GROWTH & DEVELOPMENT NI: provide oral stimulation – pacifiers,

DEFINITION breastfeeding
Growth – progressive increase in physical size Anal (1 – 3 y/o)
( cm, kg) - elimination is a way of discovery and exerting
Development – progressive increase in skill independence
& the ability to function NI: achieve bowel and bladder control even if
Maturation – readiness ( learning takes hospitalized
place quickly & effortlessly when the child is Phallic (3 – 6y/o)
ready. - increased knowledge of 2 sexes
DEVELOPMENT NI: accept sexual interest and answer questions
Developmental milestone – standard of reference about birth or sexual difference
by which to compare the child’s behavior at - libido diverted to school
specific ages NI: achieve positive experiences to promote self
Developmental delay(s) – variable of esteem
development which lags behind the range of a Genital (>12y/o)
given age - establish sexual aims and finding new love
DEVELOPMENT objects
Developmental task – skills and competencies NI: opportunities to relate w/ opposite sex;
associated with each developmental stage verbalization about new feelings
PRINCIPLES Psychological Dimension
1. Continuous ( Erickson)
2. Orderly and sequential A. Trust vs Mistrust – ( 0-1 years old )
3. Highly individualized B. Autonomy vs shame & doubt – (1-3 y)
4. Different rates C. Initiative vs Guilt – (3-7 yrs old )
PRINCIPLES D. Industry vs Inferiority – (7-11y)
5.Cephalocaudal E. Identity vs role confusion – (11-21 y)
6. Proximodistal ERIKSONS PSYCHOSOCIAL THEORIES
7. Simple to complex 1. Social development
8. Sensitive periods 2. Role of play in development
9. Practice Developmental task
FACTORS THAT AFFECT GROWTH AND - skill or growth responsibility arising at a
DEVELOPMENT particular time in an individual’s life
I. Genetics - foundation of accomplishment of future tasks
a. Gender Trust vs Mistrust
b. Health (Infancy)
c. Intelligence T: safe environment; dependable people
d. Temperament M: suspicious, fearful, shun emotional
FACTORS THAT AFFECT GROWTH AND involvement
DEVELOPMENT NI: provide primary caregiver and visual
II. Environment stimulation
a. Socioeconomic level Autonomy vs Shame and Doubt
b. Parent-Child Relationship (Toddler)
c. Ordinal position in the family A: build on new motor and mental abilities, take
d. Health pride in accomplishments
THEORIES OF GROWTH & DEVELOPMENT S: doubt and stop trying
1. FREUD – PSYCHOSEXUAL NI: provide opportunities for decision making and
2. ERICKSON - PSYCHOSOCIAL give praises
3. SULLIVAN – INTERPERSONAL Initiative vs Guilt
4. KOHLBERG-MORAL (Preschooler)
5. PIAGET – COGNITIVE I: how to do basic things well, encourage if the
6. HAVIGHURST – DEVELOPMENTAL TASK parents answer the child’s question
PSYCHOSEXUAL DIMENSION G: limited brainstorming and problem-solving
(FREUD) skills, wait for clues
A. Oral ( 0-1 years old ) NI: provide opportunities for exploration,
B. Anal ( 1-3 years) imagination and creativity answer questions and
C. Phallic / Oedipal (3-7 years) do not inhibit fantasy
D. Latency ( 7-11 years) Industry vs. Inferiority:
E. Genital ( 11-21 years ) School age (6-12 years)
Freud’s Psychosexual Theory Ind: how to do things well
- Experience at different stages influences Inf: always worried about poor or incorrect
personality traits performance
Oral (0 – 1 y/o) NI: provide opportunities for completing short
- oral stimulation for nutrition, enjoyment and projects, give praise and rewards
release of tension
Identity vs Role Confusion
(Adolescence)
I: learns who is he or what kind of person he will
become
R: unsure of who they are or who they can
become, may rebel
NI: provide opportunities to discuss feelings and
support and praise for decision-making
Cognitive
(Piaget )
A. Sensorimotor – 0-2 years old
