SUBJECT NAME : ADVANCED NURSING

PRACTICE

UNIT : VIII UNIT, THE HEALTHY

CHILD

TOPIC : GROWTH & DEVELOPMENT

NAME : P. BEULAH,

DESIGNATION : PROFESSOR – Child Health

Nursing Dept.
 CONTENTS
• Objectives
• Definition
• Principles
• Factors
• Monitoring
• Reflexes
• Milestones & Stages
 GROWTH AND DEVELOPMENT

OBJECTIVES

• Definition of growth and development

• Principles of growth and development
• Factors affecting growth and development
• Growth and development from birth to adult.
 INTRODUCTION

 Growth denotes increase in physical size of the

body and development denotes improvement in
skills and function of an individual.

 Together they denote physical, intellectual,

emotional and social wellbeing of a person.

 Normal growth and development is observed only

if there is proper nutrition and without any
recurrent episodes of infection.
 GROWTH AND DEVELOPMENTAL AGE
PERIODS
 Infancy
Neonate (birth to 1 month)
Infancy (1 month to 1 year)
 Early childhood
Toddler (1-3 yrs)
Preschool (3-6yrs)
 Middle child hood
School age (6-12 yrs)
 Late childhood
Adolescent(13 yrs to approximately 18 yrs)
 Adulthood
Young adulthood (18-40 yrs)
Middle adulthood (45-65 yrs)
Late adulthood (Begins at 65)
The final transition
 DEFINITION
GROWTH
• It refers to an increase in physical size of the body
and various organs.
• It is quantitative changes of the body. It can be
measured in kgs, pounds, meters, inches etc..
DEVELOPMENT
• It is the process of functional and physiological
maturation of the individual.
• It is progressive in skill and capacity to function.
• It is a qualitative change in the child’s functioning. It
can be measured through observation
GROWTH DEVELOPMENT
• Growth is cellular. It • Development is
takes place due to the organizational. It is
multiplication of cells. organization of all the
parts which growth
and differentiation
have produced.
• Growth may or may
not bring • Development is also
development. possible without
growth.
GROWTH DEVELOPMENT
• It is a part of • It is a comprehensive
development process. and wider term and
Development in its refers to overall
quantitative aspects changes in the
termed as growth. individual.
• Growth does not • Development is a wider
continue throughout and comprehensive
term and refers to
life. It stops when
overall changes in the
maturity has been
individual. It continues
attained.
throughout life and is
progressive.
PRINCIPLES OF GROWTH AND DEVELOPMENT
1. Cephalocaudal

•  Describes the direction

of growth and
development.
• The head region starts
growth at first,
following by which
other organs starts
developing
 2. Proximodistal

• The directional sequence

of development during
both prenatal and postnatal
stages may either be (i)
from head to foot,
• (ii) from the central axis to
the extremities of the body.
• The spinal cord develops
before outer parts of the
body.
 3. Development is Continuous:

• The process of growth and

development continues
from the conception till the
individual reaches
maturity.
• It goes on continuously
throughout life. Even after
maturity has been
attained, development
does not end.
 4. Development is Gradual:

• It does not come all

on a sudden. It is also
cumulative in nature.
 5. Development is Sequential:

• Development is
sequential or orderly
• The sequence of
development is that
the child learns sitting
first before it can
stand; it learns
standing first before it
can walk. 
 6. Growth and development is predictable

• The difference in
physiological
and
psychological
potentialities
can ‘ be
predicated by
observation and
psychological
tests.
 7. Development proceeds from simple to
complex
• Children use their
cognitive and language
skills to reason and solve
problems.
• Children at first are able
hold the big things by
using both arms, In the
next part able to hold
things in a single hand,
then only able to pick
small objects like peas
8. Development Proceeds from General to
Specific:
• In all areas of development,
general activities always
precedes specific activity.
• Eg:The fetus moves its
whole body but incapable of
making specific responses
• Infants wave their arms
randomly. They can make
such specific responses as
reaching out for an object
near them.
 9. Growth is uneven

• Asynchronous
development refers to
an uneven intellectual,
physical, and emotional
development. 
 10. Certain stage of Growth and
development are more critical
• By age five most children
demonstrate fairly good
control of pencils, crayons,
and scissors.
• Gross motor accomplishments
may include the ability to skip
and balance on one foot.
• Physical growth slows down
between five and eight years of
age, while body proportions
and motor skills become more
refined.
 11. Principle of individual difference

