JMJ Marist Brothers

NOTRE DAME OF MARBEL UNIVERSITY

College of Arts and Sciences
NURSING DEPARTMENT

Concepts & Theories on

Growth and Development
 Learning Objectives:
At the end of the lecture-discussion, the student nurses can:

1.Explain the principles of growth and development

and developmental stages according to major
theorists;

2.Evaluate a child to determine the stage of

development achieved;

3.Discuss the concept of sexuality, self-concept,

body image and self esteem.
 “ Children will not
remember you for the
material things you
provided but for the
feeling that you
cherished them.”
- Richard L. Evans-
01 Growth and Development

02 Patterns of G & D

03 Principles of G & D

04 Factors Influencing G & D

05 G&D of Body Systems

06 Growth Rate and Stages of G&D

0704 Theories of G&D

08 Sexuality
Growth and
Development
Sum of the numerous changes that takes
place during the lifetime of an individual
◍ Quantitative change
◍ Qualitative change
Growth
Quantitative Change

• used to denote an increase in physical size or a quantitative

change (Pillitteri, 2010)

• physical increase in the body’s size and appearance caused by

increasing numbers of new cells (Hatfield, 2008)
Development
Qualitative Change

• used to indicate an increase in skill or the ability to function; a

qualitative change (Pillitteri, 2010)

• can be measured by observing a child’s ability to perform specific

tasks (Pillitteri, 2010)

• capacity to learn and think increases (Hatfield, 2008)

Patterns of
G&D
• Cephalocaudal
• Proximodistal
• Differentiation
Principles of
G&D
P-E-D-I-A-T-R-I-C-S
Principles of
G&D

P rocess that is continuous

Principles of
G&D
E levation of skills from gross to
fine motor
Principles of
G&D

D evelopment from proximal to

distal
Principles of
G&D
I t needs an optimum time for

initiation of learning experiences

Principles of
G&D

A must to proceed in an orderly

sequence
Principles of
G&D

To follow a predictable and

definite pattern
Principles of
G&D

R equires practice to learn behavior

and skills
Principles of
G&D

It is cephalocaudal
Principles of
G&D

C an develop when neonatal

reflexes disappear
Principles of
G&D

S ystems in the body don’t develop

at the same rate
Factors influencing G
&D
• Genetics
• Temperament

• Environment
Genetics
SCIENCE OF GENETICS
• studies the ways in which normal and
abnormal traits are transmitted from one
generation to the next
• each parent’s individual characteristics
could reappear unchanged in later
generations
Genetics
SCIENCE OF GENETICS
• determines characteristics such as sex,
physical characteristics (eye color, potential
height, etc.) and to some extent,
temperament
• Influence reflects specifically on gender,
health & intelligence
Temperament
• is an inborn characteristic set at birth
• the 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).
Temperament
REACTION PATTERNS
• Activity Level: motor activity
• Rhythmicity: (regular & irregular rhythmicity)
• Approach: a child’s response on initial
contact with a new stimulus.
• Adaptability: the ability to change one’s
reaction to stimuli over time.
Temperament
REACTION PATTERNS
• Distractibility: Shift of attention to a new
situation
• Attention Span and Persistence.
Attention Span: Ability to remain interested in a
project or activity.
Persistence: Diligence or determination
Temperament
REACTION PATTERNS
• Intensity of Reaction: reaction to stress
• Threshold of Response: the intensity level
of stimulation that is necessary to evoke a
reaction.
• Mood Quality: disposition (positive or
negative mood quality)
Temperament
CATEGORIES
• Difficult: arrhythmic, withdrawing, low in
adaptability, intense, and negative in mood

• Slow to warm up: inactive, low in approach

and adaptability, and negative in mood
Temperament
CATEGORIES
• Intermediate: some characteristics of both
groups

• Easy: rhythmic, approaching, adaptable,

mild, and positive in mood
Nursing Implications
❖It is useful to talk to parents about their child’s
reactivity patterns these patterns tend to persist

❖ringing these characteristics to parents’ attention

helps them better understand their child and lays
the foundation for beginning to accept and respect
the child as an individual.

