Provider 3

‫ذذ‬ Family, Social, Cultural, and

Religious Influences on Child
Health Promotion
Dr Aml Sayed Abdelrahem
Dr Mini Jackson
Objectives
At the end of the lecture, the students will be able to:
✓ Explain the Social, Cultural, Religious, and Family Influences on Child Health Promotion
o Family Structure and Function
o Family Roles and Relationships
o Parenting
o Special Parenting Situations
o Influences in the Surrounding Environment
o Understanding Cultures in the Health Care Encounter
✓ Describe the Child Rights
✓ Describe Communication, Physical, and Developmental Assessment
o Guidelines for Communication and I nterviewing
o Communicating with Families
o History Taking
o Nutritional Assessment
o General Approaches Toward Examining the Child
o Physical Examination
o Dev elopment Milestones
o Principles of Growth and Development
o Factors influencing Growth and Development
o Theories of Dev elopment
 Family Structure and Function
• A family can be defined as an institution where individuals, related through
biology or enduring commitments, and representing similar or different
generations and genders, participate in roles involving mutual socialization,
nurturance, and emotional commitment (Hanson, Gedaly-Duff, and
Kaakinen,2005).
• The family structure, or family composition, consists of individuals, each
with a socially recognized status and position, who interact with one
another on a regular, recurring basis in socially sanctioned ways
• Traditionally, the family structure was either a nuclear or extended family.
In recent years, family composition has assumed new configurations, with
the single-parent family and blended family becoming prominent forms.
• Nurses must be able to meet the needs of children from many diverse
family structures and home situations. A family’s structure affects the
direction of nursing care.
• The U.S. Census Bureau uses four definitions for families: the
traditional nuclear family, the nuclear family, the blended family or
household, and the extended family or household.
• In addition, numerous other types of families have been defined such
as single-parent, binuclear, polygamous, communal, and gay, lesbian,
bisexual, and transgender families.
Types of Family
• Nuclear Family
• The nuclear family is composed of two parents and their children. The parent-
child relationship may be biologic, step, adoptive, or foster. Sibling ties may be
biologic, step, half, or adoptive. The parents are not necessarily married. No other
relatives or nonrelatives are present in the household.
• Blended Family
• A blended family or household, also called a reconstituted family, includes at
least one stepparent, stepsibling, or half-sibling. A stepparent is the spouse of a
child’s biologic parent but is not the child’s biologic parent. Stepsiblings do not
share a common biologic parent; the biologic parent of one child is the
stepparent of the other. Half-siblings share only one biologic parent.
• Extended Family
• An extended family or household includes at least one parent, one or more
children, and one or more members (related or unrelated) other than a parent or
sibling. Parent-child and sibling relationships may be biologic, step, adoptive, or
foster.
 Types of Family
• Single Parent family: The contemporary single-parent family has emerged
partially as a consequence of the women’s rights movement and also as a result of more
women (and men) establishing separate households because of divorce, death, desertion,
or single parenthood. With women’s increased psychologic and financial independence and
the increased acceptability of single parents in society, more unmarried women are
deliberately choosing mother-child families
• Binuclear Family
• The term binuclear family refers to parents continuing the parenting role while terminating
the spousal unit. The degree of cooperation between households and the time the child
spends with each can vary. In joint custody the court assigns divorcing parents equal rights
and responsibilities concerning the minor child or children.
• Polygamous Family
• Polygamy refers to either multiple wives (polygyny) or, rarely, husbands (polyandry). Many
societies practice polygyny that is further designated as sororal, in which the wives are
sisters, or nonsororal, in which the wives are unrelated. Sororal polygyny is widespread
throughout the world. Most often, mothers and their children share a husband and father,
with each mother and her children living in the same or separate household.
 Types of family
• Communal Family
• Communal families may have divergent beliefs, practices, and organization, the basic
impetus for formation is often dissatisfaction with the nuclear family structure, social
systems, and goals of the larger community. communal groups share common ownership
of property. In cooperatives, property ownership is private, but certain goods and services
are shared and exchanged without monetary consideration. There is strong reliance on
group members and material interdependence. Both provide collective security for
nonproductive members, share homemaking and childrearing functions, and help
overcome the problem of interpersonal isolation or loneliness.
• Gay, Lesbian, Bisexual, and Transgender Families
• A same-sex, homosexual, or gay/lesbian/bisexual/transgender (GLBT) family is one in
which there is a legal or common law tie between two persons of the same sex who have
children. There are a growing number of families with same-sex parents in the United
States, with an estimated one fifth of all same-sex couples raising children. Although some
children in gay/lesbian households are biologic from a former marriage relationship,
children may be present in other circumstances.
• They may be foster or adoptive parents, lesbian mothers may conceive through artificial
fertilization, or a gay male couple may become parents through use of a surrogate mother.
When children are brought up in GLBT families, the relationships seem as natural to them
as heterosexual parents do to their offspring.
• Nurses need to be nonjudgmental and to learn to accept differences
rather than demonstrate prejudice that can have a detrimental effect
on the nurse-child-family relationship.
• Moreover, the more nurses know about the child’s family and
lifestyle, the more they can help the parents and the child
 Family roles and relationships
Parental roles: In all family groups the socially recognized status of father
and mother exists with socially sanctioned roles that prescribe appropriate
sexual behavior and childrearing responsibilities. The guides for behavior in
these roles serve to control sexual conflict in society and provide for
prolonged care of children.

