GROWTH AND DEVELOPMENT FACTORS AFFECTING GROWTH AND DEVELOPMENT

GROWTH 1. GENETICS
- Family history of diseases may be inherited
- An increase in physical size or a quantitative
- Chromosomes carry genes that determine
change. It include height, weight, dentition, and
physical characteristics, intellectual potential and
bone age.
personality
DEVELOPMENT - Sex, race and nationality
2. NUTRITION
- An increase in skill or the ability to function or a - The greatest influence on physical and
qualitative change intellectual development
MATURATION 3. ENVIRONMENT
A. harmful pre-natal environmental factors:
- Synonymous with development  Nutritional deficiencies
MORAL DEVELOPMENT  Mechanical problems
 Metabolic endocrine disturbances
- Ability to know right from wrong and to apply  Medical treatment
these to real-life situations  Infectious diseases/illness during pregnancy
COGNITIVE DEVELOPMENT  Faulty placental implantation/malfunction
 Smoking/alcoholism/use of certain drugs
- Ability to learn or understand from experience, to B. Natal Environment- immediate factors that
acquire and retain knowledge, to respond to a the child is exposed during birth
new situation, and to solve problems  Anesthesia
PRINCIPLES OF GROWTH AND DEVELOPMENT  Method of delivery
 Immediate care
1. G and D is a continuous process from conception C. Post Natal Environment
to death influenced by maturational, A. External
environmental and genetic factors  Socioeconomic status of the family
2. G and D proceeds in an orderly sequence  Nutrition
3. Different children pass through the predictable  Illness and injury
stages at different rates  Parent-child relationship
4. All body systems do not develop at the same time  Ordinal position in the family
5. Development is cephalocaudal B. Internal
6. Development proceeds from proximal to distal  Intelligence
parts and from gross skills to refined skills
 Hormonal imbalance
7. There is an optimum time for initiation of
 Emotions
experiences or learning
4. CULTURE
8. Primitive reflexes must be lost before
- Habits, beliefs, language, values and attitudes of
development
cultural groups influence the child’s G and D
9. A great deal of behavior and skill is learned by
5. HEALTH STATUS
practice
- At the cellular level, inherited or acquired disease
10. The rate pattern of G and D can be altered by
can affect the delivery of nutrients, hormones or
nutrition, disease and congenital abnormalities
oxygen to organs thus affecting the organ’s
11. Certain stages of G and D are more critical than
growth and function
others
6. FAMILY
12. Development becomes initially differentiated.
- Because of the special bond and influence of the
Differentiated development begins with a
family on the child, there can be no separation of
generalized response and progresses to a skilled
child from family in the health care setting
response
A. Parenteral Attitudes
13. Children are individuals, not little adults, who
- Parents have stage-related needs and tasks that
must be seen as a part of the family
affect their children
14. Children are influenced by genetic factors, home
- Superimposed on these developmental issues are
and environment, and parental attitudes
other factors affecting parental attitudes:
 Educational status
 Childhood experiences
 Financial pressures
 Marital status
 Available support system
 Child’s temperament
  Child’s personality
B. Child-Rearing Philosophies
- Well educated, well-read parents provide their
children with extra stimulation and opportunities
for learning beginning at a young age
- Parents may have overzealous approach toward
accomplishing tasks which may be a source of
frustration for both parents and child-e.g. a child
who is 6months old will not be able to walk alone
no matter how much time and effort the parents
expend

STAGES OF HUMAN DEVELOPMENT

STAGES AGE
Newborn Birth to 28 days
Infancy 1 to 12 months
Toddler 1 to 3 years
Preschool Age 3 to 6 years
School Age 6 to 12 years
Adolescence 12 to 18 years
Early Adult 20 to 40 years
Middle Adult 40 to 65 years
Late Adult 65 and above

THEORIES OF DEVELOPMENT

THEORY

- is a systematic statement of principles that

provides a framework for explaining some
phenomenon
- Developmental theories provide road maps for
explaining human development