❖It is essential for successful childrearing (Foley,

2007).
Environment
• Living conditions of the child,
socioeconomic status, climate and
community

• Family structures, including family size,

sibling order, parent–child relationships, and
cultural background, all affect the growth
and development of the child.
Environment

• Socioeconomic Level
• Parent–Child Relationship
• Ordinal Position in the Family
• Health
Nutrition
• the quality of a child’s nutrition during then
growing years (including prenatally) has a
major influence on health and stature
(Rolfes, Pinna, & Whitney, 2009)

• plays a vital role in the body’s susceptibility

to disease because poor nutrition limits the
body’s ability to resist infection
Nutrition

• Poor nutrition also plays a major role in the

development of chronic illness

• Establishing healthy eating patterns early in

life, therefore, can contribute to better
health in adult years.
Healthy Eating Guidelines

• Eat a Variety of Foods

• Balance the Food You Eat With Physical
Activity— Maintain or Improve Your Weight
• Choose a Diet With Plenty of Grain Products,
Vegetables, and Fruits
Healthy Eating Guidelines
• Choose a Diet Low in Fat, Saturated Fat, and
Cholesterol
• Choose a Diet Moderate in Sugars.
• Choose a Diet Moderate in Salt and Sodium
• If Drinking Alcoholic Beverages, do so in
Moderation
Healthy Diet Components
• Protein
• Carbohydrate
• Fat
• Vitamins
• Minerals
G & D of Body Systems
• Nervous System
• Respiratory System
• Cardiovascular and Hematologic Systems
• Gastrointestinal System
• Endocrine System and Hormonal Function
• Genitourinary System
• Musculoskeletal System
• Integumentary and Immune Systems
 Nervous System
• At birth the nervous system is immature.
• As the child grows, the quality of the nerve
impulses sent through the nervous system
develops and matures.
• As these nerve impulses become more
mature, the child’s gross and fine motor skills
increase in complexity. The child becomes
more coordinated and able to develop motor
skills
 Sensory Organs
Eyes
• Newborns do not focus clearly but will stare at
a human face directly in front of them.

• 2 months: the infant can focus and follow an

object with the eyes
 Sensory Organs
Eyes
• 7 months: depth perception has matured
enough so that the infant can transfer objects
back and forth between his or her hands.
• Visual acuity of children gradually increases
from birth, when the visual acuity is usually
between 20/100 and 20/400 until about 7 years
of age, when most children have 20/20 vision
(Traboulsi, 2006).
 Sensory Organs
Ears
• In infants and young children, this tube is
straighter, shorter, and wider than in the older
child and adult.

• Hearing in children is acute, and the infant will

respond to sounds within the first month of life.
 Respiratory System

• The respiratory tract grows and changes until

the child is about 12 years of age.

• first 5 years,: child’s airway increases in length

but not in diameter
 Respiratory System

• Infants and young children have larger tongues

in proportion to their mouths, shorter necks,
narrower airways and the structures are closer
together
 Respiratory System

Think about this.

Because the infant is a nose

breather, it is essential to keep the
nasal passages clear to enable
the infant to breath and to eat.
 Respiratory System
• The ability to breath through the mouth when
the nose is blocked is not automatic but
develops as the child’s neurologic development
increases.
• tonsillar tissue is enlarged in the early school-
age child, but the pharynx, which contains the
tonsils, is still small, so the possibility of
obstruction of the upper airway is more likely.
 Respiratory System

• children older than 2 years, the right bronchus

is shorter, wider, and more vertical than the left
• Infants use the diaphragm and abdominal
muscles to breathe.
• Beginning at about age 2 to 3 years, the child
starts using the thoracic muscles to breath.
 Respiratory System

Think about this.

If the child inhales a foreign

body, it is more likely to be
drawn into the right bronchus
rather than the left.
 Respiratory System

• The change from using abdominal to using

thoracic muscles for respiration is completed by
the age of 7 years.
• Because accessory muscles are used for
breathing, weakness of these muscles can
cause respiratory failure
 Respiratory System

This is critical to remember.

