COMMUNITY BASED

REHABILITATION
1 PRESENTED BY
NURSES’ AND MIDWIVES’ TRAINING COLLEGE
TAMALE

ABUKARI IBRAHIM
DIP. IN NURSING,AMPN,BSC.
NURS.
NMTC,TAMALE
 CONCEPTS OF CHILD
DEVELOPMENT

NMTC,TAMALE
 INTRODUCTION
• Child development is sequential in nature; i.e there is often a
hierarchy of skills from which milestones can be determined.

• Developmental skills are achieved sequentially following a remarkably

consistent pattern, there is however a wide normal range.

NMTC,TAMALE
 • It is a continuous process, cumulative and directional.
• It is a continuous process with a predictable sequence, yet having a
unique course for every child.
• It does not progress at the same rate and each stage is affected by the
preceding developmental experiences.

NMTC,TAMALE
 Examples of Pace of Growth
• A rapid pace from birth to 1 ½-2 years
• A slower pace from 2 years to puberty
• A rapid pace from puberty to
approximately 15 years
• A sharp decline from 16 years to approximately 24 years when full
adult size is reached

NMTC,TAMALE
 A continues course

NMTC,TAMALE
 7 pediatric age groups during childhood
According to
• the anatomical characteristic
• physiological characteristic
• psychological characteristic

fetus infant toddler pre-school school adolescence

NMTC,TAMALE
 • Because these developmental changes may be strongly influenced by
certain factors such as genetic and events during prenatal life,
• genetics and prenatal development are usually included as part of the
study of child development.
• It is both a quantitative and qualitative process

NMTC,TAMALE
 Child development
• Refers to the stages of biological, psychological and emotional
changes that occur in human beings between birth and the end of
adolescence, as the individual progresses from dependency to
increasing autonomy (Wiki, 2016).

NMTC,TAMALE
 Definition cont’
• It is the stages of physical, psychological and social growth and
attainment that occurs from birth to adulthood.

NMTC,TAMALE
 Human growth and development
• Human growth and development are orderly predictable processes
that begin from conception and continue throughout life. They are
two different phenomena which are inseparable.
i. Growth
ii. Development

NMTC,TAMALE
 • Growth refers to the increase in size and structure in both external
and internal organs, that is, the measurable aspects of the individual
like weight and height (quantitative change).
• Development refers to the observable aspects of the progressive
changes in the individual such as, acquisition of functions and skills
(qualitative change).

NMTC,TAMALE
 • Growth
• Increase in physical size of a whole or any of its parts, or an increase in
number and size of cells: Growth can be measured .

• Development
• A progressive (continuous), orderly series of changes (conditions )that leads
to activities, new motives for activities, and patterns of behavior that gives
qualitative results.

NMTC,TAMALE
 • Growth refers to an increase in physical size of the whole body or any
of its parts. It is largely attributed to multiplication of cells and increase
in the intracellular substance.
• Development refers to a progressive increase in the skills and
capacity to function.
• An increase in function and complexity that occurs through growth,
maturation, and learning e.g. The process of language acquisition.

NMTC,TAMALE
 Development
• Development becomes increasingly complex as the child matures. It is
a qualitative change in the child’s functioning, more challenging to
measure objectively.
• It can be measured through observation. Includes acquisition of gross
and fine motor skills, personality, and mental development.
• Development is the sequential process by which infants and children
gain various skills and functions

NMTC,TAMALE
 Maturation
• Maturity marks the end of growth and development, characterized by
completion of structural changes, and attainment of capacity
functions physically and mentally.

• Indicates an increase in competence and ability, making it possible to

function at a higher level.

NMTC,TAMALE
 • It is the physical change in the complexity of body structures that
enables a child to function at increasingly higher levels.
• The level of maturation depends on child’s heredity.
• Maturity is programmed genetically and may occur as a result of
several changes

NMTC,TAMALE
 Characteristics of Growth and Development
• Every child has a unique pattern of growth and development but all
children follow certain predictable characteristics which are that:
i. Growth and development are similar for all
ii. Growth and development proceeds from general to specific:
iii. Growth and development are contineous
iv. Growth and development proceed at different rates:

NMTC,TAMALE
 Growth and development are similar for all
• This means that all children follow a similar pattern of growth and
development, with one stage leading into the next.
• For instance, all babies’ weights and heights increase from birth to
maturity, and also all babies learn to sit before they walk.