• Individuals differ in the

rate of growth and
development.
• Boys and girls have
different development
rates.
 12. Co-ordination between increase in size
and maturation
• Maturation refers to the
sequential characteristic
of biological growth and
development.
• Changes in the brain and
nervous system account
largely for maturation.
And help children to
improve in thinking and
motor skills.
 14. The Principle of Developmental Pace:

• Maturity indicators do not

appear at regular
intervals.
• Infancy is a period of
accelerated growth when
maturity indicators appear
in various aspects of
growth.
• During the pre-school and
early school years, the
pace of growth slackens
15. Skills are learned by practice
FACTORS INFLUENCING GROWTH AND DEVELOPMENT

1. Heredity is the transmission of physical characteristics

from parents to children through their genes.
– It influences- physical appearance such as height,
weight, body structure, the colour of the eye, the texture
of the hair, and even intelligence and aptitudes.
2. Environment involves the physical surroundings and
geographical conditions of the place the child lives in, as
well his social environment and relationships with family
and peers.
– well-nurtured child does better than a deprived one; the
environment children are constantly immersed in
contributes to this. 
3. Sex: It affects the physical growth and development of a
child.
– Boys and girls grow in different ways, especially nearing
puberty.
– Boys tend to be taller and physically stronger than girls.

4. Exercise and Health: children deliberately

engaging in physical activities knowing it would help them
grow. 
– Exercise here refers to the normal play time and 
sports activities which help the body gain an increase in
muscular strength and put on bone mass
5. Hormones: Their timely functioning is critical
for normal physical growth and development in
children.
Imbalances in the functioning of hormone-secreting
glands can result in growth defects, obesity,
behavioural problems and other diseases. 
6. Nutrition: It’s a critical factor in growth as
everything the body needs to build and repair itself
comes from the food we eat.
Malnutrition can cause deficiency diseases that
adversely affect the growth and development of
children
7. Familial Influence: Whether they are raised
by their parents, grandparents or foster care, they
need basic love, care and courtesy to develop as
healthy functional individuals.
• The most positive growth is seen when families
invest time, energy and love with child through
activities, like reading, playing with them and
having deep meaningful conversations
9. Socio-Economic Status: Children from poorer
families may not have access to educational
resources and good nutrition to reach their full
potential. 
10. Maternal nutritional deficiencies: 
Malpositions, metabolic , endocrine
disturbances.
• Infectious diseases( or diseases like rubella,
toxoplasmosis, syphilis, herpes)
• Rh incompatibility, smoking , alcohol and intake
of certain drugs.
11. Genetic factors: Actual outcome of
growth= genetic potential+ environmental
influences. Mutations- inherited by offspring
Genetic studies make use of twin and family data
 GROWTH AND DEVELOPMENT
MONITORING
Assessment of growth:
 Assessment of physical growth can be done by
anthropometric measurement and the study of
velocity of physical growth.
 Measurement of different growth parameters is
the importance nursing responsibility in child
care.
 WEIGHT

 Weight is one of the best criteria for assessment of

growth and a good indicator of health nutritional status of
child.

 Among Indian children ,weight of the full terms

neonate at birth is approximately 2.5kg to3.5 kg.

 There is about 10% loss weight first week of life, which

regains by 10 days of age.
 LENGTH AND HEIGHT
 Increase in height indicates skeletal growth.
Yearly increments in height gradually diminished
from birth to maturity.
 At birth average length of a healthy Indian
newborn baby is 50 cm.
 It increases to 60cm at 3 months,70 cm of a 9
month and 75cm at 1 year of age.
 Then weight gain is about 25-30 gm per day for
1st 3 month and 400gm/month till one year of age.
 The infants double weight gain their birth weight
by 5 month of age, trebled by 1 year,4th time by
2 years ,five times by 3 year ,6 times by 7 year
and ten times by 10 yrs.
 Then weight increases rapidly during puberty
followed by weight increases to adult size.
 In 2nd year ,there is 12cm increase,3rd year it is 9
cm, 4th year it is 7cm, and in 5th year is 6cm.
 So the child double the birth by 4 to 4.5 years of
the age afterwards there is about 5 cm increase
in every year till onset of puberty.
 BODY MASS INDEX(BMI)

