of Development
Theories of development explain common patterns of growth needed for effective nursing interventions and clinical decision-making.
Unique needs across age spans (6-year-olds vs. 25-year-olds vs. 65-year-olds) mandate understanding developmental stages for appropriate assessments and interventions.
Key Point: Developmental theories segment the lifespan into stages, each characterized by common characteristics and associated tasks.
Developmental Task Theory (Robert Havighurst)
Postulates that learning is lifelong and progresses through six life stages, each with multiple tasks.
Definition of developmental task: "Midway between an individual need and societal demand,…an active learner interacting with an active social environment" (Havighurst, 1971).
Failure to master a task may hinder future success and social interactions.
Limitations: While broad, Havighurst's tasks have nonspecific timeframes limiting individual assessments.
Psychoanalytic Theory (Sigmund Freud)
Freud's psychoanalytic theory, developed in the Victorian era, introduces concepts of sexual repression and dominance factors impacting behavior.
Key Point: Freud’s theory examines motivations behind human behavior and personality development through instinctual drives such as libido, aggression, and survival.
Components of the personality:
Id: Represents basic instincts and urges; dominant in infants.
Ego: Develops between 4-6 months; balances id’s demands against reality.
Superego: Forms between ages 5-6; acts as conscience based on environmental interactions.
Defense mechanisms identified by Anna Freud protect the ego during threats.
Cognitive Development Theory (Jean Piaget)
Piaget observed cognitive development through four sequential stages:
Sensorimotor (Birth-2 years): Learning through senses and reflexive actions; develops object permanence.
Preoperational (2-7 years): Symbolic thinking; ego-centric viewpoint; limited logical reasoning.
Concrete Operations (7-11 years): Logic and reasoning develop; understanding of conservation and perspectives.
Formal Operations (11-adolescence): Abstract thinking ability emerges; capable of scientific reasoning.
Adaptation involves restoring balance through:
Assimilation: Integrating new experiences into existing frameworks.
Accommodation: Modifying frameworks to fit new information.
Psychosocial Development Theory (Erik Erikson)
Erikson hypothesized that individuals negotiate eight developmental stages, providing a framework for identity formation and personal development from infancy into old age.
Successful progression through these stages involves mastering the associated tasks, while failures can yield maladjustment.
Stages in Erikson's Theory:
Trust vs. Mistrust (Birth-18 Months)
Autonomy vs. Shame and Doubt (18 Months-3 Years)
Initiative vs. Guilt (3-5 Years)
Industry vs. Inferiority (6-11 Years)
Identity vs. Role Confusion (11-21 Years)
Intimacy vs. Isolation (21-40 Years)
Generativity vs. Stagnation (40-65 Years)
Ego Integrity vs. Despair (65 years and above)
Moral Development Theory (Lawrence Kohlberg)
Kohlberg focused on moral reasoning seen in responses to moral dilemmas across three levels:
Preconventional:
Stage 1: Punishment-obedience orientation
Stage 2: Personal interest orientation
Conventional:
Stage 3: Good boy-nice girl orientation
Stage 4: Law and order orientation
Postconventional:
Stage 5: Social contract orientation
Stage 6: Universal ethical principles orientation
Critique by Carol Gilligan
Gilligan argued Kohlberg's findings may not fully encompass female moral development, emphasizing relationships and care.
Spiritual Development Theory (James Fowler)
Fowler described faith development influenced by cognitive, psychosocial, and moral changes throughout life stages, encompassing both personal faith journey and external religious experiences.
The Gestational Period: Conception to Birth
Defined as the period from conception to birth, typically lasting 40 weeks or roughly 280 days.
Fetal Physical Development During Gestation
First Trimester (weeks 1-12):
Embryonic phase begins when sperm meets egg.
Organ systems begin formation (heart, brain).
By week 8, all key organs are formed, transitioning to ‘fetus’ status.
Second Trimester (weeks 13-26):
Rapid growth and further organ maturation.
Mother feels fetal movements (quickening).
Third Trimester (weeks 27-birth):
Increased size and subcutaneous fat accumulation.
By week 39, considered full term; an average birth weight range of 5 lb 8 oz to 8 lb 13 oz (2500-4000 g).
Maternal Changes During Pregnancy
Vital maternal health directly impacts fetal well-being, influenced by physical changes including:
Increased blood volume and cardiac output by 30% by 35 weeks.
Hormones affecting metabolic activity to support fetal growth.
Common Health Problems During Gestation
Teratogens:
Substances harmful to fetal development during pregnancy (e.g., alcohol, nicotine).
Effects of Maternal Age:
Increased risks associated with adolescent and older maternal age (>40).
Maternal Conditions:
Diseases like rubella or gestational diabetes potentially affecting fetal development.
Neonatal Period: Birth to 28 Days
Critical adaptations and stabilizations occur post-birth; reflexes prevailing.
Physical Development of the Neonate
Key characteristics include:
Normal weight range and measurement parameters (approx. 5 lb 8 oz to 8 lb 13 oz, 18-22 inches long).
Apgar Score assessing respiratory effort, heart rate, muscle tone, reflex irritability, and skin color at 1 and 5 minutes post-birth.
Heat regulation and thermoregulation as ongoing essential adjustments.
Psychosocial Development of the Neonate
Development of trust during the initial 18 months, based on responsive interactions with caregivers.
Common Health Problems of the Neonate
Conditions like respiratory distress, jaundice, birth injuries, and congenital anomalies arising from early health challenges.
Infancy: 1 Month to 1 Year
Characterized by rapid physical growth and skill acquisition.
Physical Development of the Infant
Growth milestones:
Weight loss of approximately 8% to 10% post-birth; regaining by 2 weeks. However, gains around 1.5 pounds per month are typical in subsequent months.
Doubling in weight by 5 months and tripling by 1 year.
Cognitive Development of the Infant
Elevated sensory and movement-based interactions leading into early speech development by 1 year.
Common Health Problems of the Infant
Anticipated issues like failure to thrive, dental caries, and unintentional injuries.
Toddlerhood: Ages 1 to 3 Years
Marked by increased independence and notable strides in physical and cognitive skills.
Physical Development of the Toddler
Expected growth rate alongside emerging gross motor skills, with learning to walk, climb, and control bodily functions by 24 months.
Cognitive Development of the Toddler
Transitioning from sensorimotor to preconceptual thought under Piaget's framework.
Preschool Stage: Ages 4 to 5 Years
Development of verbal skills, social interaction, and early learning.
Physical Development of the Preschooler
Includes average weight gain and refinement of motor skills.
School Age: Ages 6 to 12 Years
Children gain independence and reliance on peer relationships grows.
Cognitive Development of the School-Age Child
Classified under concrete operations, marked by logic development and systematic thinking improvements.
Adolescence: Ages 12 to 18 Years
Transition into adulthood characterized by profound physical, cognitive, and emotional developments.
Common Health Problems of Adolescents
Health challenges including accidents, substance abuse, depression, and eating disorders, highlighting the need for age-appropriate healthcare interventions.