• Parental role definitions have changed as a result of the changing

economy and increased opportunities for women. As the woman’s role
has changed, the complementary role of the man has also changed.
Many fathers are more active in childrearing and household tasks.
 ROLE LEARNING
• Roles are learned through the socialization process. During all stages of
development, children learn and practice, through interaction with others and
in their play, a set of social roles and the characteristics of other roles. They
behave in patterned and more or less predictable ways because they learn
roles that define mutual expectations in typical social relationships. Although
role definitions are changing, the basic determinants of parenting remain the
same.
• Children respond to life situations according to behaviors learned in reciprocal
transactions. As they acquire important role-taking skills, their relationships
with others change. For instance, when a teenager is also the mother but lives
in a household with the grandmother, the teenager may be viewed more as
an adolescent than as a mother.
• Children become proficient at understanding others as they acquire the ability
to discriminate their own perspectives from those of others. Children who get
along well with others and attain status in the peer group have well-
developed role-taking skills.
Family Size and Configuration
• Parenting practices differ between small and large families. Small families
place more emphasis on the individual development of the children.
Parenting is intensive rather than extensive, and there is constant
pressure to measure up to family expectations.
• In small families, children have more democratic participation than in
larger families. Adolescents in small families identify more strongly with
their parents and rely more on them for advice. They have well-
developed, autonomous inner controls as contrasted with adolescents
from larger families, who rely more on adult authority.
• Children in a large family are able to adjust to a variety of changes and
crises. There is more emphasis on the group and less on the individual.
The large number of people sharing a limited amount of space requires a
greater degree of organization, administration, and authoritarian control
• Older siblings in large families often administer discipline
• In situations such as death or illness of a parent, an older sibling often
assumes responsibility for the family at considerable personal
sacrifice. Large families generate a sense of security in the children
that is fostered by sibling support and cooperation.
• However, adolescents from a large family are more peer oriented
than family oriented.
PARENTING AND PARENTING STYLES
• Parenting styles are often classified as authoritarian, permissive, or
authoritative.
• Authoritarian parents try to control their children’s behavior and attitudes
through unquestioned mandates. They establish rules and regulations or
standards of conduct that they expect to be followed rigidly and
unquestioningly. The message is: “Do it because I say so.” Punishment need
not be corporal but may be stern withdrawal of love and approval. Careful
training often results in rigidly conforming behavior in the children, who
tend to be sensitive, shy, self-conscious, retiring, and submissive. They are
more likely to be courteous, loyal, honest, and dependable, but docile.
These behaviors are more typically observed when close supervision and
affection accompany parental authority. If not, this style of parenting may
be associated with both defiant and antisocial behaviors.
• Permissive parents exert little or no control over their children’s actions. They
avoid imposing their own standards of conduct and allow their children to
regulate their own activity as much as possible. These parents consider
themselves to be resources for the children, not role models. If rules do exist,
the parents explain the underlying reason, elicit the children’s opinions, and
consult them in decision-making processes. These parents rarely punish the
children.
• Authoritative parents combine practices from both of the previously described
parenting styles. They direct their children’s behavior and attitudes by
emphasizing the reason for rules and negatively reinforcing deviations. They
respect the individuality of each child and allow the child to voice objections to
family standards or regulations. Parental control is firm and consistent but
tempered with encouragement, understanding, and security. Parents’ realistic
standards and reasonable expectations produce children with high self-esteem
who are self-reliant, assertive, inquisitive, content, and highly interactive with
other children.
• In the authoritative style, authority is shared and children are included in
discussions, fostering an independent and assertive style of participation in
family life. When working with individual families, nurses should give these
differing styles equal respect.
SPECIAL PARENTING SITUATIONS
PARENTING THE ADOPTED CHILD
• Adoption establishes a legal relationship between a child and parents who
are not related by birth but who have the same rights and obligations that
exist between children and their biologic parents. In the past the biologic
mother alone made the decision to relinquish the rights to her child. In
recent years the courts have acknowledged the legal rights of the biologic
father regarding this decision. As the child’s rights have become
recognized, older children have successfully dissolved their legal bond
with their biologic parents to pursue adoption by adults of their choice.
Furthermore, there is a growing interest and demand within the gay and
lesbian (GLBT) community to adopt.
• Siblings, adopted or biologic, who are old enough to understand, should
be included in decisions regarding the commitment to adopt, with
reassurance that they are not being replaced.
Issues of Origin
• The task of telling children that they are adopted can be a cause of deep
concern and anxiety. The timing arises naturally as parents become aware
of the child’s readiness. Most authorities believe that children should be
informed at an age young enough so that, as they grow older, they do not
remember a time when they did not know they were adopted.
• Parents should anticipate behavior changes after the disclosure, especially
in older children. Children may use the fact of their adoption as a weapon
to manipulate and threaten parents. Statements such as “My real mother
would not treat me like this” or “You don’t love me as much because I’m