 It is an important criteria which helps to assess

the normal growth or its deviations.
BMI = kg/m2
 BMI remains content up to the age of 5 Years .
If the BMI more than kg/m2,it indicates obesity
and if it is less than 15 kg/m2 it indicates
malnutrition.
 BMI Categories

• Underweight = ≤18.5
• Normal weight = 18.5-24.9
• Over weight = 25-29.9
• Obesity = BMI of 30 or greater
 HEAD CIRCUMFERENCE
 It is related to brain growth and development of
intracranial volume. Average head circumference
measured about 35cm at birth.
 At 3 months it is about 40cm, at 6 month 43cm, at
1 year 45cm, at 2 years 48cm,at 7 year 50cm and
at 12 years of age it is about 52cm, almost same
as adult.
 CHEST CIRCUMFERENCE
 Chest circumference or thoracic diameters is an
importance parameter of growth and nutrition
status.

 At birth it is 2-3cm less than head circumference

at 6 to12 months of age both become equal.

 After 1st year of age, chest circumference is

greater than head circumference by 2.5cm and
by the age of 5 year ,it is about 5cm larger than
head circumference.
 GROWTH OF NEWBORN

DEFINITION:
Period from birth to 28 days of life is called
neonatal period and the infant in this period is
termed as neonate or newborn baby.

REFLEXES:
Rooting reflex:
When the cheek or corner of the mouth is
stroked, infants head should turn towards the
stimulus and the mouth should open.
 Sucking reflex:
When touching or stroking the
movements begin.
 Swallowing reflex:
The passage of food from the
posterior aspect of mouth to the stomach.
 Gagging reflex:
When the posterior pharynx is
stimulated with food, there is an immediate
return of undigested food.
 Extrusion:
When substance placed on anterior portion
of the tongue, it will be expelled out.
 Blinking reflex:
Protection of eye by rapid eye lid closure
when the eyes are exposed to bright light.
 Dolls eye reflex:
When you are showing on object to a
newborn, normally eyes do not move but the
head turns to the right or left side towards the
object.
 Papillary reflex:
Pupil contracts when bright light shines, it
persists throughout life.
 Sneeze reflex:
Passage respond spontaneously to
irritation or obstruction, persists throughout the life.
 Glabellar reflex:
Tapping briskly on glabellas(bridge of
nose) cause eyes to close tightly.
 Yawn reflex:
Infant has spontaneous response to
decreased oxygen by increasing amount of inspired
air, persists throughout life.
 Cough reflex:
Irritation of mucous membranes of larynx or
tracheobronchial tree causes coughing, persists
throughout the life usually present after 1 st day of
birth.
 Babinski reflex:
Stroking outer sole of food upward from
heel and across ball of foot to hyperextend and
hallux to dorsiflex.
Ankle reflex:
Briskly torsi flexing foot while
supporting knee in partially flexed position results in
1-2 oscillating movements eventually no beats
should be left.
 Tonic neck reflex:
Turning the head quickly to one side while
the baby is supine ,arm and legs on the side the
head is turned towards extent ,arm and legs on the
opposite side.
 Perez reflex:
While the baby is prone on firm surface and
thumb is passed along spine, defecation or
urination may occur disappears by 4-6 months.
 Palmar grasp:
When the objects are place in the palm of
the newborn, it grasps the objects.
 Planter grasp:
When objects touch the soul of the foot at
the base of the toes, toes grasps around very
small objects.
 Dancing or stepping reflex:
Hold newborn in vertical position with the
feet touching a flat firm surface, there will be a
rapid alternating flexion and extension of the legs.

