GROWTH AND

DEVELOPMENT

Prepared by: Shalini Santiago-Barroso, RN MAN

 Growth – denotes increase in body size: focus in on
child’s height and weight. It occurs as cell divides and
synthesize new proteins
 Development – gradual growth and change from a
lower to a more advance state
 Maturation – “Readiness” States that learning takes
place quickly and effortlessly when the child is ready.
 Growth and development is a continuous process
from conception till death
 Behavior is the most sensitive and comprehensive
indicator of developmental status
 Play – is central to life of a child, it is the
universal language used by a child
 Aspects of development – Denver
Developmental Screening test –used to
evaluate one development in the following:
A. Fine motor Adaptive
B. Gross motor
C. Personal – Social
D. Language
Principles of Growth and Development

 Directional trends – occur in regular direction

reflecting the development of neuromuscular
functions: these apply to physical, mental
social and emotional development.
a. cephalo-caudal – occuring along the body’s
long axis in which control overhead, mouth,
eye movements precedes control over upper
body, torso and legs.
Cont.

b. Proximo-Distal – progressing from the center of the

body to the extremity in which the child develops
are movement before fine motor finger ability. It is
symmetrical in ecah side as it develops at the same
direction and the same rate as the other.
c. Mass – specific- sometimes referred to as
“differentation” in which the child masters simple
operations before complex functions and moves
from broad to general patterns of behavior to more
refined patterns.
 Sequential Trend – involves a predictable
sequence of growth and development stage
through which a child normally passes, these
is true of motor skills LOCOMOTION – child
crawls before creeping: creeps before
standing and stand before walking.
 Secular trend – refers to worldwide trends in
the rate of and age of maturation.
Basic Division of Childhood
STAGE AGE PERIOD

Neonate From 28 days of life

Infant 1 month – 1 year

Toddler 1 – 3 years

Preschooler 3 – 5 years

School age child 6 – 12 years

Adolescent 13 – 20 years
 Developmental Milestone
AGE PHYSICAL GROSS LANGUA INTERPER PLAY
& FINE GE SONAL
MOTOR SOCIAL

Neonate Dance Head lag cry Visual Looks

-1 month reflex grasp references at
reflex for human mobile
face

2 months Closure of Social

posterior smiles
fontanel
AGE PHYSIC GROSS LANGUA INTERP PLAY
AL & FINE GE ERSONA
MOTOR L
SOCIAL
3 months Grasp Hands Boos and Recogniz Plays
reflex held coos ed rattle
fades open mother

4 months Lifts Laughs Recogniz

head and aloud ed and
chest very
Brings talkative
hand
together
AGE PHYSICA GROSS & LANGUAGE INTERPE PLAY
Cont. of infancy milestone
L FINE
MOTOR
RSONAL
SOCIAL
5 Moro Rolls over , 2 Vocal Introduc
months reflex hand grasp displeasure ed
disappear teething
rings
6 Double Sits with
months birth support
weight

7 Crawls, m-m-m Consonan Transferr

months bounces, When crying ts sounds ed
feeds in Begins to objects
mouth raking fear from
grasp hand to
hand
AGE PHYSICAL GROSS & LANGUAGE INTERPE PLAY
FINE RSONAL
MOTOR SOCIAL
8 Plantar Sits
months reflex without
disappears suppport

9 Begins to Combines to Cries Introdu

months creep syllables when ced
scolded balls
10 Moves Understands Respond Peek –
months from “NO” to own a-boo
prone to name Pat – a
sitting,pull Cake
self to
stand,
points at
objects
AGE PHYSICAL GROSS & LANGUA INTERPE PLAY
FINE GE RSONAL
MOTOR SOCIAL
11 Cruises
months almost
ready to
walk