adopted” hurt parents and increase their feelings of insecurity.
• Adopted children need the same undemanding love, combined with firm
discipline and limit setting, as any other child.
Adolescence
• Adolescence may be an especially trying time for parents of adopted
children. Adolescents may use their adoption to defy parental
authority or as a justification for aberrant behavior. As they attempt
to master the task of identity formation, they may begin to have
feelings of abandonment by their biologic parents. Gender
differences in reacting to adoption may surface.
• Adopted children fantasize about their biologic parents and may feel
the need to discover their parents’ identity to define themselves and
their own identity. It is important for parents to keep the lines of
communication open and to reassure their child that they understand
the need to search for their identity.
Cross-Racial and International Adoption
• Adoption of children from racial backgrounds different from that of the
family is commonplace. children of a cross-racial adoption must deal with
physical and sometimes cultural differences. It is advised that parents who
adopt children with different ethnic background do everything to preserve
the adopted children’s racial heritage.
• It is vital that family members declare to others that this is their child and a
cherished member of the family. In international adoptions the medical
information the parents receive may be incomplete or sketchy; weight,
height, and head circumference are often the only objective information
present in the child’s medical record. Many internationally adopted
children were born prematurely, and common health problems such as
infant diarrhea and malnutrition delay growth and development. Some
children have serious or multiple health problems that can be stressful for
the parents.
INFLUENCES IN THE SURROUNDING ENVIRONMENT
SCHOOLS
• In addition to academic and cognitive progress, teachers are concerned with the
emotional and social development of the children in their care. Both parents and
teachers act to model, shape, and promote positive behavior, constrain negative
behavior, and enforce standards of conduct.
• Ideally, parents and teachers work together for the benefit of the children in
their care.
• Schools serve as a major source of socialization for children. Next to the family,
schools exert a major force in providing continuity and passing down culture
from one generation to the next. This, in turn, prepares children to carry out the
social roles they are expected to assume as they develop into adults. School is
the center of cultural diffusion wherein the cultural standards of the larger
group are disseminated into the community.
• School is an important institution in which children systematically learn
about the negative consequences of behavior that departs from social
expectations.
• School also serves as an avenue for children to participate in the larger
society in rewarding ways, to promote social mobility, and to connect the
family with new knowledge and services. Like parents, teachers are
responsible for transmitting knowledge and culture (i.e., values on which
there is a broad consensus) to the children in their care. Teachers are also
expected to stimulate and guide children’s intellectual development and
creative problem solving. Traditionally, the socialization process of school
began when children entered kindergarten.
 PEER CULTURES
• Peer groups also have an impact on the socialization of children. Peer relationships
become increasingly important and influential as children proceed through school.
• During their lives, children are subjected to many influential factors, such as family,
religious community, and social class. In peer-group interactions, they confront a
variety of these sets of values. The values imposed by the peer group are
especially compelling because children must accept and conform to them to be
accepted as members of the group. When the peer values are not too different
from those of family and teachers, the mild conflict created by these small
differences serves to separate children from the adults in their lives and to
strengthen the feeling of belonging to the peer group.
• The peer-group culture has secrets, mores, and codes of ethics that promote
group solidarity and detachment from adults.
• As children move from one level to the next, they discard the folkways of the
younger group as they adopt those of the new group. For example, a school-age
child rides a bicycle to school, whereas the high school student prefers a car.
SOCIAL ROLES
• Much of children’s self-concept comes from their ideas about their
social roles. Roles are cultural creations; therefore, the culture
prescribes patterns of behavior for persons in a variety of social
positions. All persons who hold similar social positions have an
obligation to behave in a particular manner.
• A role prohibits some behaviors and allows others. Because culture
outlines and clarifies roles, it is a significant influence on the
development of children’s self-concept (i.e., attitudes and beliefs they
have about themselves). To establish their place in the group, children
learn to follow a mode of behavior that is in agreement with the
standards specific to the group and learn how they can expect others
to behave toward them.
 COCULTURAL OR SUBCULTURAL
INFLUENCES
• Except in rare circumstances, children grow and develop in a blend of cultures.
Subcultures or co-cultures are groups within a cultural group that possess their
own standards and mores. For example, nursing or medicine constitutes a
subculture or co-culture. Most of these co-cultures were formed when groups
of people clustered together by preferences, external pressure from the
majority culture, or geographic isolation.
• Although cultural differences may be related to geographic boundaries, co-
cultures are not always restricted by location, especially in the context of
Internet support groups and social media. Considering children, in particular,
some subcultures are even related to the stages of development. For example,
the behavior of school-age children and adolescents demonstrate age-related
subcultures. Those that seem to exert great influence upon children and their
families are ethnicity, social class, minority group membership,
religion/spirituality, schools, communities, and peer groups.
 COMMUNITIES
• The child’s or adolescent’s community is made up of family, school, neighborhood, youth organizations, and other members.
Four categories of external assets that youth receive from the community are:

1. Support—Young people need to feel support, care, and love from their families, neighbors, and others.
They also need organizations and institutions that offer positive, supportive environments.
2. Empowerment—Young people need to feel valued by their community and be able to contribute to
others. They need to feel safe and secure.
3. Boundaries and expectations—Young people need to know what is expected of them and what activities
and behaviors are within the community boundaries and what are outside of them.
4. Constructive use of time—Young people need opportunities for growth through constructive, enriching
opportunities and through quality time at home.
• Internal assets must also be nurtured in the community’ syoung members. These internal qualities guide
choices and create a sense of centeredness, purpose, and focus. The four categories of internal assets are:
1. Commitment to learning—Young people need to develop a commitment to education and life-long
learning.
2. Positive values—Youth need to have a strong sense of values that direct their choices.
3. Social competencies—Young people need competencies that help them make positive choices and build
relationships.
4. Positive identity—Young people need a sense of their own power, purpose, worth, and promise.
UNDERSTANDING CULTURES IN THE
HEALTH CARE ENCOUNTER
• BRIDGING THE GAP
• Health care institutions and researchers have compiled several different ways
that health care providers can attend to all the different facets that make up an
individual’s culture. Cultural competence promotes gathering information about a
specific culture rather than building the health care provider’s skills— for
example, supplying information about common foods, health care beliefs, and
important rituals
• A family’s religious and sociocultural backgrounds can influence their decisions
about health care and the religious traditions and clergy they want to include
during their loved one’s illness. It also influences how they discuss serious topics
with their children—for example, their own health conditions; the significance of
illness, suffering, pain, death, and dying; and the rituals and traditions associated
with important life events, such as birth and death
CULTURAL DEFINITIONS
• Culture characterizes a particular group with its values, beliefs,
norms, patterns, and practices that are learned, shared, and
transmitted from one generation to another (Leininger, 2001).
• Culture is not the same as race or ethnicity. Race is a socially
constructed term with roots in anthropology, distinguishing variety in
humans by physical traits. Ethnicity is the affiliation of a set of persons
who share a unique cultural, social, and linguistic heritage
• It is important to understand nursing’s contribution to culturally
congruent care.
• A set of values learned in childhood may characterize children’s
attitudes and behaviors for life, influencing long-range goals and
short-range impulses.
 COMPONENTS OF CULTURAL
HUMILITY
• Cultural humility includes the following tenets:
• Lifelong commitment to self-reflection and critique
• Addressing the power imbalances in the nurse-client relationship
• Developing mutually beneficial and non paternalistic partnerships with the
community in which one is working
• Cultures may also differ in whether status in a group is based on age or skill. Even
children’s play and their types of games are culturally determined. In some
cultures, children play in groups composed of members of the same gender, and in
others, they play in mixed-gender groups. In some cultures, team games
predominate, and in others, most play is limited to individual games. Standards
and norms vary from culture to culture and from location to location; a practice
that is accepted in one area may meet with disapproval or create tension in
another. The extent to which cultures tolerate divergence from the established
norm also varies among cultures and subcultural groups.
Child Rights
Why should children have ‘special’ rights?
Children are the constitutional unit of the societies
Children are the hope of the countries future.
Children are vulnerable and need special care.
Children need protection
Children are a distinct group with different needs and rights
from adults
Children have specific rights as part of their Human Rights.
 Islamic view of children right
◼ keep to child the right to called in good name.
◼ keep to child the right to called to his father name.
◼ Keep to child right in lactation and weaning.
◼ Instruct to educate, play to be kind with children
◼ Instruct to rear the child in good manner and teach him
the right and wrong.
◼ Give girls her right and equalize between her and boy in
dealing with them.
 Islamic view of children right
◼ Islam forbidden the adoption to keep the affinities and right to
keep his family name
◼ Islam keep the right for illegitimate to be able to live and keep
his humanity.
◼ Keep privacy of children :separate between girls and boys at
age of 7 years.
 The Convention on the Rights
of the Child
In 1989, the general assembly of the United Nations adopted
special human rights convention for children.
By now more 180 countries have signed the convention on the
right of the child, but children around the world still die
from disease that can easily be treated or immunized
against, still have to work long hours instead of going to
school or playing and exposed to violence and harmful
drugs.
 Convention on the Rights of the Child