 Moro reflex:
The newborn head is suddenly allowed to
drape backward an inch, there will be symmetric
abduction and extension of the arms and legs
with fanning of fingers.
 GROWTH OF INFANT(1-12 MONTHS)

• Milestones:
1st month : social smile

2nd month: vocalize

3rd month : head control

4th month : hand control

5th month : turns over
6th month: sits alone
7th month : crawl
8th month: creeping
9th month: stands with
support
10th month: walk with support
11th month: stands alone
12th month: walk without
support
1st MONTH
• Reflexes:
-Primitive reflexes present and strong
- Dolls eye reflex and dance reflex fading
-Obligatory nose breathing(most infants)
Gross Motor:
-Assumes flexed position with pelvis high but not under
abdomen when prone
- Can turn head side to side when prone
- In sitting position, back is uniformly rounded with
absence of head control.
Fine M otor:
-Grasp reflex strong
-Hand clenches on contact with rattle
3rd MONTH
• Reflexes:
-Primitive reflexes fading
• Gross motor:
-Able to hold head more erect when sitting.
-Assumes symmetric body positioning
-When held in standing position, able to hear
slight fraction of weight on legs.
• Fine Motor:
-Actively holds rattle but will not reach for it.
-Grasp reflex absent
-Pulls at blankets and cloths
4th MONTH
• Reflexes:
-Drooling begins
-Moro, tonic neck and rooting reflexes have
disappears.
• Gross Motor:
-Has almost no head lag when pulled to sitting
position.
-Balances head well in sitting position.
-Rolls from back to side
-Able to sit erect if propped up.
• Fine Motor:
-Inspects and plays with hands ,pulls
clothing or blanket over face in play
-Ttries to reach objects with both hands
-Play with rattle placed in hand, shakes it
but cannot pick it up if dropped.
-Can carry objects to mouth.
5th MONTH
• PHYSICAL:
-Beginning signs of tooth eruption
-Birth weight doubles
• Gross Motor:
-Aable to sit for longer periods when back is
well supported back straight.
-When sitting, able to hold head erect and
steady.
-Can turn over from abdomen to back
-When supine, pulls feet to mouth.
 Fine Motor:
-Able to grasp
objects voluntarily
-Uses palmer grasp
approach
-Plays with toes
-Takes objects
directly to mouth
-Holds one cube
while regarding as
second one.
6th MONTH
• Physical:
-Growth rate may begin to decline
-Weight gain of 90 to 150 gm weekly for next 6 month
-Height gain of 1.25cm monthly for next 6 months
-Teething may begin with eruption of two lower central
incisors
-Chewing and biting may occur.
• Gross Motor:
-When prone, can lift chest and upper abdomen off
surface ,bearing weight on hands
-Sits in high chair with back straight
-When held in standing position, bears almost all of weight
• Fine Motor:
- Re secure a dropped objects
- Grasps and manipulates small objects
- Holds bottle
- Grasps feet and pulls to mouth.
7th MONTH
• Physical:
-Eruption of upper central incisors
• Gross motor:
- Sits, learning forward on both hands
-Sits erect momentarily
-Bears full weight on feet
-When held in standing position, bounces
actively.
• Fine Motor:

-Transfers objects from one hand to another

- Holds two cubes more than momentarily
- Bangs cubes on table
8th MONTH
• Physical:
-Parachute reflex appears
• Fine motor:
- Sits steadily un supported
- May stand by holding a furniture
• Gross Motor:
-Retains two cubes while regarding 3rd cube
-Rings bell purposely
-Reaches persistently for toys out of reach
9th MONTH
• Physical:
-Eruption of upper lateral incisor may begin
• Fine Motor:
-Creeps on hands and knees
-Pulls self to standing position and holds a
furniture
-Recovers balance when leaning forward but
cannot do so when leaning sideways.
• Gross Motor:
-Grasp 3 rd cube
-Preference for use of dominant hand now
evident
10th MONTH
• Reflexes:
-Labyrinth-righting reflex is strongest when
infants is in prone or supine position, is able to
raise hand.
• Gross Motor:
-Can change from prone to sitting position
-Recovers balance easily while sitting
- While standing lifts one foot to take a step.
• Fine Motor:
-Crude release of an object begins
-Grasps bell by handle.
11th MONTH
• Physical:
- Eruption of lower lateral incisor may begin
• Gross Motor:
- When sitting, pivots to reach toward back to
pickup an object.
• Fine Motor:
- Explores objects more thoroughly
- Has neat pincer grasp
- Puts one object after another in to a
container
12th MONTH
• Physical:
-Birth weight trebled
-Birth length increased by 50%
-Anterior fontanel's almost closed
-Landau reflex fading
-Lumbar curve develops during walking.
• Gross motor:
-Can sit down from standing position without
help.
• Fine Motor:
-Releases cube in cup
-Tries to insert a pellet into a narrow
necked bottle but fails.
• Language/ speech development:
Receptive language:
- Responds to human voices
Expressive language:
- Cries when hungry or un comfortable
- 6-8 words at 1 year
 Hearing

