PRINCIPLES OF GROWTH AND DEVELOPMENT
Growth – increase in physical size or quantitative
change
Development – increase in skill or ability to function
(qualitative stage)
Psychosexual Development – refers to developing
instinct or sensual pleasure (Freud)
Psychosocial Development - refers to Erikson's stages
of personality development
Moral Development – ability to know the right from
wrong
Cognitive development – ability to learn or understand
from experience, to acquire and retain knowledge, to
respond to a situation and to solve problems
Temperament – usual reaction pattern of an individual,
or an individual's characteristic manner of thinking,
behaving or reacting to stimuli in the environment
THEORIES OF DEVELOPMENT
Developmental task – skill or a growth responsibility
arising at a particular time in an individual's life
Frued's Psychoanalytic (Psychosexual) Theory
Infant – Oral phase because infants are interested in
oral pleasure or stimulation
Toddler – Anal phase because children's interests focus
on anal region as they begin toilet training
Preschooler - Phallic phase, shift from anal to genital
area
School-age child – latent phase, a time which libido
appears to be diverted into concrete thinking
Adolescent – Genital phase, establishment of new
sexual aims and the finding of new love object
Erikson's Theory of Psychosocial Development
Infant – Trust vs. Mistrust
Toddler – Autonomy vs. Shame or Doubt
Preschooler – Initiative vs. Guilt
School-age Child – Industry vs. Inferiority
Adolescent – Identity vs. Role Confusion
Piaget's Theory of Cognitive Development
Infant – sensorimotor stage, babies relate to the world
thru their senses
Toddler- children complete the final stages of
sensorimotor period; symbolic thought and egocentric
thinking
Preschooler – intuitive thought, centering, role fantasy,
assimilation, egocentrism
School-age children - concrete operational thought;
discover concrete solutions to everyday problems and
recognized cause-and-effect relationships
Adolescent – scientific reasoning and also understand
deductive reasoning
Kohlberg's Theory of Moral Development
Infant – prereligious stage
Toddler – begin to formulate a sense of right or wrong,
but their reason for doing "right" is centered most
strongly in "mother or father says so" rather than in any
spiritual or societal motivation
Preschooler – tend to do good out of self-interest rather
than out of true intent to do good or because of a strong
spiritual motivation
School-age children – engage in actions that are "nice"
or "fair" rather than necessarily right
Adolescent – capable of abstract thought and
internalizing standards of conduct; post conventional
development
NURSING CARE OF THE FAMILY WITH AN INFANT
Growth and Development
PHYSICAL GROWTH
Weight – 2x by 6 months; 3x by 1 year, girl 9.5 kg, boy
10 kg
Height – 50% increase during the first year; second half
of first year, apparent lengthening of legs; end of the first
year, child's leg appear disproportionately short or
bowed
Head circumference – increases rapidly during the
infant period to reflect rapid brain growth
Body Systems
Cardiovascular system – HR slows (100-120 bpm);
sinus arrhythmia; decreased PR and elevated BP;
physiologic anemia 2-3 months of age; fetal Hgb to adult
Hgb 5 to 6 months of age
Respiratory – RR slows by the end of first year
GIT – immature in its ability to digest food and
mechanically move it along
Liver – immature; extrusion reflex
Kidneys – immature and inefficient at eliminating body
wastes as an adult; unable to concentrate urine,
dehydration
Endocrine – immature in response to pituitary
stimulation; infant not able to respond to stress
Immune system – functional by 2 months of age; can
actively produce both IgG and IgM by 1 year; IgA, IgE,
IgD not plentiful until preschool age, reason why infants
need protection from infection
Gross Motor Development
1. Ventral suspension
- 1-month-old lift head momentarily, then drops it again
- 2-month-old holds their heads on the same plane as
the rest of their body
- 3-month-old lifts and maintains head well
- Landau reflex 3 months, parachute reaction 6 to 9
months
2. Prone position
- 1 month – lift their heads easily and turn them easily to
the side
- 2 month – can raise their heads and maintain position,
cannot raise chest high enough
- 3 month – lifts shoulders and head well off the table
and look around when prone; can turn to side-lying
position
- 4 month – lift their chests and look around actively,
turn heads from side to side
- 5 month – rest weight on forearms when prone, can
turn completely over
- 6 month – rest weight on arms with extended arms,
can raise chests and upper part of the abdomen
- 9 months – creep from prone position
3. Sitting position
- 1 month – gross head lag