Basic Facts
Children’s rights are violated throughout the world every
day…

Between 15 and 20 million children are

working as slaves at this moment.

An estimated 2 million children worldwide

are sexually exploited every year.
 Convention on the Rights of the Child

Basic Facts
An estimated 25 million children and
adolescents are currently uprooted from their
homes; they make up nearly half of the
refugee population worldwide.

There are an estimated 100 million children

living on the streets today.
So, what are rights?
SURVIVAL

PROTECTION

DEVELOPMENT

PARTICIPATION
 All children have the right to
SURVIVAL
To live

Get good health care

Get good food regularly

Have a name- child

identity

To have a nationality
 All children have the right to
PROTECTION
◼ To have a family that will protect child.
◼ To be safe from every harm- physical or mental.

◼ To have a world that is at

least as good as the one

their parent inherited.
◼ To have privacy.
 All children have the right to
DEVELOPMENT

to education

rest and leisure

recreation
 All children have the right to
PARTICIPATION
To express himself freely

To know about things related to

child life

To be a member of associations

To enjoy his culture

 Article 5 CRITICAL ARTICLES OF THE CONVENTION
Children’s Right to Respect
for Their Capacities
Providers should explore with the child their level of
understanding of any proposed treatment, their views
about it .

A child’s competence to give or refuse consent to

treatment must be considered, especially when the
parent takes an opposing view.
 Article 12
The Right To Be Listened To
and Taken Seriously
Assure to the child who is capable of forming his
or her own views the right to express those views
freely in all matters affecting the child, the views
of the child being given suitable weight in
accordance with the age and maturity of the
child.
 Article 16
The Right to Privacy and Respect
for Confidentiality

For this purpose, the child shall in particular,

be provided with the opportunity to be heard
in all decisions and administrative proceedings
affecting the child, either directly, or through a
representative or an appropriate body, in a
manner consistent with the procedural rules of
national law
 Article 16
The Right to Privacy and Respect
for Confidentiality
The confidentiality of adolescents to seek
medical help should be respected.

There is a need to develop and promote clear

policies on who is allowed to confidential
advice and information.
 Provision Rights
Article 28

Every child has the right to free education at primary

school level. Different kinds of secondary school
education should be available for children. For those
with ability higher education should be provided. Right
to leisure, recreation and cultural activities.
Right to Health

◼ Access to quality health services

◼ Rights of children with disabilities
◼ Adolescents and reproductive health
knowledge
◼ Right to benefit from social security
◼ Right to an adequate standard of living
Right to Special Protection

◼ Protection from all forms of exploitation

(economic, sexual).
◼ Violence against children (physical,
psychological & sexual).
◼ Female Genital Mutilation & early
marriage.
◼ Hazardous occupations.
◼ Smoking, substance abuse, and trafficking.
◼ Street children.
 And what’s next?

Our focus Our approach

Home and family

Schools Protection of children
Institutions Prevention of violence
Community Prosecution of criminals
Media Participation of children

www.coe.int/children 50
 National Child Day
􀂄 celebrate NCD with children and their
families and community as a means to share
information about children’s rights

􀂄 November 20th – special day to honor and

respect children

􀂄 UN declaration of the Child Right in 1959

􀂄 UN Convention on the Rights of the Child in
1989
 Convention on the Rights of the Child

Educate yourself about the CRC.

Contact local, state, and national politicians

Write letters asking them to ratify the CRC.