• 3-4 months : Child turns his head towards the

source of sound.
• 5-6 months : Child turns the head to one side
and then downward if a sound is made below
the level of ears.
• 10 month : Child directly looks at the source of
diagonally.
 Vision

• 1st month – Baby can fixate on his mother as she

talks to him.
• 3-4 month : Child can fixate intently on an object
shown to him (grasping with eye).
• 6 weeks : Binocular vision begins and is well
established by 4 months .
• 6 months : Child adjusts his position to follow
object of interest.
• 1 year : Follow rapidly moving object.
 Psychosocial (Erick Erickson)
[Sense of trust Vs Mistrust]
Trust – Firm believing the reliability, truth or ability
Mistrust – Lack of trust or confidence; distrust.
Complete dependence on care giver.

Intellectual development (Jean Piaget)

[Sensory motor] (0-2 years)
Stimuli are recognized, absorbed and
incorporated into existing action
Psychosexual (freud)
[Oral stage] – This is the first social and sexual
stage of an infant’s development, during which
the infant focuses on satisfying hunger. This is
satisfied by chewing, sucking and biting.

Spiritual development (fowler)

[Undifferentiated] – Feeling of trust, warmth and
security from the foundation of the later
development of faith.
Moral development (Kohlberg)
[Pre-conventional morality stage] (0-2 years)
Unable to understand good or bad.
The good is what I like and want.

Language/speech development:
Receptive language:
• Responds to human voices.
Expressive language:
• Cries when hungry or uncomfortable.
• 6-8 words at one words.
 GROWTH OF TODDLER(1-3 YEARS)
1 Year
Gross motor:
- Walks without help
- Creeps upstairs
- Runs clumsily
- Falls often
Fine Motor:
- Builds tower of 2 cubes
- Holds 2 cubes in one hand
- Scribbles spontaneously
- Uses cup well but often rotates spoon before it.
2 YEARS
• Physical development:
-Hand circumference49-50cm
-Usual weight gain of 1.8-2.7kg/year
-Usual height gain of 10 to 12.5 cm/year
-Primary dentition of 16 teeth.

• Gross motor:
-Picks up object without falling
-Kicks ball forward without over balancing.
• Fine motor:
-Builds tower of 6 or 7 cubes
-Aligns two or more cubes like a train
-Turns door knob
-Able to remember and imitate some
actions and gestures.
3 years
• Physical development:
-Birth weight quadrupled
-May have day time bladder control

• Gross motor:
-Jumps with both feet
-Stands on one foot momentarily
-Takes a few steps on tiptoe
• Fine motor:
-Builds tower of 8 cubes
-Good hand finger co ordination
-In drawing ,imitates vertical and horizontal
strokes.
• Language/speech development:
1 year(6 to 8 words)
2nd year(300 words)
3 rd year (900 words)
Psycho social (Erick Erickson)
[Autonomy Vs Shame]
Autonomy – The right of a person, an organization, r
Shame – The unpleasant feeling of guilt and
embarrassment when you are wrong.

Psycho sexual (Freud)

[Anal stage] – Obtain pleasure from the feeling of a
distended bladder, from masses of feaces in the
rectum and from release of content from those
organs
 Spiritual development (Fowler)
[Intuitive projective] – Imitates religious behavior
such as bowing the head in prayer, but does not
understand the meaning.

Intellectual development(jean Piaget)

• Preoperational ( 2 to 7 years).
• Pre-conceptional phase ( 2 to 4 years).
• Beginning of mental representation of events and
differentiates past and present.
 Moral development (Kohl berg)
[Pre conventional morality]
Birth to 2yrs – The good is what the child like and
wants.
2 to 3yrs – Child is punished for doing something, its
wrong; if not punished it must be right.