- 2 months – can hold their head fairly; tend to bob
forward
- 3 months – slight head lag when pulled to a sitting
position
- 4 months – no head lag when pulled to a sitting
position
- 5 months – straighten the back when held or propped
in a sitting position
- 6 months – sit momentarily without support
- 7 months – sits alone but only when the hands are
held forward for balance
- 8 months – sit securely without any additional support
- 9 months – sit so steadily they can lean forward and
regain their balance
4. Standing position
- 1 month – newborn stepping reflex
- 2 month – hold their head up with the same show of
support as in a sitting position
- 3 month – try to support part of their weight
- 4 month – able to support their weight on their legs
- 5 month – continues the ability to sustain a portion of
weight, tonic neck reflex
- 6 month – support nearly their full weight
- 7 month – bounces with enjoyment in a standing
position
- 9 month – can stand holding onto a table
- 10 month – can pull themselves to a standing position,
but cannot let themselves down again
- 11 months – cruise
- 12 months – stand alone at least momentarily
Fine Motor Development
1 month – strong grasp reflex, difficult to extend the
fingers
2 month – grasp reflex begins to fade, holds an object
for a few minutes before dropping it
3 month – reach attractive object in front of them
4 month – bring their hands together and pull at their
clothes; shake a rattle placed in their hands; scooping or
raking
5 months – can accept objects handed to them by
grasping with whole hand
6 months – grasping has advanced to a point where a
child can hold objects in both hands
(moro, palmar grasp and tonic reflex completely faded)
7 months – can transfer toys from one hand to the other
8 months- random reaching and ineffective grasping
have disappeared
10 months – ability to bring the thumb and first finger
together in a pincer grasp
12 months – semistraight line with a crayon
Developmental Milestones
Socialization and Language
2 months – makes cooing sounds; differentiates cry
3 months – laughs out loud
6 months – may say vowel sound
7 months – shows beginning fear of strangers
8 months – has peak fear of strangers
9 months – says first word (da-da)
10 months – uses pincer grasp to pick up objects
Play
1 months – Enjoys watching face of primary caregiver,
listening to soothing sounds
2 months – enjoys bright-colored mobiles
3 months – spends time looking at hands or uses them
as toy during the month (hand regard)
4 months – need space to turn
5 months – handles rattles well
6 months – enjoys bathtub toys, rubber ring for teething
7 months – likes objects that are good size for
transferring
8 months – enjoys manipulation, rattles and toys of
different textures
9 months – needs space for creeping
10 months – play games like patty-cake and peek-a-boo
11 months – "cruises"
12 months – likes toys that fit inside each other; nursery
rhymes
Vision
1 months – regard object in the midline of their vision
2 months – focus well and follow objects with eyes;
binocular vision
3 months – can follow an object across their midline
4 months – recognize familiar objects
6 months – capable of organized depth perception
7 months – children pat their image in a mirror
10 months – infant look under a towel or around a
corner for a concealed object
Emotional Development
3 months – demonstrate increased social awareness by
readily smiling at the sight of a parent's face
5 months – may show displeasure when an object is
taken away from them
7 months – obvious fear of strangers
8 months – stranger anxiety
12 months – overcome fear of strangers
Cognitive Development
Primary Circular Reaction – during this time, an infant
explores object by grasping them with the hands or by
mouthing them
Secondary Circular Reaction – infants can grasp the
idea their actions can initiate pleasurable sensations
Coordination of Secondary Schema – discovers
object permanence
GROWTH AND DEVELOPMENT OF TODDLER
Physical growth
Weight, height, and head circumference – gains 5-6
lbs during toddler period; head circumference increases
2cm during the second year; by 2 years, chest
circumference has grown greater than that of the head
Body contour – prominent abdomen, forward curve of
the spine at the sacral area, waddle or walk with a wide
stance
Body systems
Respirations – slow slightly; abdominal
HR – slows from 110-90 bpm; BP 99/64
Brain – 90% adult size
Respiratory system – lumens of vessels enlarge
progressively
Stomach – secretion become more acid; capacity
increases
IgG and IgM antibody – production becomes mature at
2 years of age
Teeth – 8 new teeth (canines and first molar)
Developmental Milestones
- Period of slow and steady, not sudden, growth
Fine motor
15th month – Puts small pellets into small bottles.