DEVELOPMENTAL TASK

- a skill or growth responsibility arising at a

particular time in an individual’s life, the
achievement of which will provide a foundation
for the accomplishment of future tasks.
SIGMUND FREUD – PSYCHOANALYTIC/ PSYCHOSEXUAL THEORY

- an Austrian neurologist
- founder of psychoanalysis
- described child development as a series of psychosexual stages in which a child’s gratification becomes focused
on a particular body part

STAGES DESCRIPTION NURSING IMPLICATIONS

ORAL * explores by using mouth, tongue - provide oral stimulation by giving
STAGE - suck for enjoyment or relief of tension, as well as nourishment pacifiers; do not discourage thumb
(0-1 year - concerned with self-gratification sucking
old) - all Id, operating on the pleasure principle, striving for immediate - breastfeeding may provide ore
gratification of needs stimulation than formula feeding
- a sense of trust and security begins
- EGO begins to emerge, begins to see self as separate from the
mother; this marks beginning development of self
ANAL -toddlers find pleasure in both retentions of feces and defecation - help children achieve bowel and
STAGE - toilet training occurs bladder control without undue
(1-3 - conflict is between those demands from society and parents, emphasis on its importance
years sensations of pleasure associated with the anus - if at all possible, continue bowel
old) - begins to gain a sense of control over instinctive drives training while the child is
Learns to delay immediate gratification to gain a future goal hospitalized
PHALLIC -experiences pleasurable and conflicting feelings associated with the - accept sexual interests such as
STAGE genital organs fondling own genitals, as a normal
(3-6 - Pleasures of masturbation area of exploration
years - fantasy life set the stage of the OEDIPUS COMPLEX and the - help parents answer questions
old) ELECTRA COMPLEX about birth and sexual differences
- emergence of the superego is the solution to and the result of these
intense impulses
LATENC -personality development non active or dormant - help child to have positive
Y STAGE - tapering off of conscious biological and sexual urges experiences to be able to develop
(6-12 - sexual impulses are channeled into a more culturally accepted level self-esteem that will help the child
years of activity prepare for the conflicts of
old) - growth of ego functions adolescence
- ability to care and relate to others outside the home is the central
task
GENITAL -onset of puberty when genital organs mature - provide appropriate
STAGE - gains gratification from own body opportunities for the child to
(12 and - develops satisfying sexual and emotional relationship with opposite relate with opposite sex
beyond) sex - allow to verbalize feelings about
- Plans life goals and gains strong sense of identity new relationships

