Growth and Development Across the Life Span

> GROWTH
» is used to denote an increase in physical size or a quantitative change
» The pattern of physiologic growth is similar to all people.
o Indicators of Growth:
 1. Height 3. Bone size
 2. Weight 4. Dentition
> DEVELOPMENT
» used to denote an increase in skill or the ability to function.
o Qualitative change
 It is the behavioral aspect of growth.
o Maturation
 A synonym for development
 Behaving in a sensible grown up way.
> Principles of Growth and Development
» Growth and development are continuous processes from conception until death.
» Growth and development proceed in an orderly sequence.
» Different children pass through the predictable stages at different rates.
» Development occurs in cephalocaudal direction.
» Development proceeds from proximal to distal body parts
» Development proceeds from gross to refined skills (simple to complex acts).
» There is an optimum time for initiation of experiences & learning.
» Neonatal reflexes must be lost before development can proceed.
» A great deal of skill and behavior is learned by practice.
> Factors affecting Growth & Development
» Genetics
o Gender o Health
o Race o Intelligence

» Environment
o Socio-economic level o Health
o Parent-child relationship o Nutrition
o Ordinal position in the family

Theories of Human Development

> Developmental Task
» is a skill or a growth responsibility arising at a particular time in an individual`s life.
» it`s successful achievement will provide a foundation for the accomplishment of future tasks.
 I. SIGMUND FREUD THEORY
 Refers to the Personality Development
 Also known as the Psychosexual theory
 The concepts of unconscious mind, defense mechanisms, the id, ego and the
superego.
o Structures of the Psyche
 ID
 developed during infancy
 operates under “pleasure principle”
 EGO
  developed during toddler period
 operates under “reality principle”
 balances the id and superego
 SUPEREGO
 developed during preschool period
 operates under “conscience-morality principle”
o Five Stages of Psychosexual Theory

Five Stages of Psychosexual Theory

Fixation Positive outcome Nursing implications
A. ORAL STAGE » Child explores » difficulty in trusting » produces 1. Provide oral stimulation like
(birth to 18 the world by others may be pleasure & pacifiers.
months) using the demonstrated by: sense of 2. Do not discourage thumb
mouth, esp. the o nail biting comfort & safety sucking.
tongue o alcoholism 3. Encourage breastfeeding
» Feelings of o smoking rather than bottle feeding
dependence o argumentativenes because it requires the infant
arise & can s to expend more energy.
persist through o overeating 4. Encourage the caregiver to
life o overdependence have feeding pleasurable &
provide when required.
B. ANAL STAGE ➢ Anus & » results in obsessive » creative 1. Help the child achieve
(18 months – 3 rectum are the compulsive personality personality & bowel & bladder elimination
years) centers of traits (cruelty, temper productivity. without undue emphasis on
pleasure. tantrums.) its importance.
➢ It occurs 2. Even when hospitalized,
during toilet continue toilet training.
training in which
child learns to
control urination
& defecation.
C. PHALLIC ➢ Genitals are » results in difficulties » encourages 1. Explain to the caregiver to
STAGE (3-6 the center of with sexual identity & identity & accept the child`s interest like
years old) pleasure problems with authority identifies with fondling with his genitals.
➢ Child learns the parent of the 2. Help the parents answer
sexual identity opposite sex & the child`s questions about
through the later takes on a birth & sexual differences.
awareness of love
the genital area. relationship.
➢ Masturbation
Oedipus
offers pleasure
Complex- refers
to the male
child`s attraction
to his mother &
hostile attitudes
to his father.