Scribbles voluntarily with a pencil or crayon, holds spoon
well but may still turn it upside down on the way to the
mouth
18th month – no longer rotates a spoon to bring it to
mouth
24 month – can open the doors by turning doorknobs,
unscrew lids
30 month – makes simple lines or strokes for crosses
with a pencil
Gross motor
15th month – walks alone well; can seat self in chair;
can creep upstairs
18th month – 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
24th month – walks upstairs alone still using both feet
on same step at the same time
30th month – can jump down from chairs
Language
15th month – 4-6 words
18th month – 7-20 words; uses jargoning; names 1
body part
24th month – 50 words; 2-word sentences
30th month – verbal language increasing steadily
Play
15th month – can stack 2 blocks; enjoys being read to;
drops toys for adult to recover
18th month – imitates household chores, dusting, etc.;
begins parallel play
24th month – parallel play evident
30th month – spends time playing house, imitating
parent's actions
Cognitive Development
Sensorimotor 5: Tertiary circular reaction – 12-18
months; child experiment by trial and error methods
Sensorimotor 6: Deferred imitation – 18-24 months;
can pretend and use deferred imitation; object
permanence is complete
Preoperational thought – 24 months; able to use
assimilation or change situation to fit thoughts
Psychosocial: Autonomy vs. shame or guilt – 24-36
months; learn independence and the beginning of
problem solving
NURSING CARE OF A FAMILY WITH A PRESCHOOL
CHILD
Physical growth
Ectomorphic (slim)/endomorohic (large) – body type
becomes apparent
Lymphatic Tissue – increase in size, particularly the
tonsils, and level of IgA and IgG antibodies increase
Heart sounds – physiologic splitting may be present
and innocent heart murmurs may be heard for the first
time
PR – decreases to 85bpm
BP – 100/60
Bladder – easily palpable above the symphysis pubis
Weight – slight; 4.5 lb a year
Height – minimal; 2-3.5 in a year
Teeth – 20 deciduous teeth by age 3
Developmental Milestones
Fine motor
3 years – undresses self; stacks tower of blocks; draws
a cross
4 years – can do simple buttons
5 years – draws a 6-part man; can lace shoes
Gross motor
3 years – runs; alternates feet on stairs; stands on one
foot
4 years – constantly in motion; jumps; skips
5 years – throws overhand
Language
3 years – vocabulary of 900 words
4 years – vocabulary of 1500 words
5 years – vocabulary of 2100 words
Play
3 years – able to take turns; very imaginative
4 years – pretending is major activity
5 years – likes games with numbers and letters
Emotional Development
Developmental task – initiative versus guilt
Imitation – role-playing
Fantasy – cannot differentiate between fantasy and
reality
Oedipus complex – strong emotional attachment a
preschool boy demonstrates toward his mother
Electra complex – attachment of a preschool girl to her
father
Socialization
3 years – capable of sharing; they play with other
children their age
4 years – involved in arguments
5 years – develop "best" friendship
Cognitive Development
3 years – still preoperational; enters second phase,
intuitional thought – they lack the insight to view
themselves as others see them or put themselves in
another's place (centering)
NURSING CARE OF A FAMILY WITH A SCHOOL-
AGE CHILD
Physical Growth
By 10 years of age – brain growth complete, fine motor
becomes refined
Malocclusion – teeth malalignment may be present
Age 9 – IgG, IgA reach adult levels
10-14 years old – timing of the onset of puberty
Sexual maturation – 12-18 years for girls, 14-20 years
for boys
Nocturnal emissions – ejaculation during sleep
Developmental Milestones
Gross Motor
Age 6 – jump, tumble, skip, hop, walk straight, ride a
bicycle
Age 7 – appears quiet; gender differences begin to
manifest
Age 8 – movements are more graceful
Age 9 – enough eye-hand coordination
Age 12 – plunge into activities with intensity and
concentration
Fine motor
Age 6 – "eraser year" because children are never quite
content with what they have done
Age 8 – can read regular-size type
Play
Age 6 – continues to be rough
Age 7 – requires more props for play; indicates start of a
decline imaginative play
Language Development
Age 6 – talk in full sentences
Age 9 – discover "dirty" jokes
Age 12 – sense of humor is apparent
Industry vs. Inferiority
• If gaining a sense of initiative can be defined as
learning how to do things, then gaining a sense
of industry is learning how to do things well.
• If children are prevented from achieving a sense
of industry or do not receive rewards for
accomplishment, they can develop a feeling of
inferiority or become convinced they cannot do
things they actually can do.
Socialization
Age 6 – play in groups, but also prefer one-to-one
contact
Age 7 – increasingly aware of family roles
Age 8 – seek the company of other children
Age 9 – take the values of their peer group very
seriously
Age 10 – enjoys group, but also enjoy privacy
Age 12 – more comfortable in social situation
Cognitive Development
Ages 5-7 – transitional stage, preoperational thought to
concrete operational thought
Decentering – ability to project oneself into other
people's situation
Accommodation – ability to adapt thought processes to
fit what is perceived (understanding that there can be
more than one reason for other people's actions
Conservation – ability to perceive that a change in
shape does not necessarily mean a change in size
Class inclusion – ability to understand that objects can
belong to more than one classification
NURSING CARE OF A FAMILY WITH AN
ADOLESCENT
Adolescence – 13 to 20 years
Puberty – an individual first becomes capable of sexual
reproduction
Identity vs. Role confusion
• The developmental task in early and mid-
adolescence is to form a sense of identity or
decide who they are and what kind of person
they will be.
• If young people do not achieve a sense of
identity, they develop a sense of role confusion
or can have little idea what kind of person they
are.
Cognitive Development
Age 12-13 – final stage, formal operational thought