ERIK ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT

AGE PSYCHOSOCIAL RESOLUTION OF CRISIS NURSING IMPLICATIONS

CRISIS
INFANCY Trust vs. Mistrust Successful: 1. provide a primary caregiver
(birth to 18 Task: attachment Trust in persons; faith and hope about 2. provide experiences that add
months) to the mother the environment and future to security, such as soft
Unsuccessful: sounds and touch
General difficulties relating to persons 3. provide visual stimulation for
effectively; suspicion; trust-fear conflict; active child involvement
fear of the future
EARLY Autonomy vs. Successful: 1. provide opportunities for
CHILDHOO Shame and Doubt Sense of self control and adequacy; will decision making, such as
D (toddler Task: gaining some power offering choices of clothes to
18months- basic control over Unsuccessful: wear
3yrs) self and Independence- fear conflict; severe 2. praise for ability to make
environment feelings or self-doubt decisions rather than judging
corrections of any one
decision
LATE Initiative vs. Guilt Successful: 1. provide opportunities for
CHILDHOO Task: becoming Ability to initiate one’s own activities; exploring new places or
D purposeful and sense of purpose activities
( preschool directive Unsuccessful: 2. allow play to include
er 3-6years Aggression – fear conflict; sense of activities involving clay, water
old) inadequacy or guilt or finger paint
SCHOOL Industry vs. Successful: 1. provide opportunities such as
AGE (6-12 Inferiority Competence; ability to learn and word allowing child to assemble
years old) Task: developing Unsuccessful: and complete short projects
social, physical, Sense of inferiority; difficulty learning and so that the child feels
and learning skills working rewarded for
accomplishment
ADOLESCE Identity vs. Role Successful: 1. provide opportunities to
NCE (12-20 Confusion Sense of personal identity discuss feelings about events
years old) Task: developing Unsuccessful: important to him
sense of identity Confusion about who one is; identity 2. offer support and praise for
submerged in relationships or group decision making
memberships
EARLY Intimacy vs. Successful:
ADULTHOO Isolation Ability to love deeply and commit oneself
D (20-35 Task: establishing Unsuccessful:
years old) intimate bonds of Emotional isolation, egocentricity
love and
friendship
MIDDLE Generativity vs. Successful:
ADULTHOO Stagnation Ability to give and care for others
D (35-65 Task: fulfilling life Unsuccessful:
years old) goals that involve Self-absorption; inability to grow as a
family, career, and person
society
LATE Integrity vs. Successful:
ADULTHOO Despair Sense of integrity and fulfillment
D (65 years Task: looking back Unsuccessful:
to death) over one’s life and Dissatisfaction with life
accepting it

JEAN PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

PHASE AND AGE SPAN SIGNIFICANT BEHAVIORS

STAGES
SENSORIMOTOR
NEONATAL Birth – 1 most action is reflexive
REFLEX month
Primary Circular 1-4 months 1. perception of events is centered on the body
Reaction 2. objects are extension of self
3. toy: rattle
Secondary 4-8 months 1. acknowledges the external environment
Circular Reaction 2. infant learns to initiate, recognize, and repeat pleasurable experience
from the environment
3. memory traces are present
4. toy: mirror
5. game: peek-a-boo
Coordination of 8-12 months 1. plan activities to attain specific goals
Secondary 2. can search for and retrieve toy that disappears from view
Reactions 3. increased sense of separateness
4. toy: nesting toys (colored boxes, boxes)
Tertiary Circular 12-18 months 1. experiments to discover new properties of objects and events
Reaction 2. capable of space and time perception and permanence
3. game: throw and retrieve
Invention of New 18-24 months 1. uses memory and imitation to act
Means 2. can solve basic problems
3. toys: toys with several uses (blocks, rings, boxes)
PREOPERATIONA
L THOUGHT
Pre conceptual 2.4 years 1. uses an egocentric approach to accommodate the demands of an
Phase environment
2. displays static thinking
3. prelogical reasoning
4. everything is significant and relates to “me”
5. explores the environment
6. language development is rapid
7. associates words with objects
Intuitive Phase 4-7 years 1. centering
2. lack of conservation and reversibility
3. role fantasy thinking
4. assimilation
5. magical thinking
6. accommodation
7. unable to state cause-effect relationship
Concrete 7-12 years 1. inductive reasoning
Operational 2. solve everyday problems
Thought 3. recognize cause-effect relationship
4. with concept of conversation
5. numbers: 7years old
6. quantity: 7-8years old
7. weight: 9years old
8. volume: 11years old
9. aware of reversibility
10. activity: collecting and classifying objects
Formal 12 years 1. uses operational thinking
Operational 2. abstract thought rather than concrete thought
Thought 3. activity: “talk time”
 CENTERING- look at an object and see only one characteristic of that object
 CONVERSATION- change in form does not change in size or amount of content
 REVERSIBILITY- ability to retrieve steps
 ASSIMILATION- changing a situation on one’s perception if it fits his thoughts
 ACCOMODATION- adapt thoughts perceived to fit what is perceived