Talk to your parents about the CRC.

Educate the adults in your life!

Advocate for awareness of the CRC.

Begin a social awareness/ human
rights club.
Communication, Physical and
Developmental Assessment
 Guidelines for Communication and
Interviewing
• Appropriate Introduction
• Assurance of Privacy and Confidentiality
• Computer Privacy and Applications in Nursing
• Telephone Triage and Counseling
 Communicating with Parents
• Encouraging the Parents to Talk
• Directing the Focus
• Listening and Cultural Awareness
• Using Silence
• Being Empathic
• Providing Anticipatory Guidance
• Avoiding Blocks to Communication
Communicating with Children
Communicating with Children
 Importance Of Child Health Assessment

Opportunity to provide families with information about :

⥽ Health promotion
⥽ Signs of health and illness
⥽ Expected developmental progress
 ❤ Health History
❤ Physical Assessment
Component Of Child

❤ Nutritional Assessment
Assessment

❤ Developmental Milestones Assessment

 PHYSICAL EXAMINATION

PLEASE REFER TO PRECLINICAL SLIDES ON •

HISTORY TAKING AND PHYSICAL EXAMINATION
Growth & Development- Definitions of Terms
Growth
 It is the process of physical maturation resulting an increase in size of
the body and various organs. It occurs by multiplication of cells and an
increase in intracellular substance. It is quantitative changes of the
body which can be measured in inches/ centimeters and
pounds/kilograms. It is progressive and measurable phenomenon.
Development
• It is the process of functional and physiological maturation of the
individual. It is progressive increase in skill and capacity to function. It
is related to maturation and myelination of the nervous system. It
includes psychological, emotional and social changes. It is qualitative
aspect of maturation and difficult to measure.
Maturation
• It is an increase in competence and change in behavior and ability to
function at a higher level depending upon the genetic inheritance.
Importance of Learning Growth and Development

It helps the nurses in the following aspects:

 To learn what to expect from a particular child at a particular age.
 To assess the normal growth and development of children
 To detect deviations from normal growth and development.
 To ascertain the needs of the child according to the level of growth
and development.
 To plan and provide holistic nursing management to the child based
on developmental stages.
 To reach and guide the parents and caregivers to anticipate the
problems and to render loving care to their children.
 To develop a rapport with the child to enhance the provision of health
care and to help to build healthy life style for optimum health for the
future
Characteristics/Principles of Growth and
Development
• Growth and development depend upon each other and in normal
child they are parallel and proceed concurrently.
The characteristics and principles which regulates growth and
development in children are as follows:
• Growth and development is continuous and orderly process from
conception until death with individual difference and is unique to
each child.
• It proceeds by stages and it’s orderly sequence is predictable and
same in all children but there may be difference in time of
achievement.
• Different children pass through the predictable stages at different
rates. All body parts do not develop at the same time
• There is co-ordination between increase in size and maturation.
• They proceed in cephalocaudal (i.e. from the head down to the tail)
and proximodistal (i.e. from the center or midline to periphery)
direction.
• Initial mass activities and movements are replaced by specific
response or actions by the complex process of individualized changes.
• Rate of growth and development is interrelated and rapid in infancy and in
puberty but slow in preschool and school age.
• Growth and development depend on combination of many interdependent
factors especially by heredity and environment.
• There is an optimum time for initiation of experiences or learning
• Neonatal reflexes must be lost before development can proceed
• A great deal of skill and behavior is learned by practice
Stages of Growth and Development
Prenatal Period
• Ovum- 0 to 14 days after conception
• Embryo-14 days to 8 weeks
• Fetus-8 weeks to birth
Postnatal Period
• Neonate-From birth to four weeks of life
• Infancy-First year of life
• Toddler-One to 3 years
• Preschool child (early childhood)- 3 to 6 years
Stages of Growth and Development
• School going child (middle childhood)
• 6 to 10 years (girls)
• 6 to 12 years (boys)
• Adolescent –from puberty to Adulthood
• Prepubescent (early adolescent / late childhood)
• 10 to 12 years (girls)
• 12 to 14 years (boys)
• Pubescent (Middle adolescent)
• 12 to 14 years (girls)
• 14 to 16 years (boys)
• Post pubescent (late adolescent)
• 14 to 18 years (girls)
• 16 to 20 years (boys)
Factors influencing Growth and Development
Growth and development depend upon multiple factors of determinants.
They influence directly or indirectly by promoting or hindering the process
Genetic Factors
• Each child has a different genetic potential. Generic predisposition is the
important factor which influence the growth and development of children.
Different characteristics such as height, body structure, color of skin, eyes
and hair etc. depend upon inherited gene from parents.
• Abnormal genes from ancestors may produce different familial disease
which usually hinders the growth and development, e.g. thalassemia,
hemophilia, galactosemia, etc. The process of growth and development is
also affected in children with chromosomal abnormalities e.g. in Down’s
syndrome, Turner’s syndrome, Klinefelter syndrome.
Factors influencing Growth and Development
• Sex: The sex of children influences their physical attributes and
patterns of growth. At birth, male babies are heavier and longer than
female babies. Boys maintain this superiority until about 11 years of
age. Girls mature earlier than boys and bone development is more
advanced in girls. But mean height and weight are usually less in girls
than boys at the time of full maturity.
• Race and Nationality: Growth potential of different racial groups is
different in varying extent. Physical characteristics of different
national groups also vary. Height and stature of Americans and
Indians are usually differ because of the difference in growth patterns.
Prenatal Factors
• Maternal malnutrition: Dietary insufficiency and anemia lead to intra-
uterine growth retardation. Low birth weight and preterm babies have
poor growth potentials.
• Maternal infections: Different intrauterine infections like HIV, HBV, STORCH,
etc, may transmit to the fetus via placenta and affect the fetal growth.
Various complications may occur like congential anomalies, cogenital
infections etc. which ultimately affect the growth and development in
extra-uterine life.
• Maternal substance abuse: Intake of teratogenic durgs (thalidomide,
phenytoin etc.) by the pregnant women in the first trimester affects the
organogenesis and lead to congenital malformations which hinder fetal
growth. Maternal tobacco intake (smoking and chewing) and alcohol abuse
also produce fetal growth restriction
Prenatal Factors
• Maternal illness: Pregnancy- induced hypertension, anemia, heart
disease, hypothyroidism, diabetes mellitus, chronic renal failure,
hyperphyrexia etc. have adverse effect on fetal growth. Iodine
deficiency of the mother may lead to mental retardation of the baby
in later life.
• Hormones: Hormones like thyroxine and insulin influence the fetal
growth. Thyroxine deficiency retards the skeletal maturation of the
feus. Maternal myxedema results in fetal hypothyroidism. Antithyroid
drug therapy and iodides during last trimester pf pregnancy may lead
to fetal goiter and hypothyroidism. Excess insulin stimulates fetal
growth leading to large size fetus with excessive birth weight due to
macrosomia.
Postnatal factors
 Growth potential: Growth potential is indicated by the child’s size at birth. The
smaller the child at birth, the smaller she/he is likely to be in sequent years. The
larger the child at birth, the larger she / he is likely to be in later years.
 Nutrition: Balanced amounts of essential nutrients have great significant role in
growth and development of children. Both quantitative and qualitative supply of
nutrition (i.e protein, fat, carbohydrates, vitamins and minerals) in the daily diet
are necessary for promotion of growth and development. Well nourished child has
positive physical and mental growth, whereas undernourished child usually suffers
from growth retardation and various health problems.
Postnatal factors
• Childhood illness: Chronic childhood diseases of heart, (cogenital
heart disease, rheumatic heart disease), chest (turberculosis, asthma),
kidneys (nephritic syndrome), liver (cirrhosis), malignancy,
malabsorption syndrome, digestive disorders, endocrinal
abnormalities, blood disorders, worm infestations, metabolic
disorders etc, generally lead to growth impairment.
• Acute illnesses like ARI, diarrhea, repeated attack of infections result
in malnutrition and growth retardation. Congenital anomalies,