The diameter of the infant and child’s trachea is
about the size of the child’s little finger. This
small diameter makes it extremely important to
be aware that something can easily lodged in
this small passageway and obstruct the child’s
airway.
 Cardiovascular and
Hematologic Systems
• At birth, both the right and left ventricles are
about the same size, but by a few months of
age, the left ventricle is about two times the
size of the right.
• infant’s heart rate is higher than the older
child’s or adult’s so that the infant’s cardiac
output can provide adequate oxygen to the
body
 Cardiovascular and
Hematologic Systems
• Although the size is
smaller, by the time
the child is 5 years
old, the heart has
matured, developed,
and functions just as
the adult’s
 Cardiovascular and
Hematologic Systems
• The blood volume in
the body is
proportionate to the
body weight. The
younger the child, the
higher the blood
volume is per kilogram
of body weight.
 Gastrointestinal System

• The functioning of the gastrointestinal system

begins at birth. The GI tract of the newborn
works in the same manner as that of the adult
but with some limitations. (e.g. the enzymes
secreted by the liver and pancreas)
 Gastrointestinal System

• smaller capacity of the infant’s stomach and the

increased speed at which food moves through
the GI tract require feeding smaller amounts at
more frequent interval
• small capacity of the colon leads to a bowel
movement after each feeding
 Gastrointestinal System

• Reflexes are present in infants that allow for

swallowing and prevention of aspiration when
swallowing
• cardiac sphincter at the end of the esophagus
may be lax in the infant, and food may be
regurgitated from the stomach back into the
esophagus
 Endocrine System and
Hormonal Function
• Regulating metabolism, growth, development,
and reproduction are all functions of hormones.
• The endocrine system of the infant is
adequately developed, although the functions
are immature.
• As the child grows, the endocrine system
matures in function.
 Genitourinary System
• Newborn: bladder empties when only about 15
mL of urine is present, (newborn voids as many
as 20 times a day)

• As the child gets older, the bladder has more

capacity to hold larger amounts of urine before
the child feels the urge to void.
Genitourinary System
 Genitourinary System
• urethra in females: much shorter than in males
at all ages

• kidneys in children are located lower in

relationship to the ribs than in adults- greater
risk for trauma to the kidneys
 Genitourinary System

• kidneys reach their full size and function by

adolescence

• reproductive portion in males and females

matures at the time of puberty
 Genitourinary System
• In infants and children, emptying the bladder is
a reflex action.

• Between ages 2 and 3 years, the child is able

to hold the urine in the bladder and learns to
urinate voluntarily, thus developing the control
of urination.
 Musculoskeletal System
• Childhood: bones are more sponge-like and
can bend and break more easily than in adults

• since bones are still in the process of growing,

breaks in the bone heal more quickly than do
breaks in adults.
 Musculoskeletal System
Think about this.

Bone growth takes place

between birth and puberty,
with most growth being
complete by age 20 years
 Integumentary
and Immune Systems
• newborn’s skin is thin and has less
subcutaneous fat between the layers of skin

• Sebaceous secretions in the infant and young

child are less than those in the older child and
adult, causing the skin of children to dry and
crack more easily.
 Integumentary
and Immune Systems
• Passive immunity is present at birth and
decreases during the first year of life.

• during the first year of life immunizations are

started to help the infant develop protection
against certain diseases.
 Integumentary
and Immune Systems

• As the child grows and develops, the immune

system also develops. The antibodies in the
child increase as the child progresses through
childhood.
Growth Rate and
Stages of G & D
• Most Rapid : Infancy (0-1 y.o)
• Slow : Toddler (1-3 y.o)
• Alternating : Preschooler (3-6 y.o)
• Slower : Schooler (6-12 y.o)
• Rapid : Adolescent (12-18 y.o)
Growth Rate and
Stages of G & D
AGE/STAGE FACTS
Weight: doubles by 5 or 6 months; triples
by 1 year
INFANT
Height: increase of 1 ft by 1 year of age
(0-1 y.o)
Teeth: erupt by 6 months; has 6-8
deciduous teeth by 1 year of age
Growth Rate and
Stages of G & D
AGE/STAGE FACTS
Weight: Gains 8 oz or more a month from 1 to 2 years;
Gains 3 to 5 lbs a year from 2 to 3 years of age