NMTC,TAMALE
 • In no instance do you see any child walking before learning to sit, or
reducing in height despite individual variations. The child who is even
premature may lag behind for about a year, but after that catches up
to the norm, and follows the same pattern.

NMTC,TAMALE
 Growth and development proceeds from
general to specific
• In mental as well as motor responses, general activities always
precede specific activities.
• Before birth, the foetus moves its whole body but incapable of
moving only the head.
• Even after birth, the child first responds to strange or unusual objects
with a general fear, later this fear becomes more specific.

NMTC,TAMALE
 • For instance a young child who happens to fear a dog sees any four
legged animal as a dog and will scream at seeing any such animal.
• Later he is able to differentiate and so his fear becomes specific to
dogs

NMTC,TAMALE
 Growth and development are contineous
• Growth and development are continuous from the moment of
conception to death.
• From conception, the number of cells continues to increase to form
tissues, organs and systems.
• When the individual is born he develops through the foetal and
neonatal stages, infancy, childhood, adolescence and adulthood. Due
to this, what happens at one stage of development has an influence
on the next stage.

NMTC,TAMALE
 • Similarly, emotional tension in the home will affect the young child‘s
developing personality, which will be reflected in certain personality
scars, even though his later home environment may be relatively free
from physical danger, stress or tension.

NMTC,TAMALE
 Growth and development proceed at different
rates
• The rate of growth and development is not uniform for individual
organs.
• During any one cycle of growth, the various body parts do not grow
symmetrically and so changes occur in the body proportions at
different ages.
• In early life, because the nervous system is growing rapidly, the head
is large in proportion to the rest of the body; later the extremities
grow more rapidly than the trunk and both of them grow faster than
the head.

NMTC,TAMALE
 • Different internal organs, likewise, reach their matured level at
different times.
• For instance, the heart and liver as well as genital organs grow slowly
in childhood but rapidly during the early years of adolescence.

NMTC,TAMALE
 Directional Pattern for Growth and Development
1. cephalo-caudal
2. proximo-distal patterns.

NMTC,TAMALE
 Cephalo-caudal pattern
• With this pattern, growth spreads over the body from the head to the
foot.
• This means, improvements in structure and function come first in the
head region, then in the trunk and lastly in the leg region.
• Therefore as the baby grows, when placed in the prone position he is
able to raise his head, then the neck before the chest.

NMTC,TAMALE
 Proximo-distal pattern
• With this, growth and development proceed from near to far, that is,
from the central axis of the body to the extremities.
• The baby can use his arms and hands before he can control the
movement of his fingers or hold things with the fingers.

NMTC,TAMALE
 Growth pattern

NMTC,TAMALE
 DIFFERENCES BETWEEN GROWTH AND DEVELOPMENT
GROWTH DEVELOPMENT

Refers to increase in size, length etc. usually focuses on purely Is the overall change in shape, form or structure resulting in
physical sense improved working or function.

Changes in quantitative aspect come into the domain of growth Changes in qualitative character is the focus

It is a part of developmental process It is a comprehensive term and refers to the overall changes i
individual

It does not continue throughout life. It stops when maturity has It continues throughout life and it is progressive
been attained

Growth involves body changes Development involves changes of an orderly, coherent tendin
towards the goal of maturity

Changes produced by growth are the subject of measurement. The Development implies improvement in functioning and behav
GROWTH AND DEVELOPMENT -WUNI 5/31/2023
may be quantified and hence bring qualitative changes
NMTC,TAMALE
 Factors Influencing Growth And Development
• Several factors that affect growth and development are both genetic
and environmental;
• the environment inside the mother‘s womb and the environment the
child is born in to or develops in.

NMTC,TAMALE
 Hereditary Factors
• Genes which are in the chromosomes are passed on to the individuals
from parents at the time of conception.
• The size of the parent will most often influence the size of the child.
• This may result in some members of the same family lines growing
rapidly and are heavily built, while others grow slowly and are
smallish in stature.
• Certain abnormal genes such as sickle cells are also inherited from
family lines.

