GROWTH AND

DEVELOPMENT

Rose Eden U. Tuloy, RN, MN

 GROWTH AND DEVELOPMENT AND
THE ROLE OF NURSES
 Health Promotion and Illness Prevention
- must be able to recognize the predictable stages of growth and development,
from newborn to young adult, through which each child passes (Goldson &
Reynolds, 2008).

 Health Restoration and Maintenance

- It is equally essential to consider developmental stages when caring for a
sick child or one having surgery
- Physical growth is another important factor to consider, because disease
affects children differently at various stages of growth
PRINCIPLES OF GROWTH AND
DEVELOPMENT
Growth - denote an increase in physical size or a quantitative change.

Development - indicate an increase in skill or the ability to function (a

qualitative change). Maturation is a synonym for development

 Psychosexual development (Sigmund Freud)

 Psychosocial development (Erikson’s stages of personality development)
 Moral development (Lawrence Kohlberg)
 Cognitive development (Jean Piaget)
PRINCIPLES
 Growth and development are continuous processes from conception until
death.
 Growth and development proceed in an orderly sequence
 Different children pass through the predictable stages at different rates.
 All body systems do not develop at the same rate.
 Development is cephalocaudal. (Cephalo is a Greek word meaning “head”;
caudal means “tail.”)
 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
FACTORS INFLUENCING GROWTH
AND DEVELOPMENT
1. GENETICS
a. Gender
b. Health
c. Intelligence
2. TEMPERAMENT - usual reaction pattern of an individual, or an
individual’s characteristic manner of thinking, behaving, or reacting to
stimuli in the environment (Chess & Thomas, 1995). An inborn
characteristic set at birth.
REACTION PATTERN (CHESS &
THOMAS, 1995)
Nine separate characteristics that define temperament or how children react
to situations.
1. Activity Level - The level of activity among children differs widely.
2. Rhythmicity - A child who has rhythmicity manifests a regular rhythm in
physiologic functions.
3. Approach - refers to a child’s response on initial contact with a new
stimulus.
4. Adaptability - is the ability to change one’s reaction to stimuli over time.
5. Intensity of Reaction - Some children react to situations with their whole
being.
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6. Distractibility - Children who are easily distracted or who can easily
shift their attention to a new situation (distractibility) are easy to care
for.
7. Attention Span and Persistence - Attention span is the ability to remain
interested in a project or activity.
8. Threshold of Response - is the intensity level of stimulation that is
necessary to evoke a reaction.
9. Mood Quality - A child who is always happy and laughing has a
positive mood quality.
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Although individual children show characteristics from all groups, most
children can be categorized into one of four groups:

1. Difficult: arrhythmic, withdrawing, low in adaptability, intense, and

negative in mood.
2. Slow to warm up: inactive, low in approach and adaptability, and
negative in mood.
3. Intermediate: some characteristics of both groups.

4. Easy: rhythmic, approaching, adaptable, mild, and positive in mood

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3. ENVIRONMENT

a) Socioeconomic Level
b) Parent–Child Relationship
c) Ordinal Position in the Family
d) Health
4. NUTRITION - Nutrition also plays a vital role in the body’s
. susceptibility to disease because poor nutrition limits the body’s ability
to resist infection.
.
Food Guide Pyramid Guidelines for a Healthy Diet
a) Eat a Variety of Foods.
b) Balance the Food You Eat With Physical Activity - Maintain or Improve
Your Weight.
c) Choose a Diet With Plenty of Grain Products, Vegetables, and Fruits.
d) Choose a Diet Low in Fat, Saturated Fat, and Cholesterol.
e) Choose a Diet Moderate in Sugars.
f) Choose a Diet Moderate in Salt and Sodium.
g) If Drinking Alcoholic Beverages, do so in Moderation.
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THEORIES OF DEVELOPMENT
 A theory is a systematic statement of principles that provides a
framework for explaining some phenomenon. Developmental theories
provide road maps for explaining human development.