accidental injury and prolong hospitalization usually have adverse
effect on growth and development.
Postnatal factors
 Physical environment: Housing, living conditions, safety measures,
environmental sanitation, sunshine, ventilation and fresh air, hygiene, safe water
supply, etc., are having direct influence on child’s growth and development.
Drought, famine and disaster also influence on child’s growth.
 Psychological environment: Healthy family, good parent child relationship and
healthy interaction with other family members, neighbors, friends, peers and
teachers are important factors for promoting emotional, social and intellectual
development. Lack of love, affection and security leads to emotional disturbances
which hinders emotional maturity and personality development.
 Cultural influences: Growth and development of an individual child are
influenced by the culture in which he or she is growing up. The childrearing
practices, food habit, traditional beliefs, social taboos, attitude towards health,
standard of living, educational level, etc. inf luence the child’s growth and
development.
 Socio-economic status: Poor socio- economic groups may have less favorable
environment for growth and development than the middle and upper groups.
 Play and exercise: Play and exercise promote physiological activity and stimulate
muscular development. Physical, physiological, social, moral, intellectual and
emotional developments are enhanced by play and exercise.
 Birth order of the child: Birth order alone does not determine intelligence,
personality traits or method of coping but it has a significant influence on all of
these.
 Intelligence: Intelligence of the child influences mental and social development.
A child with higher intelligence adjusts with environment promptly and fulfill own
needs and demands, whereas a child with low level of intelligence fails to do that.
 Hormonal influence: Hormones are the important aspects of internal
environment which have vital role in growth and development of the children
Different Aspects of Development
Motor Development
Motor development depends upon maturation of muscular, skeletal and nervous system. It is
usually termed as gross and fine motor development.
 Gross motor development involves control of the child over his / her body by increasing
mobility. The important gross motor developmental milestones include head holding,
sitting, standing, walking, running, climbing upstairs, riding tricycle etc. It promotes
independent locomotion and proceeds fine motor activities.
 Fine motor development depends upon neural tract maturation. Initial neurological
reflexes are replaced by purposeful activities. Fine motor development promotes adaptive
activities with fine sensorimotor adjustments and include eye-coordination, hand eye co-
ordination, hand to mouth co-ordination, hand skill as finger-thumb apposition, grasping,
dressing etc. It develops as the reflexes give way to the acquisition of motor dexterity
Language Development
 Language development is the sensory motor development. It depends upon
hearing, level of understanding, power of imitation and encouragement. It is skill
of communication with development of true speech.
Personal and Social Development
 Personal and social development includes personal reactions to his own social and
cultural situations with neuromotor maturity and environmental stimulation. It is
related to interpersonal and social skill as social smile, recognition of mother, use
of toys, play and mimicry.
Sensory Development
 Sensory development depends upon myelinization of nervous system and responds
to specific stimuli. Taste, smell, touch and hearing are initial senses present in
newborn babies.
Emotional Development and Personality Development
 Emotional development and personality development is a continuous process. It is
the sumtotal of physiologic, psychologic and sociologic qualities of the individual.
Adequate guidance and problem solving at different stages help for the healthy
progress to next stage of personality development which promotes emotional
maturation in adulthood. The emotional needs include effective mothering, love,
affection, safety, security, protection, play, faith, achievement of potentialities,
guidance and counseling, independence, acceptance with positive approach,
approval, etc.
Psychosexual Development
• The sex of a child is determined genetically at the time of conception.
Development of sexuality after birth is influenced by the development
of physical, mental, emotional and sociocultural aspect of living.
Human sexuality is expressed in every day life.
• Accoriding to Sigmund Freud the development of sexuality proceeds
in different stages i.e, oral, anal, phallic, latency, puberty and geniality.
Frued’s phases of psychosexual development
• The oral stage includes roughly the period of infancy, the first year of life.
Gratification sensual satisfaction is obtained through stimulation of oral
region or sensory area of mouth as in breastfeeding and sucking.
• The anal stage includes the toddler period, the second and third years of
life. Gratification is obtained from the anal and urethral areas through
holding or expelling feces or urine.
• The phallic stage includes the preschool period, the 4th and 5th years of
life. The greatest sensual enjoyment is obtained from the genital region by
fondling the genitals. The oedipal complex develops in this stage. The child
loves and feels attraction to the parent of opposite sex and the parent of
same sex is considered as rival.
• The latency stage includes the school age from 6th to 12th year of life
(roughly). In this stage sexual interests are repressed and lie dormant.
The child develops close relationship with others of same sex and
same age. This is period of gang formation, gang loyalities and fierce.
Oedipal conflict resolved in this stage.
• The pubescent stage and adolescence include the period from 12
years of age to adulthood. In this period of puberty and genitality, the
secondary sexual characteristics appear in both sexes with experience
of romanticism and emotional changes.
• Social development or socialization is achieved through the training of the
child by meeting and communicating with peoples and participating in the
group activities.
• Intellectual development depends upon genetic inheritance and
environment influences through mental maturation and achievement of
intelligence.
• Moral development helps in formation of value system. It is not acquired
by simply following rules of society but through an internal and personal
series of changes in attitudes. Moral development parallels mental
development and consists of two stages i.e. respect for rules and a sense of
justice.
• Spiritual development is closely related to cultural background and
influences the family relationship and responsibilities. It is expressed
through religious belief, rituals, symbols specific to religious traditions and
faith.
DEVELOPMENTAL MILESTONES
KINDLY REFER TO THE PRECLINICAL SLIDES ON ‘ GROWTH &
DEVELOPMENT & DEVELOPMENTAL MILESTONES’