NMTC,TAMALE
 • It is not possible to change genetic influence once it has established,
however,
• the nurse can use this knowledge to prevent couples who have
genetic traits or abnormalities from marrying to prevent the fusion of
abnormal genes that may result in genetic abnormalities in the child,
which consequently affects the growth and development of the child

NMTC,TAMALE
 Internal Environmental
• This refers to the prenatal environment.
• The health of a baby is closely related to what happens to him/her in
the mother‘s womb.
• For instance, Nutrition of the mother, maternal infections and
diseases, drugs used during pregnancy, maternal emotions and
certain environmental substances influence the development of the
foetus.

NMTC,TAMALE
 NOTE
• The first three months of foetal life are critical.
• It is the period during which different organs and body parts form,
and so any interference with this process may lead to congenital
malformations.

NMTC,TAMALE
 • Maternal Nutrition
• The foetus depends on the mother for nourishment to develop.
• A poorly nourished mother during pregnancy will deliver an
unhealthy baby whose development will be affected since the foetus
uses nutrients to develop.

NMTC,TAMALE
 • Maternal Illness
• Most illnesses of the mother during pregnancy affect the
development of the foetus.
• Malaria infection of the mother during pregnancy results in infection
of the placenta which is transferred to the foetus to cause low birth
weight of the baby or even abortion.

NMTC,TAMALE
 • Diseases like German measles, syphilis can cause destruction of vital
organs of the foetus resulting in congenital abnormalities, which may
include cleft lip and palate, spina bifida, etc

NMTC,TAMALE
 • Again, pregnant woman who is infected with gonorrhoea if not
treated before delivery can infect the child‘s eye through the birth
canal (from the infected vaginal discharge), to cause ophthalmia
neonatorum with consequent blindness if not well treated.

NMTC,TAMALE
 • Drugs
• Drugs like thalidomide which was effective for excessive vomiting, is
an example of a teratogenic drug. When drug such as tetracycline is
taken during pregnancy, it causes yellow teeth in the child.
• Excessive alcohol intake in a pregnant woman may cause foetal
alcohol syndrome which causes growth restriction (Fraser and
Cooper, 2003).

NMTC,TAMALE
 • Exposure To Ultraviolet Rays
• Prolonged exposure to ultraviolet rays like x-rays during pregnancy
can also cause congenital malformations.

NMTC,TAMALE
 External environment
• When the physical environment of the child is clean, well ventilated,
has good water supply, good social amenities and good food, the child
develops better than the child whose physical environment lacks any
of the factors mentioned.

NMTC,TAMALE
 • When the child‘s emotional needs like love and security are provided,
it helps to build the child‘s emotions and he is able to adjust and
respond well to the challenges of life, thereby helping in proper
growth and development.

NMTC,TAMALE
 • The cultural setting in which the child is brought up also influences his
development.

• As we have mentioned earlier, certain cultural practices could

influence the growth and development of the child either positively
or negatively.

NMTC,TAMALE
 • Social factors such as education, level of income, religion and
opportunities for obtaining health care, as well as health beliefs and
practices, all influence the growth and development of the child.

NMTC,TAMALE
 Developmental Milestone of the Child
• This refers to the child‘s motor, cognitive and behavioural ability at
each stage of development.
• It is important for the nurse to have knowledge on these so that any
deviations could be identified early and appropriate measures taken
to prevent disabilities and other developmental problems.

NMTC,TAMALE
 Assignment
• With the aid of a table use the following headings to make a
developmental milestone of a child from birth to one year using
Guillermo R. Blanco (1979) chart.

i. Age
ii. Motor activity
iii. Behaviour
iv. Social outlook

NMTC,TAMALE
 CHARACTERISTIC AND BEHAVIOURS AT EACH
OF STAGES OF DEVLOPMENT
• Human development can be grouped sequentially as follows;
1. Prenatal stage
2. Neonatal period
3. Infancy period
4. Toddler age
5. Preschool age
6. School age
7. Adolescence

NMTC,TAMALE
 Prenatal stage
• This is the period from conception to birth. Or It is the formative
phase in human development which ends with the body parts in their
initiation stages.
• t is marked by three distinct stages as follows;

