Importance of Knowledge (of normal

growth and development)

Health promotion, illness identification
Chapter 28
Principles of Growth and
Development

Anticipatory guidance given at appropriate time

Delays identified, evaluated, interventions
implemented

Health restoration, maintenance

Hospitalized child explanations at
developmental level
Nutritional needs based on stage of growth

General Principles of Growth and

Development

Principles of Growth and Development

Growth
Increase in physical size or quantitative change

Development
Increase in skill or the ability to function
(qualitative change)

Maturation

Individual for each child

Interrelated and Interdependent
Ongoing throughout life
Many influences

Synonym for development

See box 28.2, p. 791

Orderly Patterns
Cephalocaudal: head downward
Proximodistal: center outward
Differentiation: simple to complex

Stages of Childhood

Infant: birth to 1 year

Toddler: 1 to 3 years
Preschool: 3 to 6 years
School-age: 6 to 12 years
Adolescence: 12 to 18 years

Principles of Growth and Development

Factors Influencing Growth and

Development

Cognitive development

Genetics

Ability to learn or understand from experience

Environment

Ability to acquire and retain knowledge

Ability to respond to new situation and solve
problems
Piagets theory of cognitive development (will
discuss later)

Factors Influencing Growth and

Development : Genetics

Factors Influencing Growth and

Development : Genetics

Gender

Temperament usual reaction pattern of an

individual

girls shorter/lighter than boys except during

pubertal growth spurt

Health
Inherited disorders

Intelligence

Reaction patterns that define temperament

(what of each would make a child easy to
care for? difficult?)
Activity level
Rhythmicity
Approach
Adaptability

Factors Influencing Growth and

Development : Genetics

Temperament

Reaction patterns (continued)

Categories See box 28.3, p. 793

(photocopied handout)

Intensity of reaction
Distractibility
Attention span, persistence
Threshold of response
Mood quality

The Easy Child

The Difficult Child
Slow-to-Warm-Up Child

Temperament
Nursing implications

Factors Influencing Growth and

Development : Environment
Socioeconomic level

Assess how parents rate their children

Nutrition

Help parents understand temperament

differences some kids NEED extra preparation
for events/circumstances

Health care

Children Learn What They Live (respect)

Stress

Children with different intensity of reactions will

exhibit pain differently; may need more or less
preparation for procedures, medications;
playroom versus toys in room

Lack of toys/books/clothes

Parent-child relationship
Ordinal position (birth order)
Health chronic illnesses

Factors Influencing Growth and

Development (contd)

Factors Influencing Growth and

Development (contd)

Nutrition (see pp 795-796)

Food pyramid guidelines

Food pyramid guidelines

Moderate sugars

Variety of foods

Moderate salt, sodium

Balance

Moderate alcohol

Grain products, fruits, vegetables

Low fat

Theories of Development

Theorist: Sigmund Freud

Freud: personality development

Erikson: psychosocial development
Piaget: cognitive development
Kohlberg: moral development

Pp. 800-801
Psychosexual development
Id
Ego
Superego

Freud
Oral stage: birth to 1 year
Concentrates on the mouth: sucking, chewing,
eating

Anal stage: 1 to 3 years

Preoccupied with ability to eliminate

Freud (contd)
Latency stage: 6 to 11 years
Focus on socialization and increasing problemsolving abilities
Appropriate gender roles adopted
Oedipal or Electra conflicts resolved
Superego developed to keep id under control

Psychosocial Development:
Eriksons Theory
Pp. 800-803
Addresses development over the life span
Consists of eight different stages of development
Each stage has a crisis that exists so that healthy
personality development can occur
A person must master psychosocial crises in order to
grow and progress to the next stage of development

Freud (contd)
Phallic stage: 3 to 6 years
Strong curiosity about genitals; girls want a penis, and
boys dont want to lose their penis
Oedipal complex: attachment of a boy to his mother
Electra complex: attachment of a girl to her father

Freud (contd)
Genital stage: around 12 years to adulthood
Struggles with independence
Changing relationships
Struggles with hormones and sexuality in socially
accepted ways
Learns to form appropriate relationships

Erikson
Trust versus mistrust: birth to 1 year
Must have food, clothing, safety, physical contact
(holding) needs met
Learns to trust the world as a safe place if these
are met

Erikson
Autonomy versus shame and doubt: 1 to 3
years
Learning to control bodily functions
Independence starts to emerge
Allow child to do things on own (realistic, safe)

Erikson (contd)
Initiative versus guilt: 3 to 6 years
Learns about the environment through activity
Develops a conscience
Allow child exploratory and self-initiated play

Industry versus inferiority: 6 to 12 years

Enjoys projects, rules, and order
Industry provides the child with purpose and
confidence; if unsuccessful, can lead to inferiority

Erikson (contd)
Identity versus role confusion: 12 to 18 years
Working on own identity
Worried about how they are seen by others
Some role confusion is healthy and should result
in a self-reflective personality
Allow teen to discuss feeling and decisions
Encourage/allow teens friends to visit in hospital

Theorist: Jean Piaget

Pp. 803-806
Viewed as sequential and orderly
Child adapts to the environment
Experiences encourage growth and development
Moves through stages, simple to complex
Uses experiences to solve problems

Piaget
Stages

Piagets Sensorimotor Theory

Stage 1: Reflexes: birth to 2 months
Stage 2: Primary circular reaction: 1 to 4 months
Stage 3: Secondary circular reaction: 4 to 8 months
Stage 4: Coordination of secondary schemata: 8 to 12
months
Stage 5: Tertiary circular reaction: 12 to 18 months
Stage 6: Inventions of new means/mental combinations:
18 to 24 months

Sensorimotor (birth to 2 years)

From reflex activity to purposeful
movements and then problem-solving
Object permanence begins at 9-10 months
of age
Stranger anxiety begins at 6-8 months and
can continue through toddlerhood
Separation anxiety begins at 9-10 months
and continues through toddlerhood

Piaget
Preoperational (2 to 7 years)
Develops language skills
Egocentric, has magical thinking my brother
got sick because I was mad at him,
unrealistic cause-and-effect

Concrete operational (7 to 11 years)

Realistic cause-and-effect
Begins classifying/sorting objects
Develops conservation of matter (liquid med demo)

Formal operational (11 years to

adulthood)
Abstract and logical thought

Nursing applications of
Piagets theory
Preoperational (2-7 yrs.)
Utilize developing language skills
Provide explanations for care
Dispel magical thinking

Utilize medical play (therapeutic play)

Demonstrate procedures, use of equipment
on dolls
Allow child to play with (safe) medical
equipment

Nursing applications of
Piagets theory
Sensorimotor (birth-2 yrs.)
Provide stimulating environment
Verbal and motor

Help minimize separation anxiety

Encourage parents to stay with child as
much as possible
Have parents tell child they are leaving and
that they will return
Try to replicate the home routine as much
as possible

Nursing applications of
Piagets theory
Concrete operational (7-11 yrs.)
Give explanations for all treatment
Allow to see and handle equipment if
possible

Formal operational (12-adult)

Give clear and detailed instructions, may
give written handouts/instructions

Social-Moral Development:
Lawrence Kohlberg

Lawrence Kohlberg: Three Levels

table 28.7, p. 806

Children acquire moral reasoning in a developmental

sequence
Theory was based on cognitive developmental theory (Piaget)
Based on a premise that at birth we are void of morals or
ethics
Moral development occurs through social interaction with the
environment around us
Moral development can be advanced and promoted through
the use of formal education

Preconventional level: 2 to 7 years

Conventional level: 7 to 12 years
Postconventional autonomous level: 12 years
and older