B. Pre-operational – 2-7 years old
C. Operational concrete – 7-12 yrs old
D. Operational formal – 12 years old- adult
Sensorimotor
( 0-2yr old)
- relate through senses, separate from
environment, practical intelligence
- “Practical intelligence”
- Words and symbols is not yet available
- Primary Circular Reaction
- Secondary Circular Reaction
- Tertiary Circular Reaction
Primary Circular Reaction
(1- 4 months)
Hand-mouth and ear-eye coordination develop
Infants spends time looking at objects and try to
separate self from the object
Enjoyable activity: rattle or taped voice of the
parent
Secondary Circular Reaction
( 4-8 months)
Infants learns to initiate, recognize and repeat
pleasurable experiences from the environment
Memory traces are present, infant anticipates
familiar events
Good toy: mobile
Good game: peek-a-boo
Coordination of Secondary Reactions ( 8-12
months)
Infants begin to demonstrate goal-directed
behavior ( infant don’t just want to hit the mobile
but he also wants to reach it)
Recognizes shapes and sizes of familiar objects
Good toy: colored boxes
Tertiary Circular Reaction
(12-18 months)
Children use trial and error to explore both
permanence and the different actions of
things/toy
Child is able to experiment to discover new
properties of objects and events
Capable of space and time perception
Objects outside self are understood as causes of
their actions
Good game: throw and retrieve
Preoperational
( 2-7yr old)
toddler: symbolism, animism, simple
abstractions, prelogical thinking, poor concept of
time and distance
pre-schooler: centering, egocentric, literal
thinking, static thinking, no conservation or
reversibility, no cause and effect, assimilation,
role fantasy, magical thinking, accomodation
Good toy: items that require imagination-
modeling clay
Concrete Operational
( 7-12yr old)
- Systematic reasoning
- Concept of reversibility cause and effect)
- inductive reasoning (specific to general)
- Concept of conservation (7 yo – numbers;
7-8 yo quantity; 9 yo – weight; 11 yo –
volume)
- Good activity: collecting and classifying
natural objects( plants, seashells)
Formal Operational Thought
(>12yr old)
- solve hypothetical problems, abstract thought,
deductive reasoning (general to specific),
causality, time
- talk time to sort attitudes and opinions
Moral / Ethical
(Kohlberg)
PRECONVENTIONAL – LEVEL I
Stage I – PREMORAL ( 0-6 mos)
stage of gratification
Stage II – PREMORAL ( 6-12 months)
stage of end justify the mean
Stage III- PREMORAL (1-3 years old)
morality/ avoidance of punishment
Stage IV – Naïve instrumental hedonism (3-7
years old )
“scratch my back and I’ll scratch yours”
CONVENTIONAL – LEVEL II
Stage V – Conformity (7-9 years old)
Stage VI – Law & order (9-12 yrs old )
POST CONVENTIONAL – LEVEL III
Stage VII- first stage of true morality (12-18 yrs
old)
Stage VIII – True morality –(18-21 years old )
universal moral- ethical orientation
2 months
G: 45 degree head control
F: EYES midline
S: SOCIAL SMILE
L: CRYING
Rooting/Extrusion reflexes diminish
Posterior fontanelle closes
3 MONTHS
G: 3 mos - 90 deg head control (no head lag)
F: 3 mos – eyes past midline
L: 3 mos – squeals, laughs, bables
S: 3 mos – recognize, familiar faces
4 months
G : lifts head and chest when prone
F: brings hands together
(3rd month: HAND RECOGNITION)
L: COOS/GURGLES/ SQUEALS , moves head to
sound
S: plays with rattles, enjoys social interaction
(-)PALMAR/STEPPING
(-) Extrusion/ MORO
5 MONTHS
G: 5 mos – rolls from front to back Busy boxes
F: 5 mos – grasps voluntarily Play gyms
L: 5 mos - simple vowel sounds 7-9 mos
S: 5 mos – smiles at mirror image Block play
6 months Splashing bath toys
G: good head control Cloth textured toys
*HEADBANGING Large balls
