GOD grant me the Serenity

to accept the things I cannot

change,
Courage to change the things
I can and the
Wisdom to know the
difference……
 e
Growth and development

Dr. L. M. Adarlo 
Growth -
• Denote an increase in physical
size and appearance
• Quantitative changes caused
by increasing number of cells
such as height, weight, blood
pressure
Growth -
• Denote an increase in physical
size (height, weight, HC)
• Plot ht. and wt on a growth
chart
• HC is measured for age 2 yrs
and below
Growth -
• Growth charts are available
through the CDC and
Prevention
• It determines the pattern of
child's growth
Development
• Progression towards maturity in
mental , physical, social, markers of
normal development
• Observe the specific activities a child
can accomplish to establish whether
development milestones are achieved
Development
• Refers to the qualitative increase in
capacity or function
• Used to indicate an increase in skills
• Example:
 ability to sit without support at 8
months
 No head lag at 3 months
 Walks holding someone’s hands at
15 months
Nurses Role
• Health promotion and illness prevention
• Health restoration and maintenance
Developmental task
• A skill or growth arising at a particular
time in an individual’s life, the achievement
of which will provide a foundations for the
accomplishment of the future task
 Principles of Growth4and Development
Principles Examples
Growth and development An infant triples birth weight and
are continuous process increase height by 50% during the
from conception until first year of life
death.
Growth in height occurs in only one
It proceeds in an orderly sequence- from smaller to larger,
sequence development also proceed in a
predictable order. A child will crawl
first before they can sit
Different children pass
through predictable stages A parent wonder why her child begins
at different rates. walking at 9 month but some walk at
12 months. Both are developing
normally but at different rate
 Principles Examples
All body system do not Certain body tissues matures rapidly.
develop at the same
rate
Sp
Neurologic tissue experiences its peak
growth during the first year of life,
whereas genital tissue grows little until
puberty
Development is A newborn can lift the head and chest
cephalocaudal. when he is 2 months. The baby can lift
head, chest & abdomen at 4. At 5 mos.
the infant has enough control to turn
over, by 1 yr. child can stand & possibly
walk.
Proceeds from A newborn makes little use of arms and
proximal to distal body hands, at 3-4 mos. By 10 mos. The infant
parts can coordinate the arm, thumb and the
index finger well to use a pincer- like
grasp
 Principles Examples
It proceeds from gross A 3 year old colors best with a big
to refined skills crayon, while a 12 year old able to write
using a fine pen
Optimum time for A child cannot learn to sit, unless his
initiation of experience nervous system is fully develop to allow
and learning back control

Neonatal reflexes must Neonatal reflexes replaces by purposeful

be lost before movements. An infant cannot grasp with
development can skills until the grasp reflex has faded
proceed

A great deal of skills Infant practice and practice over and

and behaviour is over again, example taking a first step
learned by practice before they accomplish the skills of
walking
 Patterns of Growth and Development
• Neurologic Tissue (Spinal cord, brain)
grows rapidly the first 2 years, brain
reaches mature proportions by 2 to 5 years

• Lymphoid tissue (spleen, thymus, lymph

nodes and tonsillar tissue) grows rapidly
during infancy and childhood to protect a
child against infection
 Spleen is usually palpable 1 to 2cm in
preschool children