Electra
Complex- refers
to the female
child`s attraction
to his father &
hostile attitudes
to his
 mother.
D. Latency ➢ Child`s » obsessiveness & lack of » high self- 1. Help the child to have
Stage (6-12 yrs. personality self-motivation esteem positive experiences to
Old) development help in the development of
appears to be his self-esteem.
non-active or 2. Help the child prepare for
dormant the conflicts of
➢ Energy is adolescence.
directed to 3. Encourage the child with
physical & intellectual & physical
intellectual pursuits.
activities
➢ Sexual
impulses tend to
be repressed
E. GENITAL ❖ Energy is » results in sexual » achievement of 1. Encourage separation from
STAGE (13 yrs. directed towards problems (frigidity, independence & parents.
& after) attaining a impotence & inability to wise decision 2. Provide opportunities for
mature sexual have a satisfactory making. the child to relate to the
relationship opposite sex.
❖ This involves 3. Allow the child to verbalize
reactivation of feelings about new
the pre-genital relationships
impulses

 II. ERIK ERIKSON

 Adapts & expands Freud`s theory to include the entire life span.
 Also known as the Psychosocial Development theory.
 Believes the ego to be the conscious core of the personality.
 Each stage signals a Task that must be achieved.
 The resolution of the Task can be complete, partial or unsuccessful.
o 8 Stages of Psychosocial Development

8 Stages of Psychosocial Development

Central Indicators of Indicators of Nursing Implications
Task Positive Negative
Resolution Resolution
Infancy (0-1) Trust vs. Trust to others Mistrust • Provide a primary caregiver
Mistrust Confidence Withdrawal • Provide an experience that add to security e.g.
Love Estrangement soft sounds and touch
• Provide visual stimulation for active child
involvement
Toddler (1-3 Autonomy Independence •Compulsive • Provide opportunities for decision making
years old) vs. Shame Decides for self self-restraint • Praise for ability to make decisions
and Doubt Self-control (impulsive), or • Caregivers should allow children to do things
Cooperative compliance they want to do.
Self-expression • Willfulness
(rebellious)
and defiance
(refusal to
obey)
Pre-school Initiative vs. Learns how to - Lack of self-  Provide opportunities for exploring new places
(3-5 years Guilt do things, confidence, and activities
old) Assertiveness, pessimism,  Allow play to include activities involving water,
 Purpose fear of clay or finger paint
Evaluates own wrongdoing
behavior - Overcontrol,
over
restriction of
own activity
School Age Industry vs. Learns how to - Loss of hope  Allow child to assemble and complete a short
(6-12 years Inferiority do things well - Withdrawal project so that child feels rewarded for
old) Able to create, from school accomplishments
develop and and peer
manipulate
Sense of
competence
and
perseverance
Adolescent Identity vs. Coherent of self Feelings of 
(12-20 years Role Plans to confusion,
old) Confusion actualize one`s indecisivenes
abilities s
Possible
antisocialism

 III. HARRY STACK SULLIVAN

 Theorized the Interpersonal Model, in which Behavior is motivated by needs to
avoid & satisfy needs.
 Emphasized that personality is shaped almost entirely by one’s relationships with
other people
o Levels of Cognition
 PROTOTAXIC LEVEL – unable to communicate experiences;
common among infants and newborns
 PARATAXIC LEVEL – unable to accurately communicate
experiences to others
 SYNTAXIC LEVEL – able to accurately communicate experiences
to others; developed at age 12-18 months
o Developmental Tasks:
 A. Infancy
 Period from birth until with syntaxis language
 AUTISTIC LANGUAGE is common
 Relationship with mother includes two opposing forces,
tenderness and anxiety
 B. Childhood
 BEGINNING – with syntaxis language
 END – need for playmates of equal status
 RELATIONSHIP – with mother, who is now differentiated
from other persons who nurture the child
 Development of IMAGINARY PLAYMATES
 C. Juvenile
 BEGINNING – need for peers of equal status
 END – need for chum, or a single best friend
 Children learn how to COMPETE, COMPROMISE, and
COOPERATE
 D. Preadolescence
  BEGINNING – need for best friend
 END – eruption of lust (age 8-9)
 Most crucial stage
 Rectification of earlier mistakes (stage of perfection)
 Errors made in this stage are nearly impossible to
overcome in later life
 Formation of same-gender or cross-gender CHUMSHIPS
 E. Early Adolescence
 Attraction with opposite sex
 Development of best friends (same gender)
 May confuse lust with love and develop sexual
relationships that are devoid of true intimacy
 F. Late Adolescence
 Start at any time after about age 16 or when a person is
able to feel both intimacy and lust toward the same person
 Stable pattern of sexual activity and the growth of the
syntaxis mode
 IV. LAWRENCE KOHLBERG
 Described child’s development in terms of their concept of right or wrong
 Identified stages of moral development
 Described that infants are in the PRERELIGIOUS STAGE.
o Stages of Moral Development:

Stages of Moral Development

Level 1: - authority figures are Nursing Implications
PRECONVENTIONAL obeyed
(Egocentric Focus)
A. Age: 2-3 Stage 1 - - Child does right a. Child needs to
years Heteronomous because a parent tells determine what are
Morality or him to avoid right actions.
Punishment punishment. b. Give clear
Obedience Orientation instructions to avoid
confusions
B. Age: 4-7 Stage 2: Naive - Carries out actions a. Child is unable to
years Instrumental to satisfy own needs recognize that
Hedonism or rather than society’s situations require
Instrumental Relativist - Does something for actions. Unable to take
Orientation another if that person responsibility for self
does something for care as meeting own
him in return- “an eye needs interferes with
for an eye” (TALEON this.
LAW)
II. Level 2: -Cordial interpersonal
CONVENTIONAL relationships are
(Societal Focus) maintained.
A. Age: 7- Stage 3: Conformity or - Follows rules
10 years Interpersonal because of a need to
Concordance be a good person in
Orientation own eyes and in the
eyes of others
- “Good boy or Good
girl” image is
important
B. Age: 10- Stage 4: Law & Order - Individual feels duty • Child often asks what
 12 years Orientation bound to maintain are the rules & is
social order. something “right”. May
- Follows rules of have difficulty in
authority figures as modifying a procedure
well as parents to because one method
keep the system may not be “right”.
working
III. Level 3: - Individual
POSTCONVENTIONA understands the
L (Universal Focus) morality of having
democratically
established laws
A. Age: Stage 5: Utilitarian or - Follows standards of a. An adolescent can
Older than Social Contract society for the good of be responsible for self-
12 Legalistic Orientation all people care because he views
- It is wrong to violate this as a standard of
others rights. adult
behavior.

 V. JEAN PIAGET- Cognitive Development

 Described child’s development in terms of cognitive abilities
 Variety of new experiences (STIMULI) must exist before intellectual abilities can
develop
 Defined four stages of cognitive development
o Three Primary Abilities:
 Assimilation
 process through which humans encounter & react to new
situations by using the mechanisms they already
possess.
 Accommodation
 process of change whereby cognitive processes matures
sufficiently to allow the person to solve problems that was
unsolvable before.
 Adaptation or Coping Behavior
 ability to handle the demands made by the
environment.
o Piaget`s Phases of Cognitive Development

I. SENSORIMOTOR - Sensory organs & muscles become more functional.

(birth - 2 years)

Stage 1: use of - movements are primarily reflexive.