TODDLER Height: grows 3-5 inches from 1-2 years of age; from 2-
(1-3 y.o) 3 years, grows 2-2.5 inches per year

Teeth: has 20 deciduous teeth by 3 years

Growth Rate and
Stages of G & D
AGE/STAGE FACTS
Weight: gains 3-5 lbs a year
PRESCHOOL Height: grows 1.5-2.5 inches a year
(3-6 y.o)
Growth Rate and
Stages of G & D
AGE/STAGE FACTS
Weight: gains 3-5 lbs a year
SCHOOL AGE Height: grows 1.5-2.5 inches a year
(6-12 y.o)
Growth Rate and
Stages of G & D
AGE/STAGE FACTS
Weight:
Girls: 15-55 lbs
ADOLESCENCE Boys- 15-65 lbs

(12-18 y.o) Height

Girls: 2-8 inches
Boys: 4.5-12 inches
Theories of G&D
A theory is a systematic statement of principles
that provides a framework for explaining some
phenomenon.

Thus, Developmental theories provide road

maps for explaining human development.
Developmental Task
Skills or competencies
normally occurring at
one stage and having
an effect on the
development of
subsequent stages
Developmental Task

PHYSICAL TASK PSYCHOLOGICAL TASK COGNITIVE TASK

Theories of G&D
• Psychoanalytic / Psychosexual Development
• Psychosocial Development
• Cognitive Development
• Moral Development
• Behaviorist and Social Learning
Psychoanalytic / Psychosexual
Development Theory

Proponent: Sigmund Freud

Psychosexual Development Theory
Psychosexual Development Theory
ID, EGO, SUPEREGO
ID, EGO, SUPEREGO
Oral Stage (0 - 2 y.o)

• oral gratification
• Infants: interested in oral stimulation or pleasure
• infants suck for enjoyment or relief of tension, as
well as for nourishment.
Nursing Implications

• Provide oral stimulation by giving pacifiers; do not

thumb-sucking. Breastfeeding may provide more
stimulation than formula feeding because it requires
the infant to expend more energy.
Anal Stage (2 - 3 y.o)
• children’s interests focus on the anal region as they
begin toilet training
• Elimination takes on new importance for them
• find pleasure in both the retention of feces and
defecation
• part of toddlers’ self-discovery, a way of exerting
independence, and probably accounts for some of the
difficulties parents may experience in toilet-training
children of this age
Nursing Implications

• Help children achieve bowel and bladder control

undue emphasis on shame. If at all possible,
continue bowel and bladder training while child is
hospitalized.
Phallic Stage (3 - 6 y.o)

• children’s pleasure zone appears to shift from the

anal to the genital area
• Masturbation is common during this phase
• Children may also show exhibitionism, suggesting
they hope this will lead to increased knowledge of
the two sexes
• Gratify physical curiosity
Nursing Implications

• Accept children’s sexual interest, such as fondling

their own genitals, as a normal area of exploration.
Help parents answer child’s questions about birth or
sexual differences.
Latency Stage (6 - 12 y.o)

• Resolved elektra/oedipal complex

• Quiet period
• children’s libido appears to be diverted into
concrete thinking
Nursing Implications

• Help children have positive experiences with

learning so their self-esteem continues to grow and
they can prepare for the conflicts of adolescence.
Genital Stage (12 y.o. and up)

• Great surge of genital sexual development

• establishment of new sexual aims and the finding
of new love objects
• Masturbation and sexual fantasies are common
Nursing Implications

• Provide appropriate opportunities for the child to

relate with opposite sex; allow to child to verbalize
feelings about new relationships.
Kohlberg’s Moral Development
Theory

Proponent: Lawrence Kohlberg

 PRE POST
LEVEL CONVENTIONAL
CONVENTIONAL CONVENTIONAL

1. Obedience &
5. Social contract &
punishment 3. Good interpersonal
individual rights
orientation relationships
Stages 6. Universal
2. Individualism & 4. Maintains social order
principles
exchange

2-7 years old 7-12 years old 12 years and above

Age

*Follows rules set by *Seeks conformity & *Constructs a

those in authority loyalty personal & functional
value system
Characteristics *Adjust behavior * Follows rules independent of
according to good/bad *Maintains social order authority figures &
& right/wrong peers
Psychosocial Development
Theory

Proponent: Erik Erikson

Psychosocial Development Theory
• 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.
Trust vs. Mistrust

• The child must learn trust as needs are met by

the caregiver
• Child learns to love and be loved.
Nursing Implications

• Provide a primary caregiver.