 Tonsillar tissue reach its peak size (about

twice that of an adult) at 5 years old

 Reproductive organs shows little growth

until puberty
 Factors influencing Growth and Development
1. Genetics
• Gender
• Health
• Intelligence
• Temperament
2. Environment
• Socioeconomic level
• Parent-child relationship
• Ordinal position in the family
• Health and Nutrition
1. Genetics
Physical characteristics, learning style and
temperament
Genetic abnormality which may result in
disability or illness later in life
• Gender
 average, girls are born lighter by an ounce or
two, and shorter by an inch or two than boys
 Boys tend to keep height and weight advantage
until pre-puberty
 Girls surge ahead once they begin their growth
spurt 6 months to 1yr. Earlier than boys
 Boys tend to be taller and heavier by the end of
puberty (14 to 16yrs)
Health
A child who inherit genetically transmitted disease
may not grow normally
• diseases from environmental sources
• Vulnerable children
Nutrition
• Quality in child’s nutrition influence the health, wt.
and even child’s stature
• Poor maternal nutrition limits growth and intelligence
• Lack of energy and stamina prevents children from
learning at their best
• Obesity will a slower motor skills , further they are
bullied and taunting by playmates
• Lack of calcium may lead to rickets causing
shortening and bowing of legs
Nutrition
• Lack of vitamins can lead to visual
impairment , poor healing and poor bone
growth
Nutrition Guidelines for a healthy diet
• Eat variety of foods
• Balance the food with physical activity and maintains
or improve the wt.
• Choose diet plenty of grain products, vegetable and
fruits
• Choose a diet low in saturated fats and trans fats
• Choose diet moderate in sugar
• Choose food moderate in salt and sodium
• Alcohol in moderation
• Intelligence
Children with high intelligence do not grow faster
physically than other children but they do tend to
be skilful
• Temperament
An inborn characteristics set at birth
2 Environment
.

•Socioeconomic level
lack of money or inadequate finances
inadequate nutrition etc.
•Parent-child relationship
Children who are loved tend to thrive than those who
are not
Inadequate parental love can interfere with child’s
development
•Ordinal position in the Family
Oldest child in the family excels in language
development, conversations are mainly with adults
2. Environment
• Ordinal position in the Family
• Younger children may develop language
more slowly
• Baby talk
• Children earn by watching other children
Theories of Growth and Development
 THEORY
• A systemic statement of a principles that provides a
framework for explaining some phenomenon
 DEVELOPMENT THEORIES
• Provide roadmaps for explaining human
development
 DEVELOPMENTAL TASK
• Is a skill or growth responsibility arising at a particular
time in an individual’s life, the achievement of which will
provide a foundation for accomplishment of future task
• Freud’s Psychoanalytic Theory of
Development
 Basic Division of Childhood
Stages Age Period
Neonate First 28 days of life
Infant 1 mo-1 yr.
Toddler 1-3 yrs. Old
Pre-school 3-5 years
School-age 6-12 yrs
Adolescent 13-20 yrs
Sigmund Freud

Psychoanalysis

Psychosexual
 Infancy
Age 0-12 mos.

Stage Oral Stage

Play Solitary Play

 Infancy
Mobile,

stuffed &textured toys,

Toys musical box, teething
rings

Food Solid food: 4-6 mos.

Stranger anxiety - 6 mos.

Fear Separation anxiety 8 – 12
mos.
 Infancy
lifts head when prone
1mo Visual fixation on faces

Social smile, head lags

2mos when pulled to
sitting

Raise head but not

3mos chest when in prone
Babbles and coos
 Infancy
Raise head and chest
when on prone
4mos
Grasp objects and brings
to mouth

No head lag, head

4mos steady when upright
Laughs aloud

Rolls over
5mos raking grasp
 Infancy
Doubles birth weight
6mos Eruption of first tooth
(lower central incisor)

Sits with minimal support

6mos Pulled from sitting to
standing

Plays with feet

“Dada or mama”
7mos Creeps
Thumb-finger grasp
 Infancy
Sits alone without
8mos
support

Hold bottle with good

9mos hand-mouth
coordination

Crawls
Bye-bye and pat-a-cake
9mos Steps with help
Pincer grasp
 Infancy
Pull self to stand
10mos
Knows own name

Stand with
11mos assistance
Attempts to walk

Walks with help

Triples birth weight
12mos Drinks from cup
Can say 2 words
 Infancy - Language

1mo Coos, squeals

2mos Social smile

3-4mos Laughs aloud

 Language

1yr 2 –6 words

2yrs 10 – 300 words

3yrs 900 words

 Language

6 yrs 2,100 words

2yrs 10 – 300 words

3yrs 900 words

 Toddler
Age 1-3 years old

Stage Anal Stage

Play Parallel Play

 Toddler
Mobile,

stack toys, blocks, pots,

drums to bang, push and pull
Toys toys, rocking horse, swing,
finger paints, puzzle

Food Physiologic anorexia

Regression during
Fear illness
 Toddler
Highlights
Imitation: imitates
what he sees

Verbalize the desire to

Toilet void or defecate
training
Can sit, walk and squat

Stays dry for 2 hrs with

Toilet
training
regular bowel
movement
 Toddler
extreme negativism, hates to
do anything, difficult to
Negativism
manage, Always say “NO”

Temper tantrums,
Tantrums becomes strongly
attached to parents

Toilet Terrible two’s, obstinacy

Tantrums
training Sibling rivalry
 Preschool
Age 3-6 yrs.old

Phallic stage genitals

Stage become the focus of a
child's sensual pleasure.