Language/Speech development
• 1 year - 6 to 8 words
• 2 year - 300 words
• 3 year - 900 words
GROWTH OF PRESCHOLER(3-5 YEARS)
• 3 years
Gross motor:
- Rides tricycle
-Jumps of bottom steps
-Broad jumps
-May turn to dance but balance may not be
adequate.
• Fine motor:
-Builds tower of 9-10 cubes
-Builds bridge with 3 cubes
-In drawing copies a circle imitates a cross.
4 Years
• Gross motor:
-Skips and hops on one foot
-Catches ball
-Throws ball over head
-Walks down stairs with alternate footing
• Fine motor:
-Uses scissors successfully to cut out picture
following
-Can lace shoes but not able to tie
5 years
• Gross motor:
-Skips and hops on alternate feet
-Jumps rope
-Walks backward with heels to toe
-Balance on alternate feet with eyes closed
• Fine motor:
-Ties shoelaces
-Uses scissors ,simple tools
-In drawing, copies a diamond and triangle
Psychosocial (Erick Erickson)
[Sense of initiative Vs Guilt]
Initiative – An introductory act or step;
Guilt – A feeling of responsibility

Psycho sexual (Freud)

[Phallic stage]
Oedipus complex – Boys desire their mothers
Electra complex – Girls want their fathers
 Spiritual development (Fowler)
[Intuitive projective]
Imitates religious behavior such as bowing the head in
prayer, but does not understand the meaning.

Intellectual development(Jean Piaget)

[Intuitive phase] (4-7yrs)

Children can repeat the event in play that occurred
many hours or day before.
[Pre conventional morality] – Strictly for the purpose of
self interest that avoid punishment and to have favors
turned.
 Language/speech development

• 3 years-900 words
• 4 years-1500 words
• 5 years -2100 words
play(new hall) co-operative play
 GROWTH OF SCHOOLER(6-12 YEARS)
6 Years:
Motor changes:
-Central mandible incisor erupt
-Loses first tooth
-Likes to draw, print color
Mental changes:
-Develops concepts of numbers
-Can count 13 rupees
-Knows right and left hands
-Attends first grade
-Define common objects
7 years
• Motor changes :
-Maxillary central incisors and lateral mandible
incisors erupt.
-Repeats performance to master them
-More cautious in approaches to new
performances
• Mental changes:
-Can copy a diagram
-Repeats 3 numbers backward
-Attends 2nd grade
8 years
• Motor effects:
-Movement fluid ,often graceful and poised
-Always on the go, jump, chase, skips
• Mental effects:
-Gives similarities and differences between two
things from memory
-Makes change out of a quarter
-Attends third grade
-Reads more, may plan to wake up early just to
read.
9 years
• Motor effects:
-Dresses self completely
-Hard to quite down after recess
-More limber, bones grow faster than
ligaments.
• Mental effects;
-Reads class books
-More aware of time
-Attends 4th grade
-Produces simple paintings and drawings.
10 years
• Motor effects:
-Posture is more similar to an adult
-Perform tricks on bicycle-races participate in
sports.
• Mental effects:
- Writes brief stories
- Attends 5th grade
11 years
• Motor effects:
-Will over come lordosis
-Dresses neatly
-Likely to over do
• Mental effects:
-Uses telephone for practical purposes
-Attends 6th grade
-Knows right and wrong
12 years
• Motor effects:
• Girls;
- Pubescent changes may begin to appear, body
lines soften and round out
• Boys:
- Slow growth in height and rapid weight gain,
may become obese in this period.
• Mental effects:
-Responds to magazine , radio or other
advertising
-Attends 7th grade.
• language/speech development:
20,000-30,000 words.
• play (competitive play)
girls( cooking ,grooming ,teaching)
boys( kites ,cycling team sports
 Psychosocial development(Erick Erickson)
[Sense of industry Vs Inferiority]
Industry –involved in providing a service.
Inferiority – A state of feeling less important.

Psycho sexual (Freud)

[Latent phase]
• Associate with same sex
• Peers ignore the opposite sex
 Spiritual development (Fowler)
[mythical literal faith]
• Follows the rituals practiced in the family/society

Intellectual development (Jean Piaget)

[Concrete operational stage]
• Able to understand, read and write,
• Development problem solving abilities,

Language/speech development:
20,000 – 30,000 words.
Play [Competitive play]

Girls:
• Cooking
• Grooming
• Teaching .
Boys:
• Kites
• Cycling
• Team sports.
 GROWTH OF ADOLESCENCE(13-18 YRS)

• 13 Years:
Reproductive organ development:
male:
-Prostate begins functioning
-Penis begins to lengthen
female:
-Internal and external organs continue
growing.
Cognitive development:
-Adolescent learn to think new ways to
understand complex ideas
14 years

• Reproductive organ development

• Male
-Pubic hair grows
-Growth spurt may begin
• Female
-Under arm hair growth
-Onset of menstruation.
Cognitive development:

- mind has great ability to acquire and utilize

knowledge
- members of the peer group often try to act.
 15 years
• Reproductive organ development:
male:
- Rapid growth of the penis
- Testes color deepens
female:
-Underpants may be wet at times with a clear
mucous.