12 Triples Walks Attempts Follows Enjoy

months weight, with to speak direction dropping
babinski assistance one-two objects and
reflex words observes
totally where they go,
disappears push and pull
toy to enhance
walking
Developmental milestone of a
toddler
 12 months – “ Plateau stage”
- walks alone
- names familiar objects
- verbalizes wants
- grasps spoon
 18 months – anterior fontanel closes
- sits self on a chair
- 3 block tower
Smears stools
Start bowel training
 24 months “ Terrible two”
 - peak of temper tantrums
 - Jumps orderly up and down the
stairs with both feet on the same
step
 - speaks in short sentences
 Can do 5 block tower
 Turns the door
 36 months “ Trusting three”
- walks backward
- unbutton buttons
- speaks fluently
- knows family name
- knows simple songs
- knows owns sex
- pedal well
- feeds self well
 48 months “ Furious four”
- jumps and climbs well
- copies square
- laces shoes
- exaggerates, boasts
- knows how old he is
- name colors
 5 years old “Frustrating Five”
 - runs skillfully
 - copies triangle
 - prints letter
 - draws picture of a man
 - talks constantly
 - knows relative
 Imaginary playmate
 - dramatic plays
 6 years old – year of expansion and
psychological changes
- eruption of first permanent molar
- clumsy movement
- recognizes all shapes
- fixed speech
- May begin interest in God
 7 years old
 Assimilative age
 Wiggles loose tooth
 Copies a diamond
 Enjoys teasing
 Enjoys playing alone
 Sometimes moody
 8 years old
- expansive stage with broadening
experience
- smoother movements
- writes more than prints
- counts backward
- normal homosexual
- loves to collect objects
- Sometimes withdrawn
 9 years old
▪ - neither a child or a youth
▪ - uses both hands independently
▪ - teacher find this group difficult to handle
▪ - tell time correctly
▪ - “Hero worship” begins
▪ - Stealing and Lying are common
▪ - Conflicts between child and parents are common
▪ Greatly influenced by peers
 10 years old
▪ - Age of special talents
▪ - writes legibly
▪ - reasons using cause and effect
▪ Well mannered with adult
▪ Involved in group activities
▪ Critical of adults
▪ More considerate and cooperative
▪ Joins organizations
 11-12 years old
▪ full of energy and constantly active
▪ “ Secret Language”
▪ Shares secrets with friends
 Psychosexual Development (Freud)

Stage Psychosexual Nursing Implications

stage

Infant Oral stage: Child Provide oral stimulation by giving

explores the world pacifiers, do not discourage
by using his/her thumb sucking . Breastfeeding
mouth, especially may provide more stimulation
the tongue than formula feeding because it
requires the infant to expend
more energy.
Stage Psychosexual stage Nursing Implications

Toddler Anal stage: Child learns Help children achieve

sexual identity through bowel & bladder control
awareness of genital area. without undue
emphasis on its
importance. If at all
possible, continue
bladder & bowel
training while child is
hospitalized.
Stage Psychosexual stage Nursing Implications
Con’t.
Pre Phallic stage: Child Accept child’s sexual interest,
schooler learns sexual identity such as fondling his/her own
through awareness of genitals, as a normal area of
genital area. exploration. Help the parents
answer the child’s question
about birth or sexual
differences

School Latent stage: Child’s Help the child have positive

age personality experiences as his/her self-
development appears to esteem continues to grow and
be non-active or as he/she prepares for the
dormant conflicts of adolescence.
Con’t.
Stage Psychosexual stage Nursing Implications

Adolescent Genital stage: Provide appropriate

Adolescent develops opportunities for the
sexual maturity and child to relate with the
learns to establish opposite sex; allow the
satisfactory child to verbalize feelings
relationships with the about new relationships.
opposite sex.
 Psychosocial Development
(Erikson)
Stage Developmental Task Nursing Implications

Infant To form a sense of trust Provide a primary caregiver.

versus mistrust. Child Provide experiences that add
learns to love and be to security such as soft
loved. sounds and touch. Provide
visual stimulation by active
child involvement.
Stage Developmental Task Nursing Implications

Toddler To form a sense of Provide opportunities for

autonomy versus decision making such as
shame & doubt. Child offering choices of clothes to
learns to be wear or toys to play with.
independent and Praise ability to make
make decisions from decisions rather than judge
himself or correct the child’s
or herself. decision.
Stage Developmental Task Nursing Implications

Pre To form a sense of Provide opportunities for

Schooler initiative versus guilt. exploring new place or
Child learns how to do activities. Allow play to
things (basic problem include activities involving
solving) and that doing water, clay (for modeling), or
things is desirable. finger paints.

School To form a sense of Provide opportunities such

Age industry versus as allowing child to
inferiority. Child learns assemble and complete a
how to do things well. short project so that the
child feels rewarded for the
accomplishment.
Stage Developmental Task Nursing Implications

Adolescent To form a sense of Provide opportunities

identity versus role for the adolescent to
confusion. Adolescent discuss feelings about
learns who he/she is and events important to
what kind of person him or her. Offer
he/she will be by support and praise for
adjusting into new body decision making.
image, seeking
emancipation from
parents, choosing a
vocation, and
determining a value
system.
 Cognitive Development (Piaget)
Stage of Age Nursing Implications
Development Span
Sensorimotor 1 month Stimuli are assimilated into beginning
Neonatal mental images. Behavior is entirely
reflex reflexive.