• Provide experiences that add security, such as soft

sounds and touch.

• Provide visual stimulation for active child

involvement.
Autonomy vs. Shame and Doubt

• Child becomes more independent and starts to

control over body functions.
• Child learns to be independent and make
decisions for self.
Autonomy vs. Shame and Doubt

• A toddler enjoys
active, independent
exploration as part of
building a sense of
autonomy.
Nursing Implications

• Provide opportunities for decision making, such as

offering choices of clothes to wear or toys to play
with. Praise for ability to make decisions rather than
judging correctness of decision.
Initiative vs. Guilt

• Development of conscience; learning right from

wrong
• Child learns how to do things (basic problem
solving) and that doing things is desirable
Nursing Implications

• Provide opportunities for exploring new places or

activities. Allow play to include activities involving
water, clay for modeling), or finger paint.
Industry vs. Inferiority

• Rule-following behavior;
• forming social relationships is seen as important
• child learns how to do things well
Industry vs. Inferiority

• School-age children
develop a sense of
industry by working
on projects that
result in a feeling of
accomplishment.
Nursing Implications

• Provide opportunities such as allowing child to

assemble and complete a short project so that child
feels rewarded for the accomplishment.
Identity vs. Role Confusion
• Adolescents learn who they are and what kind of
person they will be
• adjusts to a new body image, seeking emancipation
from parents, choosing a vocation, and determining
a value system.
• Peers are very important; Working on establishing
own identity
Nursing Implications

• Provide opportunities for adolescent to discuss

feelings about events important to him or her.

• Offer support and praise for decision making.

Intimacy vs. Isolation

• Intimacy is the ability to relate well with other people,

not only with members of the opposite sex but also
with one’s own sex to form long-lasting friendships.
Generativity vs. Stagnation

• People extend their concern from just themselves

and their families to the community and the world.
• They may become politically active, work to solve
environmental problems, or participate in far-
reaching community or world-based decisions.
• People with a sense of generativity are self-confident
and better able to juggle their various lives
Generativity vs. Stagnation

• People without this sense become stagnated or self

absorbed.
• Those who have devoted themselves to only one
role are more likely to find themselves at the end of
middle age with a narrow perspective and lack of
ability to cope with change.
Integrity vs. Despair

• Older adults with integrity feel good about the life

choices they have made;
• those with a feeling of despair wish life could begin over
again so that things could turn out differently.
• A sense of integrity is helpful in a grandparent who
provides childcare, as it helps children develop a sense
of trust and learn initiative (Bernal & Anuncibay, 2008).
Cognitive Development Theory

Proponent: Jean Piaget

Cognitive Development Theory
• defined four stages of cognitive
development;
• within each stage are finer units or
schemas.
• how a child learns and develops that
quality called intelligence (Hatfield, 2008)
Sensorimotor Phase (0-2 y.o.)

• “primary” - refer to activities related to a

child’s own body
• “secondary” refers to activities that are
separate from a child’s body;
• “circulatory reaction” to show that
repetition of behavior occurs
Sensorimotor Phases (0-2 y.o.)

• Neonatal Reflex
• Primary Circular Reaction
• Secondary Circular Reaction
• Coordination of Secondary Reaction
• Tertiary Circular Reaction
• Invention of new means through mental
combinations
Sensorimotor Phases (0-2 y.o.)

Neonatal Reflex (1month)

• Stimuli are assimilated into beginning
mental images. Behavior entirely reflexive.
Sensorimotor Phases (0-2 y.o.)

Primary Circular Reaction (1-4 mos)

• Hand–mouth and ear–eye coordination
develop.
• Infant spends much time looking at
objects and separating self from them.
Sensorimotor Phases (0-2 y.o.)