F: holds object in 1 hand and reaches out for 10-12 mos
another object Picture books
L: simple vowel sounds Large blocks
S: recognizes familiar faces *STRANGER ANXIETY Nesting cups
P: TEETHING PLAY
2X Birthweight, Peek-a-boo
(-) SUCKING Rocking
7 MONTHS Singing games
G: sits w/ support Squeaky toys
F: hand to hand transfer Pat-a-cake
L: “ma” when crying Peek-a-boo
PS: feeds self w/ crackers, recognizes familiar Feet & toes games
faces Fingers & hand games
8 months Listening to stories
G: sits without support, Making faces
CRAWLS Calories: 100-115 kcal/kg/day
F: hand to hand transfer of objects, waves BYE- 0-3 mos - breastmilk
BYE 4-6 mos - semi-solid food
S: STRANGER ANXIETY peaks Introduce one at a time
L: 8 mos – pronounces combined syllabus (ma- Start with small quantities
ma) Cereals, strained vegetables, meat
(-) PLANTAR 7-9 mos - Finger food, fluids
9 MONTHS 10-12 mos – 3 meals w/ snacks
G: pulls self to stand, creeps Water – 125-150 ml/k/day from 0-6 mos
F: neat pincer grasp - 135 ml/kg/day from 6-12 mos
L: mama, dada, understands no-no DAILY CARE
S: waves bye bye - bathing
10 months - diaper care
G: CREEPS, CRUISES, STAND ALONE - care of teeth
F: PINCER GRASP - dressing
S: responds to NAME when called, enjoys nursery - sleep – 16-20hrs/day;
games (peek-a-boo) - 6 mos- 1-2 naps, with 12h at night
L: understand gesture - 12 mos old; 1 nap with 12h at night
P: Nursery games - exercise
11 MONTHS Concerns
G: Stands alone, attempt to walk - Constipation /Loose Stools
F: bangs objects together
PS: holds arm or foot out in dressing - Teething – cleanliness
12 months
G: stands alone, walks with assistance - Thumb sucking – until school age
F: throws toys, attempts at 2 tower blocks, - pacifiers – wean after 3 months
attempts to use SPOON
L: one word other than mama, dada - spitting up
S: shows jealousy and affection - sleep problems – breastfed infants wake
P: weaning off from bottle to CUP *BABY BOTTLE up sooner
SYNDROME - COLIC –paroxysmal abdominal pain
3X Birthweight - DIAPER DERMATITIS
2X Birthlength - MILIARIA
PLAY – solitary play - OBESITY
1-3 mos REACTION TO ILLNESS
Balloon mobiles Discomfort and pain
Mirror play Lack of stimulation
Stuffed animals Separation anxiety
rattles Disruption of routine
Being held NURSING CARE
4-6 mos Soothing stimulation
Squeeze toys Toys from home
Human contact - Building blocks
Provide/Anticipate needs - Toys to ride on
TODDLER – 1 –3 yo Making music and noise
TODDLER Push and Pull toys
Slowed growth Puppet play
Wt gain 5-6 lbs (2.5 kg) Scribbling
5 in (12 cm) Stack-and-dump toys
Baby fat disappears Parallel Play –two toddlers play next to but
brain 90 % adult size not necessarily with each other. They are
Birth weight quadruples at 2 ½ yo engaged in separate activities , do not have
Full binocular vision well developed shared rules & have no apparent
Visual acuity – 20/40 organization.
GROWTH AND DEVELOPMENTAL DAILY CARE
MILESTONES - dressing – can put on socks, underpants,
GROSS: undershirt
15 mos – walks alone well, uses spoon but spills - sleep – 12-14H/night w/ 1 nap
18 mos – run and jump in place - dependency on security object
- walk up & down stairs holding on to railing (transitional toy)
- seat self in chair - may ask to sleep with bottle
24 mos – walks up & down stairs w/ both feet - may rebel against going to sleep
same step, same time, uses the fork, imitates a - bathing
horizontal line - care of teeth-since all 20 deciduous teeth are
2 ½ yo – tiptoes out by 2 ½ yrs, start teaching brushing of teeth;
3 yo - throws balls, rides tricycles first dental check up shld be bet. 12-18 mos.
- stands on 1 foot momentarily , Negativism – they are slowly moving out of
-copies cross and circle infancy & are more closely defining their own
LANGUAGE independent activity.
