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GROWTH AND DEVELOPMENT STUDY NOTES

OBJECTIVES

• Describe the principles of growth and development and developmental stages according to major theorists.

• Assess a child to determine if a stage of development has been achieved.

• Formulate nursing diagnoses that address wellness as well as both a potential for and an actual delay in growth and development.

• Identify expected outcomes for a growing child as well as how to manage seamless transitions across differing health care settings.

• Implement nursing care, such as suggesting age-appropriate play materials to support normal growth and development.

KEY TERMS

• Growth: Increase in physical size of a structure or a whole.

• Development: Increase in skills or capacity to function.

• Developmental milestones: Major markers of growth and development.

• Developmental task: A skill or a growth responsibility arising at a particular time in an individual’s life, the achievement of which will provide a foundation for the accomplishment of future tasks.

• Cognitive development: Ability to learn and understand from experiences, retain knowledge, respond to new situations, and solve problems.

GROWTH

• Definition: Increase in physical size of a structure or a whole.

• Nature: Quantitative.

DEVELOPMENT

• Definition: Increase in the skills or capacity to function.

• Nature: Qualitative.

• Tests used:

  • Denver Developmental Screening Test (DDST)

  • Metro Manila Developmental Screening Test (MMDST)

MMDST Areas of Assessment

• Personal-Social

• Fine-Motor Adaptive

• Gross Motor

• Language

PRINCIPLES OF GROWTH AND DEVELOPMENT

1. Growth and development is a continuous process.

2. Growth and development proceed in an orderly sequence.

3. Children pass through predictable stages at different rates.

4. All body systems do not develop at the same rate.

5. Development is cephalocaudal (head to toe).

6. Development proceeds from proximal to distal body parts.

7. Development proceeds from gross to refined skills.

8. There is an optimum time for initiation of experiences or learning.

9. Neonatal reflexes must be lost before development can proceed.

10. A great deal of skill and behavior is learned by practice.

FACTORS INFLUENCING GROWTH AND DEVELOPMENT

• Genetics and Environment: Primary factors in determining if a child will be able to reach his or her genetic potential.

• Additional Factors:

  • Gender

  • Race

  • Intelligence

  • Temperament

  • Socioeconomic Level

  • Parent-Child Relationship

  • Ordinal Position in the Family

  • Health

  • Nutrition

BASIC DIVISIONS OF CHILDHOOD STAGES

THEORIES OF CHILD DEVELOPMENT

Definition of Theories

• A theory is a systematic statement of principles that provides a framework for explaining a phenomenon.

• Developmental theories are frameworks that explain human development.

Major Theorists and Their Theories

• Sigmund Freud: Psychoanalytic/Psychosexual theory.

• Erik Erikson: Psychosocial development.

• Jean Piaget: Cognitive development.

• Lawrence Kohlberg: Moral development.

Freud's Psychosexual Stages

1. Oral (Infant)

2. Anal (Toddler)

3. Phallic (Preschool)

4. Latency (School Age)

5. Genital (Adolescents)

Erik Erikson's Psychosocial Stages

Erikson's Stages in Detail

1. Trust vs Mistrust: Reliability in caregiving results in trust; inconsistent care leads to fear and mistrust.

2. Autonomy vs Doubt: Success in independence and control leads to autonomy; failure results in doubt and shame.

3. Initiative vs Guilt: Successfully asserting initiatives in social environments leads to confidence; overly restricted exploration results in guilt.

4. Industry vs Inferiority: Success in educational tasks leads to a sense of competence; failure leads to inferiority.

5. Identity vs Role Confusion: Successful identity formation leads to clear sense of self; failure leads to confusion and insecurity.

6. Intimacy vs Isolation: Successful relationships result in love and companionship; failure results in isolation and loneliness.

7. Generativity vs Stagnation: Positive contributions to society and personal fulfillment lead to a sense of care; failure leads to self-absorption.

8. Integrity vs Despair: Reflection on life leading to a sense of completeness; failure results in regret and despair.

Piaget's Stages of Cognitive Development

1. Sensorimotor (Birth - 2 years)

2. Preoperational (2 - 7 years)

3. Concrete Operational (7 - 11 years)

4. Formal Operational (11 years and up)

Kohlberg's Stages of Moral Development

1. Pre-conventional: Obedience and punishment orientation; individualism and exchange.

2. Conventional: Good interpersonal relationships; maintaining social order.

3. Post-conventional: Social contract and individual rights; universal ethical principles.

DEVELOPMENTAL MILESTONES

• Developmental milestones serve as major markers of growth and development and help determine developmental delays.

Infancy Developmental Milestones

• 6 months: Eruption of first temporary teeth (lower central incisors).

• 30 months: Completion of temporary teeth (20 deciduous teeth).

• 3 years: Tooth brushing begins with minimal supervision.

• 6 years: Tooth brushing alone; first permanent teeth begin to appear.

Infant Concerns and Developmental Aspects

• Stranger Anxiety:

  • Begins at 6-7 months, peaks at 8 months, diminishes by 9 months.

• Exemplary Developmental Milestones:

  • 1 month: Reflex disappears; looks at mobile; regards face.

  • 4 months: Complete head control, turns front to back, laughs aloud.

Toddlerhood Developmental Concerns

• Play Type: Parallel Play (2 toddlers playing separately).

• Separation Anxiety:

  • Begins at 9 months, peaks at 18 months.

Preschoolers Developmental Milestones

• 4 years old: Can button buttons, copy a square, has a vocabulary of 1500 words.

• 5 years old: Jumps over low obstacles, identifies with the same sex, imaginary friends often appear.

School-Aged Developmental Traits

• Emphasis on industriousness and peer relationships; adjustments to school and learning tasks; awareness of societal rules.

SAFETY AND PARENTAL CONCERNS

• Awareness of accidents being major causes of childhood deaths (e.g., motor vehicle accidents, drowning).

• Encouragement of developmental safety practices; addressing common fears and anxiety.

ADOLESCENCE AND ADULTHOOD

Adolescence Characteristics

• Signs of sexual maturity; core concerns include body image, acceptance, relationships, and peer dynamics.

• Safety Concerns:

  • Major causes of death include accidents, homicide, and suicide.

Adulthood Developmental Stages

1. Young Adult (20-40 years): Development toward adulthood with responsibilities.

2. Middle Age (40-65 years): Challenges of generativity vs stagnation.

3. Older Adult (65+ years): Integrating integrity vs despair; cognitive functioning stability.

Health Problems in Adulthood

• Common health issues include sexually transmitted diseases, accidents, hypertension, and substance abuse.

• Nursing implications include promoting health and preventive strategies across all adult ages.

SUMMARY

Growth and development encompass a multifaceted array of stages and milestones that require keen observation and assessment, particularly in nursing practice. Understanding these principles not only informs care strategies but enriches the relationship dynamics with patients and their families, paving the way for enhanced outcomes throughout the lifecycle.