Growth & Development

Introduction
 Growth and Development Extends through out
the life cycle
 Principle changes occur from conception to
end of Adolescence
 Conception period is complex one. i.e. Two
cells joins and becomes one
 Important for the nurse to understand total life
cycle and behaviour to provide care for every
individual
 A knowledge of growth & development is
essential for the nurse for following reasons

1. What to expect from the child according to

the age

2. To plan for nursing management & help in

formulating plan for total care of each child

contd…
3. Understand the reason for
particular conditions and illnesses
occur in various age groups

1. To teach the parents how to

observe the children & use their
knowledge to help the children
achieve optimal growth &
development
 Definitions of Terms
 Growth : Refers to an increase in physical
size of the whole or any parts and can be measured
in inches or centimeters and in pounds or kilograms
- It results because of cell division & synthesis of
proteins

- It gives quantitative change

contd…
 Development : Refers to a progressive increase
in skill & capacity to function

- It causes a qualitative change in the child’s

functioning

- Development is orderly not haphazard

- Direct relation between each & the next

contd…
 Maturation : Refers to the development of
traits carried through the genes

- It produces an increase in competence, an

ability to function at a higher level of depending
on the child's heredity
 Concepts of Growth & Development
 The Growth & Development patterns can be
studied in two methods

- Cross Sectional method

- Longitudinal method
contd…
 Cross Sectional Method
 Many of the students of same age group studied
to establish the norms of growth and
development of specific group
 Eg ; Tests / Measurements taken from many
children in a particular age range
Scores of 3 year old Average of each
Scores of 4 year old = group considered
Scores of 5 year old as base line
 Longitudinal Method
 Individual children of large group are measured
at intervals throughout their stages of growth
and development over a period of year
 It is more difficult than Cross Sectional method
 Characteristics of Growth &
Development

 Individual Differences
 Critical periods
 Rate of Development
 Principles of Growth & Development
1. Continuous, Orderly and Sequential process
2. Growth & Development is Directional
3. Growth & Development is Unique
4. Development is related
5. Development become increasingly
differentiated
contd…
6. Development becomes increasingly integrated
and complex
7. Children are competent
8. New skills predominate
9. Development involves changes
10.Early Development is more critical than latter
11.Development is the product of Maturation &
Learning

contd...
12. Development pattern is Predictable
13. Development pattern has its own
characteristics
14. Development pattern has periods
15. There are social expectations for every
developmental periods
16. Every area of development has potential
hazards
17. Happiness varies at different periods in
development
 Stages of Growth & Development
 Prenatal period – Conception to Birth
a) Embryonic – conception to 8 wks
b) Fetal - 8wks to 40 wks
 New born - From birth to 2-4 weeks

 Toddler - 1 to 3 years

 Early child hood – 3 to 6 yrs

 Late child hood – 6 to 12 yrs

contd…
 Adolescence - Puberty to beginning of adult
life
 Early Adult hood - 18 – 25 yrs
 Middle Adult hood – 25 -40 yrs

 Late Adult hood – 40 – 60 yrs

 Old age - After 60 yrs
 Theories of Growth & Development
 Theories classified as
1.Intellectual development – Jean Piaget
2.Moral development - Jean Piaget & Kohl berg
3. Emotional development – Erik H.Erikson
4.Development of sexuality – Freud
5.Spiritual Development – James W.Fowler
 Factors influencing Growth &
Development
Factors influencing fetus Growth & Development
1. Effects of Maternal infection & Nutrition

2. Placental dysfunction

3. Fetal infection

4. Treatments of infection and drugs

5. Pre –Pregnancy infection

6. Alcohol, Caffeine, Artificial sweetners and

Smoking
contd…
7. Role of Hormones
8. Genetic Endowment
9. Ratio of surface & volume
10.Structural limitations
11.Diabetes Mellitus
12.Pregnancy Induced Hypertension ( PIH )
13.Rubella, Toxoplasmosis & Syphilis
14.Rh-Incompatability
15.Maternal Cardiac Diseases
16.Incompetent Cervix
 1.Effects of Maternal infection &
Nutrition
Maternal Nutrition affects “Fetal Programming” ie
“Fetal origin of Adult diseases”
- Alterations in fetal nutrition & endocrine status
Result in developmental adaptations
- Change in structure, physiology & metabolism
- Maternal under /over Nutrition Placental – fetal
blood flow Stunt growth
contd…
 Impaired placental blood flow