15 mos - vocalizes wants Temper Tantrums-in order to control self &
- 3 words other than dada, mama others. Mx: IGNORE THE BEHAVIOR or direct them
18 mos - uses phrases to activities they can master.( When things are
2 yo - short sentences; 2-3 words rearranged or are strange; or when persons or
- points to one body part places are unfamiliar)
3 yo - speaks fluently using longer sentences, Accidents from falls, poisoning,electrical burns
says 900 words because they are , naturally active, mobile &
- tells stories curious –(set limits & exert external control .
- plurals LOVE & CONSISTENCY are the 2 most important
PERSONAL/SOCIAL concepts in child rearing.
15 mos - pats pictures Rituals- rigid, repetitive & steroetyped.
- imitates housework EGOCENTRIC – uses “ MINE “ for everything.
18 mos - turns page 2-3 at a time Sibling rivalry
- uses spoon Discipline
2 yo – terrible stage Separation anxiety
- removes garments REACTION TO ILLNESS and NURSING
- toilet trained by day (2-3 yo) INTERVENTIONS
3 yo – trusting three Regressive behaviors - reassurance
- dry by night (3-4 yrs old) Nutrition – allow finger food
- washes and dries hands Dressing changes – allow to pull off tape
NUTRITION Medication – allow choices of
Decrease in appetite because of the slow growth “chaser” after oral medication
rate Hygiene – allow choice of bath time toy, allow to
Picky eaters, dawdling with meals put toothpaste
1, 300 kcal/day Pain – allow to express pain
Allow self feeding Stimulation
Allow choice between 2 types of food Elimination – continue potty training
Offer finger food, appetite of 3 year olds is more Rest – allow choice of toy at bedtime
capricious than that of 1 year olds PRE SCHOOL 4-6 yo
Risk of aspiration PRE SCHOOL
PLAY – Parallel Play Future body build apparent
TODDLERS Increased skeletal growth
Babbling and talking Handedness
Ball games 5 yo - may have permanent teeth
Clay Tonsils increase in size
Listening to music IgG and IgA increases
Listening to stories PRE SCHOOL
HR 85 bpm - sleep – resist taking naps
BP 100/60 - exercise – very active
4.5 - 5 kg/yr - bathing – can wash and dry hands; need
2 - 3.5 in/yr supervision
Frequent voiding - care of teeth – independent brushing
GROWTH AND DEVELOPMENTAL MILESTONES - 1st dental visit
Gross CONCERNS
3 1/2 yo - stands on 1 foot 5 sec - They love to watch adults & imitate their
- Upstairs on 1 foot/step; down 2 behavior
feet /step - Oedipus and electra complex
- can pedal a tricycle - gender roles – need exposure to parents of
- walks backwards opposite sex
- uses scissors - Socialization – capable of sharing
- helps dress himself - Discipline – “time out”
4 – 4 ½ - climbs stairs with alternate steps - Common fears – dark, mutilation, separation
- hops on 1 foot - Telling “lies” & brag & boast in order to impress
- can tie own shoes others
- can verbalize number sequence ex. - Imaginary friends & playmates are common
telephone numbers. - sharing – define limits and teach property
5 yo – heel to toe walk, skips & runs, rights
dress and undress w/o help - Regression –reaction to stress
6 yo- ventures in the neighborhood, - Sibling rivalry
graceful w/ good posture - sex education
FINE MOTOR - pre-school center
4 - draws man w/ 3 parts - broken fluency
- copies square - swearing
- print name - High energy level
5 yo - copies triangle - Curiosity
- writes alphabet REACTIONS/CONCERNS IN ILLNESS AND NURSING
- draws man with 9 parts INTERVENTIONS
6 yo- draws bahay kubo and - nutrition – food in animal/alphabet shapes
basic figures - dressing change – allow to measure, cut tape,
LANGUAGE see incision site
3 ½ yo - gives full name, sex - medication – allow to choose “chaser”
- counts to 3 or more - hygiene – allow choice of toys, wash hands
4 yo - exaggerates and boasts, and face
says 500 words - pain – allow pain expression, handle syringe,
5 yo- talks constantly analgesic
- gender specific behavior - stimulation
6 yo- says 2500 words School Age 7 – 12 yo