Primary 1–4 Hand mouth and ear-eye coordination

circular months develop. Infant spent much time looking
Reaction at objects and separating self from
them. Beginning intention of behavior is
present (the infant brings thumb to
mouth for a purpose to suck it). An
enjoyable activity for the period: a rattle
or a tape of parent’s voice.
Stage of Age Nursing Implications
Developmen Span
t

Secondary 4–8 Infant learns to initiate, recognize, and repeat

circular month pleasurable experiences from environment.
Reaction s Memory traces are present; infant anticipates
familiar events (a parent coming near him will pick
him up). Good toy for this period: mirror; good
game; peek-a-boo.

Coordination 8 – 12 Infant can plan activities to attain specific goals, can

of secondary month perceive that others can cause activity and that
reaction s activity of own body are separate from activity of
objects, can search for and retrieve toy that
disappears from view, and can recognize shapes &
sizes of familiar objects. Because of increased sense
of separateness, infant experience separation
anxiety when primary caregiver leaves. Good toy
for this period: Nesting toys ( colored boxes)
Stage of Age Nursing Implications
Development Span
Tertiary 12 – 18 Child is able to experiment to discover
circular months new properties of objects and events and
reaction is capable of space and time perception as
well as permanence. Objects outside self
are understood as causes of actions. Good
game for this period: throw and retrieve

Invention of 18 – 24 Transitional phase to the pre-operational

new means months thought period. Child uses memory and
through imitation to act, solves basic problems,
mental and foresee maneuvers that will succeed
combination or fail. Good toys for this period: those
with several uses such as blocks and
colored plastic rings.
Stage of Age Nursing Implications
Developm Span
ent
Pre – 2–7 Thought becomes more symbolic. Child
operational years can arrive at answers mentally instead of
thought through physical attempt and can
comprehend simple abstract. Child is
egocentric and display static thinking.
Concept of time is now, and concept of
distance is only as far as he or she can see.
Good toy for this period: items that require
imagination such as modeling clay.
Stage of Age Nursing Implications
Developm Span
ent
Concrete 7 – 12 Concrete operations include systematic reasoning.
operational years Uses memory to learn broad concepts and sub-
thought groups of concepts. Objects are sorted according to
attributes such as color; seriation , in which objects
are ordered according to increasing or decreasing
measures such as weight and multiplication in
which objects are simultaneously classified and
seriated using weight. Child is aware of reversity;
understands conservation. Good activity for this
Period: collecting and classifying natural objects
such as native plants, sea shells, etc. Expose child to
other view points by asking questions like “How do
you think you’d feel if you were a nurse and had to
tell someone to stay in bed?”
Stage of Age Nursing Implications
Developm Span
ent

Formal 12 Adolescent can solve hypothetical problems

operational years with scientific reasoning can understand
thought 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.
 Stages of Moral Development
(Kohlberg)
 Pre – conventional (Level I)
Age
(Year) Stage Description Nursing Implication

2–3 1 Punishment/obedience Child needs help to

orientation determine what
(“heteronomous actions are right. Give
morality”). Child does clear instructions to
right because a parent avoid confusion.
tells him or her to do so
and to avoid punishment.
Age
(Year) Stage Description Nursing Implication

4–7 2 Individualism. Child is unable to

Instruction purpose and recognize that like
exchange. Carries out situations require
actions to satisfy own actions. Unable to take
needs rather than responsibility for self-
society’s. Will do care because meeting
something for another own needs interferes
if that person does with this.
something for the child.
 Conventional (Level II)
Age Stage Description Nursing Implications
(Year)

7 – 10 3 Orientation to Child enjoys helping

interpersonal relations others because this is
of mutuality. Child “nice” behavior. Allow
follows rules because child to help in bed
of a need to be a making and other similar
“good” person I own activities. Praised for
eyes and eyes of desired behavior such as
others. sharing.
Age Stage Description Nursing Implications
(Year)

10 – 12 4 Maintenance of Child often asks what are

social order, fixed the rules and if is
rules, and something “right”. May
authority. Child have difficulty modifying
finds following a procedure because one
rules satisfying. method may not be
Follows rules of “right”. Follows self-care
authority figures measures only if
as well as parents someone is there to
in an effort to keep enforce them.
the “system”
working.
Post-conventional (Level III)
Age Stage Description Nursing Implications
(Year)

Older 5 Social contract, An adolescent can be

than 2 utilitarian law- responsible for self-care
making perspectives. because he or she views
Follows standards of this as a standard of
society for the good adult behavior.
of all people.

6 Universal ethical Many adults do not

principle orientation. reach this level of moral
Follows internalized development.
standards of
conduct.
Thank you
For
Listening.