Impaired placental synthesis of nitric oxide &

Polyamines

IUGR
Promoting optimal nutrition ensure optimal
fetal growth & risk of chronic diseases in
adults
contd…
The impact of Malaria, Diarrhea, AIDS,PID, Severe
Reproductive tract infections and UTI

Affect chemical messengers – Cytokines

Suppress appetite centre in the brain

Anorexia (intake )

Malnourishment of mother

Fetal Malnutrition
 Intestinal Parasites – Ascaris

Absorption energy, Protein, Micro Nutrients (iron,

Vit-A)

Infection

Body temperature

Metabolic stress for mother itself (10%)

Fetal inadequacy
Profound changes in the distribution of
Micronutrients ( Zinc, Iron )

Transfer of nutrients affected

Defect in fetal development

Hook worm infestation

Severe loss of iron & protein

Affects intra uterine growth

Consequences of impaired maternal
nutrition
Reproduction doesn’t occur properly
Conceptus material cannot grow & develop
normally & possibly die
LBW baby
Placental size
Brain cell & head size
Size of other organs ced

contd…
Alterations in normal cell constituents &
biochemical processes

Depend on timing, severity and duration of

Malnutrition reversible hypertrophy &
irreversible hyperplasia
 2. Placental dysfunction
 Specific Infections

Alter structure of placenta

Impaired nutrient transfer

 Malarial infection of mother
delivers
LBW babies

contd…
  Ascending infections from Vagina

Attacks amniotic sac

Organisms reach maternal blood
 Placental functions

-Endocrine
-Respiration
-Digestion
-Excretion
-Protection
 3. Fetal infection
Syphilis & HIV

Transmitted across the placenta

Decreased birth weight

Herpes infection associated with IUGR
Toxoplasmosis and Cytomegalovirus
infections impact on fetal growth is not known
4.Treatments of infection and drugs
Treatments of infection by Teratogenic drugs

Cross the Placenta

Fetal growth & development affected

 5. Pre - Pregnancy infection
Under nourishment before pregnancy due to LSEB,
Poor etc.

Chance of chronic infection in child hood &

adolescent

Malnutrition deficiency of Iron, Folate, Zinc & Vit A

IUGR
 6. Alcohol, Caffeine, Artificial
sweetners and Smoking
a) Alcohol –Ethanol ( Primary Teratogen )
Depress the CNS

Interference with cardio pulmonary adaptation in

newborn

Fetal Alcohol Syndrome (FAS)

contd…
Chronic Alcoholic woman Deliver the babies
with Microcephaly, Short palpebral fissure,
Small cheek bones, Congenital heart defects,
Pre & Post natal growth deficiency, Congenital
heart defects, Congenital Hip dislocations and
other joint anomalies and altered palmar crease
pattern.
 b) Caffeine
- High levels can cause limb defects
- Alter blood flow through uterus and
placenta
- Stimulate AMP pathways in cells
contd…
 Artificial sweetners
- No clear results
- Saccharin may be carcinogenic in high levels
- Use in moderate level will not give problem
contd…
 Smoking – Nicotine

Placental blood flow & Plasma volume

Vasoconstriction of uterine circulation

Insufficient nutrition to fetus

LBW babies
contd…
 Smoking increase the risk of
-Spontaneous Abortion
-Placenta Previa
-PROM
-Sudden Infant Death Syndrome (SIDS)
-Pneumonia
-Respiratory infections
-interfere with absorption / metabolism of
Calcium, Vit B12, A, B6 and B1
 7. Role of Hormones
 Hormone in the body affect the growth some
manner

 The Hormones are

1. Somatotrophic Hormone
2. Thyroid Hormone
3. Gonad Stimulating Hormone

contd…
1. Somatotrophic Hormone
- Stimulates skeletal and protein
anabolism
- Excess gigantism
- Lack Dwarfism
2. Thyroid Hormone
- Thyrotrophic Hormone (TH),
Triiodothyronine (T3) and Thyroxine (T4)
stimulate general metabolism
- Excess liner growth
- Deficiency cretinism MR
3. Gonad stimulating Hormone
Hypothalamus