Associative , needs
Play contact with age
mates
 Preschool
Trucks, cars, telephones,
dollhouse,
Toys playground equipments,
watercolors, clay

Doctor and Nurse kit,

Sandbox, Housekeeping
Toys
toys, simple jigsaw
puzzle, lego

castration/body
Fear mutilation/ darkness
 Preschool
Oedipal and electra
Highlights
complex

Toilet
awareness of sexuality
Highlights
training sex roles and organs
(male and female)

Sexual identity-guns is
Highlights
Illness for boys, doll is for
girls
 Preschool
Views opposite sex
Highlights negatively
Prefers same sex peers

Toilet
curious with own body
Highlights
training breaking rule

Concept of illness:
Highlights
Illness
Magical
Erik Erikson

Psychosocial
Theory
 Freud’s Psychosexual Stages of Development
STAGES AGE PERIOD PHASES

Infancy 0-12 mos.) Oral Stage

Toddler 1-3yrs.old Anal Stage
Preschooler 3-6 yrs.old Phallic Stage
School-age 6-12 yrs. Old Latent Stage
Adolescent 13-18 Genital Stage
 Erickson Psychosocial Stages of Development
STAGES AGE PERIOD PHASES
Infancy 0-18 mos Trust vs
Mistrust
Toddler 1-3yrs.old Autonomy/
Independence vs
Shame and Doubt
Preschooler 3-6 yrs.old Initiative vs Guilt

School-age 6-12 yrs. Old Industry vs Inferiority

Adolescent 13-18 Identity vs Role
Confusion
 Theories of
Growth and Development
Psychosexual Dev't (Freud)
Psychosocial Dev't (Erickson)
Cognitive Dev't (Piaget)
Moral Dev't (Kohlberg)
 THE INFANT
Infancy Psychosexual : Freud- Oral stage
(0-12 mos)
Psychosocial: Erickson-Trust vs
(0-18 mos.)
Mistrust
(0-2 yrs.) Cognitive: Piaget-Sensorimotor

Play: Solitary (noninteractive)

 1- 4 mos. – rattle
 4 –8 months - peek a boo, mirror
 9 mos. Plays simple social games (peek a
boo)
 2111111
Toys: Mobile, stuffed toys, textured toys,
musical box, teething rings
Solid food: 4-6 mos.
Highlights: Establish consistency and security
to promote TRUST
Thumbsucking activity
Attachment to caregiver
Seeks comfort from security object

Fear: Stranger anxiety (usually begins

around 6 mos)
Separation anxiety: 8 – 12 mos
Specific Motor:
1 Month
 lifts head when prone
 Visual fixation on faces
2 Months
 Social smile
 Head lags when pulled to sitting
3 Months
 Raise head but not chest when in prone
 Babbles and coos
Specific Motor:
4 Months
 Raise head and chest when on prone
 Grasp objects and brings to mouth
 No head lag, head steady when upright
 Laughs aloud
5 Months
 Rolls over
 raking grasp
Specific Motor:
6 Months
 Doubles birth weight
 Eruption of first tooth (lower central incisor)
 Sits with minimal support
 Pulled from sitting to standing
7 Months
 Plays with feet
 “Dada or mama”
 Creeps
 Thumb-finger grasp
Specific Motor:
0
8 Months
 Sits alone without support
9 Months
 Hold bottle with good hand-mouth
coordination
 Crawls
 Bye-bye and pat-a-cake
 Steps with help
 Pincer grasp
Specific Motor:
10 Months
 Pull self to stand
 Knows own name
11 Months
 Stand with assistance
 Attempts to walk
12 Months
 Walks with help
 Triples birth weight
 Drinks from cup
 Can say 2 words
 Language
Infancy - Coos, squeals
2 mos. - social smile
3- 4 mos. - Laughs aloud
1 yr - 2 –6 words
2 yrs. 10 – 300 words
3 yrs: 900 words
6 yrs: 2,100 words
Sitting Position:
1 mo. Child has gross head lag
2 mos. Hold his head fairly steady
3 mos. Slight head lag
4 mos. No head lag
5 mos. Straighten his back when held in sitting
position
6 mos. Sit with legs spread, arm stiffened, arms
on the floor
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111111111111111111111111111111111
Sitting Position:
11111111111111111111111111111111111111111110