PERSONAL/SOCIAL SCHOOL AGE
3 ½ yo - dresses w/ supervision,separates more 3-5 lb/yr
easily from mother 1-2 in /yr
4 yo – furious four, buttons up,magical thinking 10 yo – brain growth complete
5 yo – frustrative five, uses a knife Adult vision
6 yo- transition stage, Abundant tonsillar and adenoid tissue
eruption of 1st molar HR 70 bpm
NUTRITION BP 112/60
Slow/Steady growth 32 permanent teeth
Decreased appetite Pubertal onset
Offer small servings SECONDARY SEX CHARACTERISTICS
Healthy snack food GROWTH AND DEVELOPMENTAL MILESTONES
PLAY – associative play 6 yo – skip, jump, tumble, hop, ride bicycle, walk
Dress up clothes a straight line;
Housekeeping toys 7 yo –first molars & lateral incisors; sexual
Dolls and other toys for pretending differences seen in play; quiet play
Bikes, tricycles - visual acuity is 20/20
Paper and crayons - withdrawn & moody; prefer to be
Playground toys (seesaw, swing, slide) alone watching TV or listening to radio
Watercolors, fingerpaints, clay 8 yo – improved coordination; playing w/ gang
Materials for cutting, pasting important; with 10-11 permanent teeth; prefer
DAILY CARE playmates of own sex; collects objects ex, stamps
- accidents – bicycle safety, seat belts GROWTH AND DEVELOPMENTAL MILESTONES
- dressing – choose own clothes
9 yo – all activities done w/ gang, friends ADOLESCENCE 12-18YO
- hero worship, lying and stealing may ADOLESCENT
become problems Girls taller than boys 2-8 in, 15-55 lbs
10 yo – more improved coordination Growth stops 16-17 yo
- well mannered w/ adults Boys grow 4-12 in and gain 15-65 lbs
11 yo – active but awkward Growth stops 18-20 yo
- mixed sex activities; interest in the Heart and lung size increase more slowly
opposite sex HR 70 bpm
12 yo – coordination improves RR 20 breaths/min
- joins organizations BP 120/70
PERSONAL/SOCIAL/PLAY ADOLESCENT
Competitive play and recreational activities Androgen inc sebaceous gland activity resulting
Hobbies and personal interests in acne
Arts and crafts Apocrine glands inc activity
Biking 13 yo – 2nd molars
Board games PUBERTY – capable of sexual reproduction
Clubs Secondary sexual characteristics
Collecting items 32 permanent teeth should be present by age 18-
Chess 21 yrs
Comic Books GROWTH AND DEVELOPMENTAL MILESTONES
NUTRITION 13 yo – sports
Good appetite 15 yo - enjoys privacy
Food w/ high nutritional value - stays in room
- more calories and nutrients 16 yo - part time job
- hungry after school – give snacks and - charitable causes
make mealtimes enjoyable NUTRITION
DAILY CARE - faddish diet
- dressing – influenced by peers - give responsibility for food planning
- sleep – 8-12 hrs; no naps - increased calories
- exercise – games, bike riding, walking
- hygiene – 8 yo – capable of bathing alone DAILY CARE
- care of teeth – 2x yearly visit to the - dressing and hygiene
dentist; brush daily - care of teeth
- safety – bicycle, school bus safety, - sleep – need more sleep
prevention of falls and sports injuries - exercise – daily
CONCERNS CONCERNS
- problems w/ articulation – disappears 9 yo - Socialization – falling in love
- School anxiety and phobia - Obesity; Diseases – HPN
- Sex education - Acne
- Stealing – 7 yo – importance of money - Body piercing
- Violence/terrorism – education;reassurance - Fatigue - emotional fatigue
- Bullying - Menstrual irregularities
- Recreational drug and alcohol use - Sexuality and sexual activity
- Likes to stay up late; slumber parties - Poor posture
- Nightmares common - Stalking – educate girls
- Awakens early in the morning - Substance abuse
REACTION TO ILLNESS - Suicide
AND NURSING INTERVENTIONS - runaways
- Death and disability - Still need comfort ADOLESCENCE
- Unknown events & procedures - Allow to 1. Certain areas require
help special focus:
w/ care & treatment a. Skin: The
- Loss of ctrl & independence - Give choices degree of acne and patient’s level of
- Loss of contact w/ peers - Allow visits concern about acne should be evaluated.