Developmental task is 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.
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Sociocultural theories
 Learning theory
 Epigenetic theories
 Still other theories deal mainly with negative aspects of childrearing that
can cause mental illness in children, either immediately or later, when a
child reaches adulthood (see discussion on Freud that follows).
 Erikson discusses positive aspects necessary for normal growth and for
development of a mentally healthy and productive adult (Coles, 2001).
BASIC DIVISION OF CHILDHOOD
Stage Age Period
Neonate First 28 days of life
Infant 1 mo – 1 yr.
Toddler 1 – 3 yrs.
Preschooler 3 – 5 yrs.
School-Aged Child 6 – 12 yrs.
Adolescent 13 – 21 yrs.
FREUD’S PSYCHOANALYTIC THEORY
SIGMUND FREUD (1856–1939)
 An Austrian neurologist and the founder of psychoanalysis, offered the
first real theory of personality development (Edmundson, 2007).
 Freud based his theory on his observations of mentally disturbed adults.
 He described adult behavior as being the result of instinctual drives that
have a primarily sexual nature (libido) that arise from within the
person and the conflicts that develop between these instincts
(represented in the individual as the id), reality (the ego), and society
(the superego). He described child development as being a series of
psychosexual stages in which a child’s sexual gratification becomes
focused on a particular body part.
FREUD’S STAGES OF CHILDHOOD
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ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
ERIK ERIKSON (1902–1996)

 He was trained in psychoanalytic theory but later developed his own

theory of psychosocial development, a theory that stresses the
importance of culture and society in development of the personality
(Erikson, 1993).
 a person’s social view of self is more important than instinctual drives in
determining behavior, allows for a more optimistic view of the
possibilities for human growth.
 While Freud looked at ways mental illness develops, Erikson looked at
actions that lead to mental health.
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.The Young Adult
• Achieving a sense of intimacy versus isolation. Intimacy is the ability to
relate well with other people, not only with members of them opposite sex
but also with one’s own sex to form long-lasting friendships.

The Middle-Aged Adult

• The developmental task of middle age is to establish a sense of

generativity versus stagnation. People extend their concern from just
themselves and their families to the community and the world.

The Older Adult

• The developmental task of older adults is integrity versus despair. Older
adults with integrity feel good about the life choices they have made.
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
JEAN PIAGET (1896–1980)

 Swiss psychologist,
 Introduced concepts of cognitive development or the way children learn
and think that have roots similar to those of both Freud and Erikson and
yet separate from each (Wadsworth, 2003).
 Piaget defined four stages of cognitive development; within each stage
are finer units or schemas.
 Stage of Development Age Span Nursing Implication

I. Sensorimotor
a. Neonatal 1 month • Stimuli are assimilated into beginning mental
images. Behavior entirely
reflexive.

b. Primary circular reaction 1–4 month • Hand–mouth and ear–eye coordination develop.
• Enjoyable activity for this period: a rattle or tape of
parent’s voice.

• Infant learns to initiate, recognize, and repeat

c. Secondary circular 4–8 month pleasurable experiences from environment.
reaction • Good toy for this period: mirror; good game: peek-
a-boo.

• Infant can plan activities to attain specific goals.

8–12 month Perceives that others can cause activity and that
d. Coordination of secondary activities of own body are separate from activity of
reactions objects.
• Good toy for this period: nesting toys (i.e., colored
boxes).
 Stage of Development Age Span Nursing Implication
e. Tertiary circular 12–18 month • Child is able to experiment to discover new
reaction properties of objects and events.
• Good game for this period: throw and retrieve.

• Transitional phase to the preoperational thought

f. Invention of new means 18–24 month period. Uses memory and imitation to act. Can solve
through mental basic problems, foresee maneuvers that will succeed
combinations or fail.
• Good toys for this period: those with several uses,
such as blocks, colored plastic rings.

II. Preoperational 2–7 year • Thought becomes more symbolic; can arrive at
thought answers mentally instead of through physical
attempt.
• Child is egocentric
• Displays static thinking
• Concept of time is now, distance is only as far as they
can see
• No awareness of reversibility
• Unable to state cause–effect
• Good toy for this period: items that require
imagination, such as modeling clay.
 Stage of Development Age Span Nursing Implication

III. Concrete operational 7–12 years • Concrete operations includes systematic reasoning.
thought Uses memory to learn broad concepts (fruit) and
subgroups of concepts (apples, oranges).
• Child is aware of reversibility, an opposite operation
or continuation of reasoning back to a starting point.
• Understands conservation, sees constancy despite
transformation.
• Good activity: collecting and classifying natural
objects such as native plants, sea shells, etc.
IV. Formal operational 12 years • Can solve hypothetical problems with scientific
Thought reasoning;
• understands causality and can deal with the past,
present, and future.
• Adult or mature thought.
• Good activity for this period: “talk time” to sort
through attitudes and opinions.
KOHLBERG’S THEORY OF MORAL DEVELOPMENT
LAWRENCE KOHLBERG (1927–1987)

 A psychologist who studied the reasoning ability of boys and,

 based on Piaget’s development stages,
 developed a theory on the way children gain knowledge of right and
wrong or moral reasoning.
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