LHRH

Anterior Pituitary

In Male

Stimulate interstitial
cells of testes

Testosterone
 Hypothalamus

LHRH
Anterior Pituitary

In Female

FSH LH

Ovarian Follicle Corpusluteum

Estrogen Progesterone
contd…
 Excess in Gonad stimulating Hormone –
Precocious Puberty
 Less in Gonad stimulating Hormone –

Delayed Sexual Development

 8. Genetic Endowment
a) Hexogenes: Gives floor plan for growth and
development
Gene

Control rate of critical metabolic processes

Fetus size and shape determined

 9. Ratio of surface & volume
Food ingested

Metabolized into protoplasm

Remainder excreted as wasted

- The Ratio of Surface and Volume influence the growth

and development
 10.Structural limitations
-Thestructural limitations depends on gene
Engineering
11.Diabetes Mellitus
Type I Diabetic mothers

Maternal Blood glucose levels

Fetus gets the glucose

Fetal islets of langerhans produce insulin

To utilize available glucose

Excessive growth “macrosomia” and fat deposits

contd…
Mothers with advanced diabetes

Vascular changes

Efficiency of placental perfusion

IUGR

contd…
 Level of fetal insulin

Surfactant enzymes secretion

Respiratory distress syndrome

contd…
 Diminished ability of glycosylated Hb in
mothers blood to release O2

Polycythemia ( RBC )
 Glucose level leads to anomalies in Heart,

CNS & Skeletal system

 Sacral agenesis Incomplete
development of lower extremities
12.Pregnancy Induced Hypertension
( PIH )
 PIH

Maternal vasospasm & Hypovolemia

Fetal hypoxia

Malnutrition

SGA / Premature baby

13.Rubella, Toxoplasmosis & Syphilis
a) Rubella infection in mother
Causes fetal problems like

Congenital heart diseases, IUGR, Cataract,

Petechial rash, Hepatosplenomegaly,
Hyperbilirubinemia, MR or Cerebral palsy in
infancy
contd…
b) Toxoplasmosis
-Caused by protozoan –Toxoplasma Gondii
-Complications like Abortion, Prematurity, Still
births, Newborn deaths & Severe congenital
anomalies, Retinochoroiditis
-Neonatal disorders associated with congenital
infection include Convulsion, Microcephaly,
Coma & Hydrocephalus
-Survivors are often blind, deaf & severely
retarded
contd…
 Syphilis

- Caused by the Bacterium - Treponema palidum

- It results in Spontaneous abortion, Preterm
birth, Still birth, Neonatal death, Morbidity
- Treponema infection( afetr 4 mon)

Cross the Placenta

Infect the fetus

 14.Rh-Incompatability
Rh-ve mother + Rh+ve father

Rh-ve baby Rh+ve baby

No problem for 1st pregnancy

placenta act as a
barrier

Good outcome
 But during pregnancy any chance for FMH or
During delivery mixing of Feto Maternal blood

Reaction of immune system

Anti-D antibodies

Kill the fetus/In subsequent pregnancies

Contd…
  In subsequent pregnancies

Maternal antibody cross the placenta

Destroy fetal erythrocytes

Erythroblastosis Fetalis
 15.Maternal Cardiac Diseases
 Morbidity and Mortality with Maternal
Cardiac Diseases depends on 3 factors
1. Nature of cardiac lesion
2. Affect on the functional capacity of the heart
3. The development of pregnancy related
complications – PIH, Infection, Thrombosis
and Haemorrhage
contd…
  CCF

Altered haemodynamic state

Systemic circulation to fetus

O2 nation

Abortion, IUGR, Fetal hypoxia

And Preterm birth fetal death

 16.Incompetent Cervix
 Cervical Incompetence is painless dilatation of
the cervix 2nd or 3rd trimester allowing bulging
membranes through the cervical os into the
vagina

 Causes- Trauma, D&C, Induced abortion

 Treatment- Cervical Cerclage

Developmental Vulnerability Time Table
Weeks since Malformation
conception
3 Ectromelia, Ectopia cordis
4 Omphalocele,
Tracheoesophageal fistula, Hemi
vertebra
5 Nuclear Cataract,
Microphthalmia, Facial clefts
6 Gross septal or aortic abnormalities.
Cleft lip, Agnathia

7 Interventricular septal defects,

Pulmonary stenosis, Epicanthus, Cleft
palate, Brachyaphalism, Mixed sexual
characteristics

8 Persistent ostium primum, Digital

stunting