LAWRENCE KOHLBERG’S THEORY OF MORAL DEVELOPMENT

LEVEL STAGE AGE

I.PRECONVENTIONAL 1. Egocentric Judgement Birth 2yrs
MORALITY The infant has no awareness of right and wrong
Egocentric Focus 2. Punishment and Obedient orientation 2-3yrs
Fear of punishment, not respect for authority, is the reason to
decision, behavior and conformity
3. Instrumental Relativist Orientation Conformity 4-7yrs
Is based on egocentricity and narcissistic needs. There is no feeling
of justice, loyalty or gratitude
II.CONVENTIONAL 1. Interpersonal Concordance Orientation 7-10yrs
MORALITY Decisions and behavior are based on concerns about other ‘s
1. Societal focus reactions; the person wants other’s approval
2. The child has 2. Law and Order Orientation 10-12
increased The person wants established rules from authorities, and the
awareness of reason for decisions and behavior is that social and sexual rules
other’s feelings and traditions demand the response
3. A concern for
social order
begins to emerge
4. A child views
good behavior as
that which those
in authority
approve
5. If the behavior is
 not acceptable,
the child feels
guilty

III. POST CONVENTIONAL 1. Social Contract Legalistic Orientation

1. Universal focus The social rules are not the sole basis for decisions and behaviors
2. The individual because the person believes a higher moral principle applies such
focuses on as equality, justice or due process Older than
individual rights 2. Universal Ethical Principle Orientation 12
and principles of Decisions and behaviors are based on internalized rules, on
conscience conscience rather than social laws, and on self-chosen ethical and
3. The focus is on abstract principles that are universal, comprehensive and
what is best for consistent
all

ROBERT HAVIGHURST’S DEVELOPMENTAL TASK THEORY

STAGES AGE DEVELOPMENTAL TASKS

INFANCY AND 0-6 years 1. Learning to walk
EARLY 2. Learning to take solid food
CHILDHOOD 3. Learning to talk
4. Learning to control the elimination of body wastes
5. Learning sex differences and sexual modesty
6. Achieving psychological stability
7. Forming simple concepts of social and physical reality
8. Learning to relate emotionally to parents, siblings, and other people
9. Learning to distinguish right from wrong and developing a conscience
MIDDLE 6-12 years 1. Learning physical skills necessary for ordinary games
CHILDHOOD 2. Building wholesome attitudes toward oneself as a growing organism
3. Learning to get along with age mates
4. Learning an appropriate masculine or feminine social role
5. Developing fundamental skills in reading, writing, and calculating
6. Developing concepts necessary for everyday living
7. Developing conscience, morality, and a scale of values
8. Achieving personal independence
9. Developing attitude towards
ADOLESCENCE 12-18 years 1. Achieving new and more mature relations with age mates of both sexes
2. Achieving a masculine or feminine social role
3. Accepting one’s physique and using the body effectively
4. Achieving emotional independence from parents and other adults
5. Achieving assurance of economic independence
6. Selecting and preparing for an occupation
7. Preparing for marriage and family life
8. Developing intellectual skills and concepts for civic competence
9. Desiring and achieving socially responsible behavior
10. Acquiring a set of values and an ethical system as a guide to behavior
MIDDLE AGE 30-60 years 1. Achieving adult civic and social responsibility
2. Establishing and maintaining an economic standard of living
3. Assisting teenage children to become responsible and happy adults
4. Developing adult leisure time activities
5. Relating oneself to one’s spouse as a person
6. Accepting and adjusting to the physiologic changes
7. Adjusting to aging process
LATER 60 years and up 1. Adjusting to decreasing physical strength and health
MATURITY 2. Adjusting to retirement and reduced income
3. Adjusting to death of a spouse
4. Establishing an explicit affiliation with one’s age group
5. Meeting social and civil obligations
6. Establishing satisfactory physical living arrangements
JAMES FOWLER’S THEORY ON SPIRITUAL DEVELOPMENT