7 mos. Sit alone, but only when hands

held forward for balance
8 mos. Can sit securely without
additional support
9 mos. Infant sits steadily, lean forward
and regain their balance
 Car Safety
Newborn:
• use “infant only” seat, that when
properly positioned, faces the back of the
car
•Back seat of the car until they are
about 21 lbs
Toddler
• use “toddler size car seat”
• 40 to 60 lbs , sit on the back seat
Teeth: 6 mos.– first baby tooth erupts (central incisor),
followed a new one monthly.
LOWER UPPER
Central incisor
6-10 mos. 8-12 mos
Lateral incisor
10-16 mos. 9-13 mos
Cuspid
17-23 mos 16-22 mos
First molar
14-18 mos. 13-19 mos.
Second molar
23-31 mos. 25-33 mos.
 THE TODDLER
Toddler Psychosexual : Freud- Anal stage
1-3yrs.oldPsychosocial: Erickson - Autonomy/
Physio- Independence vs Shame and Doubt
logic Cognitive: Piaget-Stage I
anorexia (Preconceptual of the Preoperational
Regres- thought)
Moral Stage: Kohlberg- Preconventional
sion Level I
during Play: Parallel
illness Toys: stack toys, blocks, pots, drums to
bang, push and pull toys, rocking horse,
swing, finger paints, puzzle
 THE TOODLER
Highlights: Imitation: imitates what he sees
Toilet training
 Stays dry for 2 hrs with regular bowel movement
 Can sit, walk and squat
 verbalize the desire to void or defecate
 Negativism
• undergo extreme negativism, hates to do
anything, difficult to manage
• Always say “NO”
 Terrible two’s, obstinacy
 Sibling rivalry
 Temper tantrums, becomes strongly attached
to parents
 THE PRESCHOOLER
Preschool Psychosexual : Freud- Phallic stage
er Psychosocial: Erickson – Initiative vs Guilt
3-6 yrs.old
Moral Stage: Kohlberg- Preconventional
Level I- Stage II
Play: Associative , needs contact

with age mates

Toys: Trucks, cars, telephones, dollhouse,
Doctor and Nurse kit, Sandbox,
Housekeeping toys, playground
equipments, watercolors, clay, simple
jigsaw puzzle, lego
Preschool When they were given freedom and
er opportunity to initiate motor play such as
3-6 yrs.old
running, bike riding, sliding and wrestling,
finger paints, sand, water and modelling clay,
sense of initiative reinforced. Those who do
not develop initiative may have limited
brainstorming and problem solving skills,
they wait for clues or guidance from others
before acting
 THE PRESCHOOLER
Highlights:
 Oedipal and electra complex
 awareness of sexuality
 sex roles and organs (male and female)
 curious with own body
 Prefers same sex peers
 views opposite sex negatively
 Sexual identity-guns is for boys, doll is for girls
 breaking rule
Fear: castration/body mutilation/ darkness
Concept of illness: Magical
Physical Development
3 yrs. Old
 Pedal strike
 Walks backwards
 Climbs stairs
 Uses scissors
 Helps dress himself
4 yrs. Old
 Climbs and jumps well
 Uses alternating steps when climbing stairs
 Throws ball overhead
 Brushes teeth
Physical Development