reflexes (birth – 1 Major Neonatal reflexes
month) > Rooting
» turning the mouth or nose in the direction of any facial touch.
(6th week)
> Sucking
» using the tongue& mouth to take fluid or food. (6 months)
 > Swallowing
» movement of throat muscles to push food from mouth to
esophagus.
> Grasping
» firm contraction of the hand muscles around an object. (6
weeks – 3 months)
> Babinski
» when foot stroke, toes fan upward & outward (3 mo.)
> Moro
» when startled, arms & legs swing quickly out; then
immediately back & neonate curls up into a ball. (4th-5th
months)
> Tonic Neck
» when head is turned to side, arm & leg on same side are
extended in a fencing posture. (2nd-3rd months)
> Extrusion
» tongue pushes outward when touched by an object at the tip.
(4th months)
Stage 2: Primary - Hand-mouth & eye-ear coordination develops.
Circular Reaction - Infants spend much time looking at objects & separating self from
(1-4 months) them.
- Beginning intention of behavior is present (infant brings thumb to
mouth for a purpose: to suck it)
- Enjoyable activity for this period: a rattle or a parent’s voice.
Stage 3: Secondary - Infant learns to initiate, recognize and repeat pleasurable
Circular Reaction experiences from environment.
(4-8 months) - Memory traces are present (a parent coming near will pick him
up).
- Good toy for this period: mirror, peek-a-boo
Stage 4: - Infant can plan activities to attain specific goals.
Coordination of - Can search for and retrieve a toy that disappears for view.
Secondary - Recognizes shapes and sizes of familiar object.
Reactions (8-12 - Because of increased sense of separateness, infant experiences
months) separation anxiety.
- Good toy for this period: nesting toys (colored boxes)
Stage 5: Tertiary - Rituals are important.
Circular Reaction - Child is able to experiment to discover new properties as well as
(12-18 months) permanence
- Good game for this period: throws and retrieve
Stage 6: Invention - Uses memory and imitation to act
of New Means - Can solve basic problems
Through Mental - Foresee maneuvers that will succeed or fail
Combinations (18- - Uses make believe and pretend play
24 months)
ll. a. Pre-conceptual - Use symbols to represent objects (SYMBOLISM)
PREOPERATIONAL Phase (2-4) - With difficulty differentiating objects
(2-7 YEARS) - Generalize things from experience (PRELOGICAL REASONING)
- Exhibit faulty judgment and conclusion
b. Intuitive Phase - See only one characteristic of an object (CENTERING)
(4-7) - Fits information to their own idea (ASSIMILATION)
- Magical thinking
- Egocentrism
- Concept of time is now and distance is only as far as he can see
- Demonstrates beginning causation
III. CONCRETE - Recognizes cause-and-effect relationships
OPERATIONAL - Able to discern truth despite change in physical properties
THROUGH (7-12 (CONSERVATION)
YEARS) - Conservation of Quantity learned at age 7-8
- Conservation of Weight learned at age 9
- Conservation of Volume learned at age 11
- Inductive Reasoning (specific to general)
- Uses memory to learn
- Able to reverse steps (REVERSIBILITY)
IV. FORMAL - Considers possibilities (ABSTRACT THINKING)
OPERATIONS (12 - Scientific reasoning
YEARS) - Deductive reasoning (general to specific)
- Can deal with past, present and future
- Solves hypothetical problems

 VI. HAVIGHURST- Developmental Task

o Successful achievement of task leads to happiness & to success with later
tasks.
o Failure leads to unhappiness, disapproval by society and difficulty with later
tasks.
 Havighurst`s Developmental Stages & Tasks
 1. Infancy & Childhood
o a. Eat solid foods a. Eat solid foods
o b. Control elimination of wastes
o c. Walk
o d. Relate emotionally to others
o e. Talk
o f. Distinguish right from wrong through the
development of conscience
o g. Learn sex differences & sexual modesty
o h. Achieve psychological stability
o i. Form simple concepts of social & physical reality
 2. Middle Childhood
o a. Learn physical skills required for games
o b. Build healthy attitudes toward oneself
o c. Learn to socialize with peers
o d. Learn appropriate masculine & feminine roles
o e. Gain basic reading, writing & mathematical skills
o f. Develop concepts necessary for everyday living
o g. Formulate a conscience based on a value system
o h. Achieve personal independence
o i. Develop attitudes towards social groups & institution
 3. Adolescence
o a. Establish more mature relationship
o b. Achieve a masculine & feminine role
o c. Accept own body
o d. Establish emotional independence from parents
o e. Achieve assurance of economic independence
o f. Prepare for an occupation
o g. Prepare for marriage & establishment of family
o h. Acquire skills necessary to fulfill civic responsibilities
o i. Develop a set of values that guide behavior
 VII. Spiritual Theory by James Fowler
o Described child’s development in terms of spirituality
o Stages of Spiritual Development
 Stage 0 – Undifferentiated (0-3)
 No concept of spirituality
 Stage 1 – Intuitive-Projective (4-6)
 Spirituality is formed from images and beliefs from trusted
other
 Stage 2 – Mythic-Literal (7-12)
 Belief is marked by fantasy, stories and myths
 Stage 3 – Synthetic-Conventional (12-18)
 Societal expectations influence beliefs