Cognitive development:
-Imaginative thinking develops
-The peer group expands to include romantic
friendships.
16 years
• Reproductive organ development:
male:
-Under arm hair
-Voice change begins
female:
-Most of the growth spurt complete

Cognitive development:
-They learn selectively
-They have better memory
 17 years
• Reproductive organ development:
male:
- Average age that sperm matures
- Majority of the growth spurt complete
female:
-Acne
-Voice deepens.

Cognitive development:
-Problem solving skills gets improved
-Learn to express and receive intimate or
sexual advances
18 years
• Reproductive organ development:
male:
- Chest and shoulders fill out
- Facial body hair becomes heavier
- Acne
female:
-Full height achieved

Cognitive development:
-Able to think in logical way
-Able to sound judgment
• Language/speech development:
Continuous to learn new concepts

• play: social play

- Sports
- Parties
- Watching television
- Computer game
Psycho sexual (Freud)
[Genital stage] – Masturbation and sexual fantasies
are common.

Spiritual development (Fowler)

[Conventional faith]
Personal and social values evolved to support their
identity to explore religious affiliation.
 Intellectual development(Jean Piaget)
[Formal operational stage]
Thinking is oriented to things and events that they
can observe directly.

Moral development (Kohl berg)

[post conventional stage]
Able to differentiate from right and wrong.

Language/speech development:
Continuous to learn new concepts.
 Play

[Social play]
• Sports
• Parties
• Telephone conversations
• Watching TV
• Computer game
  GROWTH & DEVELOPMENT IN
ADULTHOOD
1) Young Adulthood Stages of Development
• A biological process which transforms a child into
an adult.
• Period of sexual maturation.
• Period of Rapid Growth and Development.
• Has best physical condition: strong, sharp senses.
• Memory and thinking (cognitive) abilities are at
their highest.  
2) Middle Adulthood Stages of Development

• Cognitive - shows an average memory loss and a reduced

ability to perform tasks requiring speed.
• The social and personality development → "mid-life
crisis" which heralds the reevaluation of one's life goals.
• By this point in life, career and family are well
established.
• People feel satisfaction and self-worth, or sense much of
life has been wasted.
3) Late Adulthood Stages of Development

• Marked by menopause and osteoporosis, a reduction

in bone density, less skin elasticity, and a loss of
muscle mass resulting in an increase of body fat.
• Cognitively→ memory and mobility tends to
decrease.
• Many people relax, enjoying the fruits of their labour.
• Children and grandchildren become the focus of
attention.
4) The Final Transition: Dying
People’s overall health deteriorates with
age Thanatology is the study of the
psychological and medical aspects of death
and dying.
STAGE THEORIES OF ADULT DEVELOPMENT

• Psychosocial Theory: Stage 5 of Erikson’s

theory is identity vs. role confusion
(Adolescence)Adolescents are in search of an
identity that will lead them to
adulthood."Who am I?"If the child over comes
earlier conflicts they are prepared to search
for identity.
• Psycho-sexual theory: Stage 6 is intimacy vs.
isolation (Young Adulthood)The most
important events are love relationships. An
individual who has not developed a sense of
identity usually will fear a committed
relationship and may retreat into isolation.
REFERENCES
Wong’s Essential of Pediatric Nursing, 10th edition; Elsevier
publication.

Principles of Pediatric Nursing; “caring for children” ;author,

Jane Ball et all., sixth edition.

Text book of Pediatric Nursing; author, Dorothy R Marlow;

6th edition

Lippincott, Pediatric Nursing; 5th edition.

https//www.ncbi.nlm.nih. gov/pmc/artices/PMC 5006399

THANK YOU