5 yrs. Old
 Runs and hops well
 Plays jumping rope
 Skips
 Balances on one foot for 8 seconds
 Ties shoelaces with a bow/ribbon
 THE SCHOOL-AGE
School- Psychosexual : Freud- Latency stage
age Psychosocial: Erickson – Industry vs
(6-12 yrs.
Inferiority
Old)
Play: Competitive
Toys: dolls, train and model kits,
bicycle, skateboards, Games and sports,
board games, books, video, audio materials,
magic tricks, collecting objects and TV
Fear: replacement and displacement
in school
loss of privacy
fear of death
School- Children learns how to do things well, when
age they are rewarded, sense of industry grows.
(6-12 yrs.
Parents who don’t show appreciation for
Old)
their children’s effort may cause them to
develop a sense of inferiority rather than
pride and accomplishment.
 THE SCHOOL-AGE
Highlights:
 Collecting age begins (cards, marbles, posters)
 develop logical reasoning
 sexual drive repress
 socialization occurs
Morality: God is good and always present to help
 Superego and morality dev’t
 learns how to do things well
 when rewarded, sense of industry grows
 develop a sense of inferiority if not appreciated
Physical Development
7 yrs. Old
 First molar and lateral incisor
 Withdrawn and moody
 Watching TV
 Psychosomatic illness
8 yrs. Old
 10-11 permanent teeth
 Prefer playmates of own sex
 Dogmatic and self-righteous
Physical Development
9 yrs. Old
 More interested in friends than family
 Trying to be like parent of the same sex
 Worry and complain a great deal
10 yrs. Old
 Cooperative and affectionate
 Peer oriented
 Secret language
 Companionship is more important than play
Physical Development
11 yrs. Old
 Critical of adults
 Hero worship
 Moody
 Interest in the opposite sex
 THE ADOLESCENT
Adolescent Psychosexual : Freud- Genital stage
(13-18) Psychosocial: Erickson – Identity vs Role
Confusion
Cognitive: Piaget- Formal Operational

thought

Adolescent establishes satisfactory

relationship with opposite sex
Adolescent Adolescent establishes satisfactory
(13-18)
relationship with opposite sex
Growth : Spurt
Task : to establish identity and self
concept
Puberty : sexual organs begins to grow and
mature (girls-10-14, boys 12-16)

Menarche - for girls

Ejaculation for boys
Young Adult Intimacy vs Isolation
Intimacy is the ability to relate well other people, not only
with members of opposite sex but also with one’s sex to
form long-lasting friendship. Risk of being rejected or hurt
when offering love and friendship
Middle- Generativity People with sense of
Aged adult versus generativity are self-
Stagnation confident better to juggle
their various lives

Older adult Ego integrity Person with integrity feels

versus Despair good about life choices he
made
Person with despair wishes
life would begin over again
 Cognitive Development (J. Piaget)
(0–2 yrs) A practical intelligence because words and
Sensorimotor symbol are not yet available at this stage,
Object babies relate to the world thru their
Permanence senses using their reflexes
(2 – 7 years)  Egocentricity(unable to see the viewpoint
Preoperational of others
 Display static thinking
 Concept of time is “now”, concept of
distance is only as far as he/she can see
 No awareness of reversibility (for every
action there is an opposite action)
 Good toy- items that requires imagination
example: modeling clay
 Thought become symbolic
 3 – 6 years old - Pre operational
3 yrs:
- Copies circles , ability to classify objects
according to colors, shapes
- Egocentricity begins to be replaced with
social interaction
5 yrs.
- Hand dominance: ties shoe laces,
handles scissors well, print letter and
numbers, jump ropes
7-12 yrs • systematic reasoning
Concrete • logical thinking
Operational • awareness of reversibility
• classification of objects according to
groups
• Good activity: collecting and classifying
natural objects such as native plants, sea
shells
12 yrs Formal Operational thought
• able to solve hypothetical problems with
scientific reasoning, understand
causality
and can deal with the past, present and
future
• Adult or mature thought is present
• Good activity: “talk time” to sort thru
attitudes and opinion
 Moral Development (Kohlberg)
0-12 mos. Pre religious stage-parents gives affection
(infancy) and approval
Amoral stage
2 – 3 yrs Pre Conventional –Level I (1)
(Toddler) Punishment/ Obedience
(Good/ bad because father or mother says
so) to avoid punishment
4 – 7 yrs Pre conventional- Level I (2)
Preschooler Individualism: instrumental purpose and
exchange. Carries out action to satisfy
own needs rather than society. Will do
something for another if that person
does something for the child
7 – 10 yrs Conventional Level II (3)
(Schooler) ( nice / fair)
Orientation to interpersonal relation of
mutuality
Childs follows rule to feel good in the
eyes of the other and on their own
eyes
Rules for good of all
10– 12 yrs Conventional Level II (4)
Maintenance of social order, fixed rule
and authority
Follows rule of authority to keep the
system working
Older than Postconventional Level III (5)
12 yrs Social contract, utilitarian law-making
perspective
Follows standard of society for the good of
all people
Postconventional Level III (6)
Universal ethical principle orientation
Follows internalized standards of conduct
NEWBORN SCREENING
• RA 9288
• Newborn Screening Act
of 2004
• a simple procedure to find out a
congenital metabolic disorder
that may lead to mental
retardation or even death if left
untreated
• ideally done on the 48 - 72 hrs.
of life; may also be done 24 hrs
after birth
1. Phenylketonuria (PKU)
-an inherited autosomal recessive trait; a
disorder in metabolism
-a rare condition in which the baby cannot
properly use one of the building blocks of
protein called phenylalanine.
- Excessive phenylalanine in the blood
causes brain damage
Normal level of phenylalanine = 2 – 8 mg/dl
Absence of Liver enzyme (Phenylalanine Hydroxylase)