- Disruption of school - Talk about interests Facial and axillary hair development are
- nutrition – allow choices markers used for assessment of pubertal
- dressing – ask opinions on bulk of development.
dressing and where to apply tape b. Eyes: Myopia
- medicine – teach name and action, allow may occur during pubertal development.
to choose form if possible The adolescent may ignore eye problems
- pain – allow expression of pain, explain because of reluctance to wear glasses.
source and cause c. Neck: The
- stimulation size of the thyroid gland should be noted.
ADOLESCENT 13-18 yo
 d. Breast:
Examination should include determination
of the stage of development. Tenderness,
erythema, dimpling, asymmetric masses or
size, discharge and axillary adenopathy
should be noted. Routine breast self-
examination should be encouraged.
e. Dentition:
Evaluating the level of hygiene, discussion
of the frequency of dental care, and a
review of the development of the third set
of molar teeth should be undertaken.
f. Female genitourinary tract:
Examination includes determination of the
stage of development as well as an
assessment of delayed puberty and abnormal
pubertal development.
A pelvic examination is indicated in vulvar
lesions; vaginal symptoms such as itching
unusual discharge or burning; lower abdominal
pain; dysmenorrhea of greater than 3 day
duration; menstrual dysfunction, & exposure to
sexually transmitted infection.
Examination is also warranted in cases of
maternal exposure to diethylstilbestrol (DES),
desire for contraception, and premarital
assessment.
2. Pubertal development:
a. Female: pubertal
changes start between ages 8 and 13 years
and changes take place for 3 to 4 years.
Breast development commonly precedes
pubic hair development. Most girls
reached adult height midway through
puberty.
b. Male: pubertal
changes start between age 9 ½ and 13 ½
years and changes take place for about 3
years. Testicular enlargement is usually
the first sign of male pubertal
development. Most boys reached adult
height during the latter half of puberty.
4. The pubertal growth
spurt is the third and last rapid growth stage
during childhood. The first and second rapid
growth stages occur in utero and shortly after
birth.
a. Adolescents gain up
to 25% of adult height and 50% of adult
weight gain during this period.
b. Individuals vary
widely in the onset and rate of pubertal
development. It is important to talk about
this variability with adolescents, and,
where appropriate, reassure them about
the normal nature of their pubertal
development.
c. This growth spurt is
associated with muscle development in
males and fat deposition in females.
ADOLESCENCE
1. Height, weight, and
blood pressure should be taken and
the data plotted in the appropriate
charts. Blood pressure should be
taken in an adult cuff.
2. Vision, hearing, and
immunizations should be checked. A
tetanus booster should be given
within the past 10 years
ADOLESCENCE
1. Laboratory studies:
a. A complete blood
count is helpful, especially in
monitoring changes in hematocrit
levels due to increased erythropoietin
activity subsequent to changes in the
level of circulating androgens. Other
screening studies include urinalysis,
tuberculin skin test, rubella titers (in
females), and mump titers (in males).
b. Syphilis testing
should be done in adolescents who
are sexually active. A culture or test
for chlamydial infection and
gonorrhea should be done during
every pelvic examination.
c. Papanicolaou (Pap)
test should be done once a year on all
sexually active adolescent females.
d. Pregnancy test with
a rapid urine
immunoenzymatic
assay for human
chorionic
gonadotropin should
be performed in
sexually active
females who are not
using any form of
contraception or who
experience a delayed
or abnormal
menstrual period.
REACTION TO ILLNESS AND NURSING
INTERVENTION
Main issue – body image – educate and Allow
participation in tx decisions; compassionate
understanding
Fears loss of control and independence - Respect
privacy and confidentiality
Fears injury and pain - Provide opportunities for
self expression
Separation from peers and lack of emotional
support - Approach w/ caring and understanding,
age compatible roommate, Phone at bedside
- Nutrition – food preferences
- Dressing – final appearance of dressing,
and time for changing
- Medicine – choice for injection site, teach
name and action
- Rest – time and length of rest periods
- Hygiene – respect modesty, extent of self-
care
- Pain – allow pain expression, ask for
analgesics stimulation