STAGE AGE CHARACTERISTICS

PRE-STAGE: UNDIFFERENTIATED
FAITH
STAGE 1: INTUITIVE-PROJECTIVE
FAITH
STAGE 2: MYTHICAL-LITERAL FAITH
STAGE 3: SYNTHETIC-
CONVENTIONAL FAITH
STAGE 4: INDIVIDUATIVE-
REFLECTIVE FAITH
STAGE 5: CONJUNCTIVE FAITH
STAGE 6: UNIVERSALIZING FAITH
Infant Trust, hope and love compete with
environmental inconsistencies or
threats of abandonment
Toddler - preschooler 1. Imitates parental behaviors
and attitudes about religion
and spirituality
2. Has no real understanding of
spiritual concepts
School aged children 1. Accepts existence of a deity
2. Religious and moral beliefs
are symbolized by stories
3. Appreciates other’s
viewpoints
4. Accepts concept of reciprocal
fairness
Adolescent Questions values and religious beliefs
in an attempt to form own identity
Late Adolescent and young adult Assumes responsibility for own
attitudes and beliefs
Adult Integrates other perspective about
faith into own definition of truth
Adult Makes concepts of love and justice
tangible

JOHN WATSON’S THEORY OF BEHAVIORISM

- American scientist who applied the research of animal behaviors to children

- Behaviors can be elicited by positive reinforcement, such as food treat, or extinguished by negative
reinforcement, such as by scolding or withdrawing attention
- Believed that he could make a child anyone he desired- from a professional to a thief or a beggar- simply by
reinforcing behavior in certain ways

Nursing Implications:

- Behavioral techniques are used to alter behavior or to teach skills to handicapped children
- Positive reinforcement encourages positive behaviors
- Parents often use reinforcement in toilet training and other skills learned in childhood

DEVELOPMENT OF SELF CONCEPT

SELF-CONCEPT

- How an individual describes himself or herself notions, beliefs, and convictions that constitute an individual’s
self-knowledge that influence the individual’s relationships with others
- Not present at birth but develops gradually as a result of unique experiences within the self, with significant
others and with the realities of the world
- May or may not reflect reality

INFANCY

- Awareness of one’s independent existence learned in part as a result of social contacts and experiences with
others

TODDLERHOOD

- More active as children explore the limit of their capabilities and the nature of their impact on others

SCHOOL AGE
 - More aware of differences among people, more sensitive to social pressures, and become more preoccupied
with issues of self-criticism and self-evaluation

ADOLESCENCE

- Focus more on physical and emotional changes and on peer acceptance

- Later Adolescence- organize their self-concept around a set of values, goals and competencies acquired
throughout childhood

BODY IMAGE

- Vital component of self-concept refers to the subjective concepts and attitudes that individuals have toward
their own bodies
- Consists of:
1. Physiologic – perception of one’s physical characteristics
2. Psychological – values and attitudes toward the body, abilities, and ideals
3. Social nature of one’s image of self – the self in relation to others

SCHOOL AGE

- Learn about internal body structure and function

- More aware of differences in body size and configuration
- Highly influenced by cultural norms of society and current fads

ADOLESCENT

- Most concerned about physical self

- Face conflicts on what they see and what they visualize as the ideal body structure
- Body image development is crucial element in shaping identity

SELF ESTEEM

- Value that the individual places on oneself

- An overall evaluation of oneself
- Affective component of self, whereas self-concept is the cognitive component a personal, subjective judgement
of one’s worthiness derived from and influenced by the social groups in the immediate environment and
individual’s perceptions of how they are valued by others
- Toddlers – egocentric; unaware of any differences between competence and social approval
- Preschool and early school age children- increasingly aware of the discrepancy between their competencies and
the abilities of more advanced children
- Positive feedback enhances self esteem
- As competencies increase and they develop meaningful relationships, their self-esteem rises
- Early adolescence- risk stage

Aspects:

 Competence, sense of control, moral, worth, worthiness of love and acceptance

Factors:

1. Child’s temperament and personality

2. Abilities and opportunities available to accomplish age-appropriate developmental tasks
3. Significant others
4. Social roles assumed and the expectations of their roles

CHILD’S REACTION TO DYING AND DEATH

INFANTS AND TODDLERS  Both lack an understanding of the concept of
death
 Aware someone is missing, may experience
separation anxiety
 Infants react to loss of caregivers with behaviors
such as crying, sleeping more and eating less
 Toddlers may develop fearfulness, become more
attached with remaining parent
 PRE SCHOOLERS  View death as temporary and reversible
 Magical thinking and egocentrism may lead to
the belief that dead person will come back
 View death as punishment; believe bad thoughts
and actions cause death
 First exposure to death is frequently the death of
pet
 Common behaviors; nightmares, bowel and
bladder problems, crying, anger, out of control
behaviors
SCHOOL AGE CHILDREN  View death as irreversible, but not necessary
inevitable
 By age 10, understand death as universal and will
happen to them
 May believe death serves as punishment for
wrongdoing
 Many deny sadness, attempt to act as adults
 Common behaviors: difficulty with concentration
in school, psychosomatic complaints, acting out
behaviors
ADOLESCENTS  View death as irreversible, universal and
inevitable
 Develop a better understanding between illness
and death
 Common behaviors: feeling of loneliness,
sadness, fear, depression; acting out behaviors
may include risk-taking, delinquency, suicide
attempts and promiscuity

INTERVENTIONS FOR HEALTH PROMOTION

ENVIRONMENTAL MANIPULATION

AUDITORY STRATEGIES

1. Monitor sound levels within the environment

2. Soft soothing music should be played for the newborn or even for school age children during their study periods
at home

VISUAL STRATEGIES

- Use of color, form, texture, and lighting

OLFACTORY STRATEGIES

- Odors may affect children’s behavior. Sources of unpleasant odor must be removed

THERMAL STRATEGIES

- Too warm or too cold environments may impose physiological demands on any child

PATTERN VARIATIONS

- Pattern encompasses variation in intensity, frequency, and phrasing of stimuli

VESTIBULAR STIMULATION

- Contributes to the neurologic rhythms of the body

- Includes heart rate, respiratory rate, and neuron synapse activity
- Carefully determine the need for stimulation, type and quality of stimulation, frequency of intervention,
intensity and quantity, rhythm of interval
- Forms: manual rocking, swinging hammocks, stroking, using waterbeds

SLEEP PROMOTION

Intervention strategies:
 1. Establishing and maintaining sleep patterns
2. Facilitating sleep
3. Applying behavior management strategies
4. Applying relaxation techniques

MANAGEMENT OF PAIN:

- Due to injury, disease, medical treatment, or non-specific states

- Strategies:
Pharmacologic Guided imaging
Non-pharmacologic Rubbing painful areas
Relaxation heat and cold application
Distraction

NUTRITIONAL SUPPORT

Interventions to enhance nutritional status of children with nutritional deficits

Strategies:

- Non-nutritive sucking
- Structuring sucking reflex
- Proper positioning
- Spacing of food intake
- Role modeling and socialization

Filipino Beliefs on Growth and Development of Children

1. Giving bath to their child on Tuesdays and Fridays will make the child unhealthy
2. Stepping over a child who is sleeping will hinder the child’s growth
3. A family with thirteen children means good luck
4. During baptism, it is important to bring out your child first ahead of the others so that he will grow up a
successful person
5. After circumcision, a boy should not step on a mortar and pestle; otherwise his organ will grow as big as the
mortar and pestle
6. Children are advised not to bite banana leaves, as this is believed to cause tooth decay
7. Newborns should sleep beside books or place books under their pillows, so that they will be intelligent as they
grow

The list is endless, each region in the Philippines have different beliefs that has been passed from generation to
generation. As long as these superstitious beliefs does not harm their children, there is nothing wrong in following
them.