Prevents conversion of phenylalanine to tyrosine (precursor

of epinephrine, thyroxine, melanine)

• excessive phenylalanine builds up in the blood stream and

tissues ( 20 times higher than normal)

spills into the urine permanent brain damage

• urine becomes mousy irreversible brain damage

or musty
Signs
• IQ < 20, progressive retardation
• Seizure
• Child becomes fair skinned, light blonde
hair, blue eyes, body pigment fades,
eczema
• Poor growth
• Frequent vomiting, aggressive hyperacidty
Treatment
• Diet Low in phenylalanine level
• Small amount of milk
• limited breast feeding
• Avoid meat, eggs, milk, fish
• Give orange juice, banana, potato, lettuce,
spinach, peas
ii. Congenital Hypothyroidism (Thyroid Dysgenesis)

1: 4000 live births

• Deficiency in the production of thyroid
hormones due to an absent or non
functioning thyroid gland
• NB appears normal at birth
• symptoms are apparent during the 1st
three months of life (Formula fed); 6 mos.
If breast feed infant
• Termed as "good baby"
• Noticed at 6 weeks
 SIGNS AND SYMPTOMS
• Depressed nasal • slow bone dev't,
bridge extremities appear
• large tongue short and fat
• puffy eyes, • dry and brittle hair
• short neck • Chronic
• Hoarse voice constipation
• dry, cold skin, • abd'l enlargement
caused by poor
muscle tone
 TREATMENT
• Lifetime adm of Levothyroxine Na
• Vit. D supplement,
• Thyroid hormone
• Monitor T3,T4
“The later the therapy is started, the more
severe the mental retardation”
iii.Galactosemia
• A carbohydrate metabolism disorder characterized by
abnormal amount of galactose in the blood and urine
• Recessive hereditary metabolic disorder in which the
enzyme to convert galactose into glucose is missing (
galactose 1 phosphate uridyltransferase)
• Accumulation of excessive galactose in the body can
cause many problems including brain damage;
cataracts
• NB appears normal at birth but experiences difficulties
after ingesting milk
Signs and Symptoms
• Severe diarrhea
• vomiting
• dehydration
• Weight loss,
• jaundice,
• Hepatomegaly
Treatment
• Galactose free milk
• Formula made with casein hydrosylate
 iv. Congenital Adrenal Hyperplasia

• an endocrine disorder wherein the body is

unable to synthesize cortisol that causes
severe salt loss, dehydration, abnormally
high levels of male sex hormones in both
boys and girls
• if not detected and treated early, baby may
die with in 7-14 days
 v. G6PD Deficiency

• A condition in which the body lacks the

enzyme called G6PD
• May have hemolytic anemia resulting from
exposure to certain drugs, foods and
chemicals
“Train up a child in a way
he should go and when
he is old, he will not
depart from it”
Proverbs 22:6