NMTC,TAMALE
 Prenatal stage
• 1. The zygotic stage from conception to implantation (12 – 14 days)
• 2. The embryonic stage from implantation to 8weeks: This is the most
delicate stage and efforts must be taken to avoid exposure to
teratogens.
• 3. Foetal stage from nine weeks to birth (40 – 42weeks)

NMTC,TAMALE
 Neonatal period
the period from the tying of umbilical cord to 28
days of life

NMTC,TAMALE
 • Head circumference 2.5 cm greater than chest circumference
• Length ¼ that of the total body
• Weak neck muscles( support head when lifting.
• Brain growth is through mylinization
• behaviour under reflexes.
• Vision poor, hearing developed

NMTC,TAMALE
 • Stimulated by rocking, cuddling and listening
• Breast engorgement
• 30-60 beats per minute
• Note:
• Limit exposure when bathing
• Cover head
• Dress them slightly warm

NMTC,TAMALE
 Infancy period
This period starts from birth to less than 1 year age

NMTC,TAMALE
  The baby grows most rapidly .
 Baby weight increases 3 times more than the birth weight .
 Height increases 1.5 times compared with the birth height .
 Every organ system continues developing and completing .
 high daily demands for energy and protein .
 Gastrointestinal function is not completely developed .
 rickets , anemia , malnutrition , and diarrhea .
 Maternal immunity gradually disappears , but auto-immunity is not mature .

NMTC,TAMALE
 • Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand by age 1 year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.

NMTC,TAMALE
 6months sitting up
2 months old: needs assistance
 6 months old: can sit alone in the tripod position
 8-9 months old: can sit without support and engage
in play

NMTC,TAMALE
 Ambulation
1 year: stand independently from a crawl position
 13 month old: walk and toddle quickly
 15 month old: can run

NMTC,TAMALE
 Toddler age
• the period from 1 year to less than 3 years age

NMTC,TAMALE
 • Growth and development are slower.
• Egocentric
• Pulse reduces to 100bpm
• Respiration within 100 bpm
• Rapid development in language , thoughts , and ability to respond to
people and objects.
• Accidental injury , road traffic injury and poisoning .

NMTC,TAMALE
 Characteristics
The infancy stage is a period of complete dependence on
adult’s.
Followers of parents anywhere
Bedtime is a dissertation
Separation anxiety
Fear of darkness
Solitary play
The most important factor for young infants is security
with primary caregivers.

NMTC,TAMALE
  They say a lot of the word NO
 UNDERSTANDS “bye bye”
 Show curiosity
 Good imitators
 Well organized with toilet training
 Point and mention body parts
 Climb stairs

NMTC,TAMALE
 • Feed themselves
• Rides tricycle
• The have tantrums
• Ovoid over criticizing

NMTC,TAMALE
 Preschool age
• the period from 3 years to 6～7 years of age

NMTC,TAMALE
 • Intelligence development increases.
• Understanding capacity gradually enhances.
• Studying simple alphabets , drawings and songs.
• Language is ecocentric and it is to Boast a lot
• Enjoys role play and cooperate play
• Afraid of blood
• Learns rules

NMTC,TAMALE
 • Uses three or four words
• Vision is still maturing
• Boys may start masturbating

NMTC,TAMALE
 School Age
• the period from 6～7 years to the starting of adolescence phase
(10 years for girls , 12 years for boys)

NMTC,TAMALE
 • Gross and fine motor development characterized by children's ability
to perform controlled movements and sequence motor skills.
• Greater reasoning, problem solving and vocabulary increases at a
rapid pace.
• their written communication skills develop.
• begin to understand others' perspectives and are concerned with
fairness, and monitor their own behavior.

NMTC,TAMALE
 ADOLESCENCE
• girls aged 10～11 to 17～18 years
• boys aged 12～13 to 18～20 years
• the second-peak of growth after infancy
• This is the period of remarkable development in which children
assume adult roles.
• Abstract thought begins to develop with the ability to test
hypotheses and manipulate more complex concepts.

NMTC,TAMALE
 • It is a transitional period between childhood and adulthood (early
adulthood) characterised by;
i. Rapid physical growth (height and weight)
ii. Pursuit of independence and identity
iii. Thoughts are more logical, abstract and idealistic

NMTC,TAMALE
 THANKS FOR THE
TIME

NMTC,TAMALE
NMTC,TAMALE