Primary Circular Reaction (1-4 mos)

• Beginning intention of behavior is present
(the infant brings thumb to mouth for a
purpose: to suck it).
• Enjoyable activity for this period: a rattle or
tape of parent’s voice.
Sensorimotor Phases (0-2 y.o.)
Secondary Circular Reaction (4-8 mos)
• infants learn that objects in the
environment are permanent and continue
to exist even though they are out of sight
or changed in some way.
• Infant learns to initiate, recognize, and
repeat pleasurable experiences from
reaction environment.
Sensorimotor Phases (0-2 y.o.)

Secondary Circular Reaction (4-8 mos)

• 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.
Sensorimotor Phases (0-2 y.o.)

Coordination of Secondary Reaction (8-12mos)

• Infant can plan activities to attain specific goals.
• Perceives that others can cause activity and
that activities of own body are separate from
activity of objects.
• Can search for and retrieve toy that disappears
from view.
Sensorimotor Phases (0-2 y.o.)
Coordination of Secondary Reaction (8-12mos)
• Recognizes shapes and sizes of familiar
objects.
• Because of increased sense of separateness,
infant experiences separation anxiety when
primary caregiver leaves.
• Good toy for this period: nesting toys (i.e.,
colored boxes).
Sensorimotor Phases (0-2 y.o.)
Tertiary Circular Reaction (12-18mos)
• Child is able to experiment to discover new
properties of objects and events.
• Capable of space perception and time
perception as well as permanence.
• Objects outside self are understood as causes
of actions.
• Good game for this period: throw and retrieve.
Sensorimotor Phases (0-2 y.o.)
Invention of new means through mental
combinations (18-24mos)
• Transitional phase to the preoperational thought
period.
• Uses memory and imitation to act.
• Can solve basic problems, foresee maneuvers
that will succeed or fail.
• Good toys for this period: those with several
uses, such as blocks, colored plastic rings.
Preoperational Phase (2-7 y.o.)

• child in this phase of development is

egocentric
• child has no concept of quantity; if it looks
like more, it is more
• sense of time is not yet developed
Preoperational Phase (2-7 y.o.)

• children are able to use symbols to

represent objects.
• Toddlers draw conclusions only from
obvious facts they see
• Good toy for this period: items that require
imagination, such as modeling clay.
Concrete Operations (7-11 y.o.)

• children develop the ability to begin

problem solving in a concrete, systematic
way.
• begin to understand that volume or weight
may remain the same even though the
appearance changes
Concrete Operations (7-11 y.o.)

• can consider another’s point of view and

can deal simultaneously with more than
one aspect of a situation
• aware of reversibility, an opposite
operation or continuation of reasoning
back to a starting point
Concrete Operations (7-11 y.o.)

• Good activity for this period: collecting and

classifying natural objects such as native
plants, sea shells, etc.
• Expose child to other viewpoints by asking
questions such as, “How do you think
you’d feel if you were a nurse and had to
tell a boy to stay in bed?”
Formal Operations (12-15 y.o.)

• adolescent is capable of dealing with

ideas, abstract concepts described only in
words or symbols
• begins to understand jokes based on
double meanings and enjoys reading and
discussing theories and philosophies.
Formal Operations (12-15 y.o.)

• Adolescents can observe and then draw

logical conclusions from their
observations.
• Can solve hypothetical problems with
scientific reasoning;
Formal Operations (12-15 y.o.)

• understands causality and can deal with

the past, present, and future
• Good activity for this period: “talk time” to
sort through attitudes and opinions.
Behaviorist and Social Learning
Theory

Proponents: John Watson, Ivan

Pavlov, B.F. Skinner
Behaviorist and Social Learning
Theory

Based on observable behaviors

which arise from conditioning
Sexuality
Refers to the totality of being a person which includes all
aspects of the human being that relate specifically to
being a boy or a girl, a man or a woman
Nursing Responsibilities
• Concept of sexuality must be given in a factual and
accurate manner

• Presentation of human reproductive system and the

process of reproduction should be made using
simple language

• Use of proper terminology for the different parts of

the reproductive system to dispel malice
Nursing Responsibilities

• Take into consideration the culture, religion, local

beliefs, customs & traditions when teaching
sexuality to avoid guilt, anxiety & confusion

• Promote an open communication with parents about

physical changes