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Growth & Development: Mary Lourdes Nacel G. Celeste, RN, MD Ellen H. Tinio, RN, MD
Growth & Development: Mary Lourdes Nacel G. Celeste, RN, MD Ellen H. Tinio, RN, MD
PEDIATRIC NURSING
Growth & development are occasionally
used interchangeably but they are totally
different .
Growth : generally used to denote an increase
in physical size (quantitative change)
wt--- kg ht ---cm
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Development
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Denver II TEST
(Denver developmental screening test II)
125 easily administered developmental test
items, with age norm, presented in a
convenient one-page format
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Principles of Growth & Development
1. G & D is a continuous process
- continuous process from conception until death
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3. Each child is unique.
- Different children pass through the predictable stages at
different rates.
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G & D follows a trend or pattern:
I. Directional Trends – occur in regular direction
reflecting the development of neuromuscular
function. This apply to physical, mental, social &
emotional development and includes:
a. Cephalocaudal
b. Proximodistal - proceeds from proximal to
distal body parts
c. Symmetrical
d. Mass to specific differentiation – child learns
from simple operation before complex function
- from gross to refined skills
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G & D follows a trend or pattern:
I. Directional Trends
II. Sequential trend – predictable sequence:
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Principles of Growth & Development
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Types of development
psychosexual development
psychosocial development
moral development
cognitive development
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1.Psychosexual development- specific type of development
that refers to developing instinct or sensual pleasure
(Freud)
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4. Cognitive development- refers to the ability to learn or
understand from experience, to acquire and retain
knowledge, to respond to new situation, to solve
problem (Piaget)
measured by intelligence tests, and by observing a
child’s ability to function effectively in his/her
environment
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Theories of Growth & development
FPEK
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Summary of Theories
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Sigmund Freud
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Sigmund Freud
Phallic phase ( 3y-6y)
Genitals : site of gratification
Masturbation & fantasy of life
Activity of infant : shows exhibitionism
Love of opposite sex (Parents oedipal complex/ electra
complex)
increased knowledge of sex
Ego development
Reason for sucking : enjoyment & release tension
N.I : Accept child fondling his/her own genitalia as
normal exploration
o Accept sexual interest and answer questions about birth or
sexual difference
o Answer child question directly
o Resolved conflict : child identifies with the parents of same
sex
PRESCHOOL : right age to introduce sexuality
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Sigmund Freud ( Psychosexual)
Latent ( 7-12 y)
Sexual drive depresses
Period of suppression
Child libido or energy is diverted to more
concrete type of thinking; libido diverted to
school
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Sigmund Freud
Genital ( 12-20y)
His/her BODY is the site of gratification
Develops satisfying sexual and emotional
relationships with members of the opposite
sex
Achieves sexual maturity
Individual plans life goals & gain a strong
sense of personal identity.
NI: provide opportunities to relate w/
opposite sex; verbalization about new
feelings
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OVERVIEW OF ERIKSON’S DEVELOPMENTAL TASKS THROUGHOUT THE
LIFESPAN
Age Stage Erikson’s Positive Outcome Negative Outcome
Task
Birth to Infancy Trust vs. Trusts self and others Demonstrates an
18 mos Mistrust inability to trust;
withdrawal, isolation
18 mos Toddler Autonomy Exercises self-control and Demonstrates defiance
to 1 y vs. Shame influences the and negativism
and Doubt environment directly
3 to 6 y Preschool Initiative vs. Begins to evaluate own Demonstrates fearful,
Guilt behavior; learns limits on pessimistic behaviors;
influence in the lacks self-confidence
environment
6 to 12 y School age Industry vs. Develops a sense of Demonstrates feelings
Inferiority confidence; uses of inadequacy,
creative energies to mediocrity, and self-
influence the doubt
environment
12 to 20 Adolescenc Identity vs. Develops a coherent Demonstrates inability
y e Role sense of self; plans for a to develop personal
confusion future of work/education and vocational identity
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Erik Erikson ( Psychosocial)
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Erik Erikson ( Psychosocial)
Autonomy vs. Shame & Doubt -
( 18 mos-3 y) toddler
A: build on new motor and mental abilities, take
pride in accomplishments
S: doubt and stop trying
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Erik Erikson ( Psychosocial)
I: how to do things
G: limited brainstorming and problem-solving skills
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Erik Erikson ( Psychosocial)
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Erik Erikson ( Psychosocial)
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Stages of Cognitive
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Stages of Cognitive
Preoperational (2-7 y )
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Stages of Cognitive
Concrete ( 7-12 y )
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LAWRENCE KOHLBERG
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Level 1 (Pre-Conventional)
1. Obedience and punishment orientation (2-3Y)
(How can I avoid punishment?)
2. Self-interest orientation (4-7Y)
(What's in it for me?)
Level 2 (Conventional)
3. Interpersonal accord and conformity (7-10Y)
(The good boy/good girl attitude)
4. Authority and social-order maintaining orientation ( 10-12Y)
(Law and order morality)
Level 3 (Post-Conventional) (>12Y)
5. Social contract orientation
6. Universal ethical principles
(Principled conscience)
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UNDERSTANDING THEM!
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Stages of Growth and Development
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Developmental Assessment
Domains assessed:
cognitive
motor
language, social / behavioral
adaptive
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infant
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DAILY CARE
- bathing
- diaper care
- care of teeth
- dressing
- sleep – 16-20hrs/day;
- 6 mos- 1-2 naps, with
12h at night
- 12 mos old; 1 nap with
12h at night
- exercise
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Gross Motor Development
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Head Control
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Sitting up
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Sitting Up
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Ambulation
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Ambulation
13 month old
Nine to 12-months
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Fine Motor - Infant
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Speech Milestones
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Fine Motor Development
6-month-old
12-month-old
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** Best color for neonates: black & white
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TODDLER – 1 –3 yo
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DEVELOPMENTAL MILESTONE
Toddler ( 1-3 y )
Physical Growth Weight : 2 ½ y = BW quadrupled
Height : adult Ht 2x Ht at 2 y
HC>CC
2 ½ yrs old = Primary dentition completed ( 20 teeth)
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Fine Motor – Older Toddler
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Toddler
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Toddler
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Toddlers
Communication :
o Approach cautiously
o Accept verbal communication literally
o Learn the toddler words for common item
and use them in conversations.
o Use short & concrete terms
o Repeat explanation and description
o Use play for demonstration
o Use visual aids
o Explain and allow to handle equipment to use
o Encourage to use comfort object
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Toddlers
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Temper Tantrums-in order to control self
& others. Mx: IGNORE THE BEHAVIOR
or direct them to activities they can
master.(When things are rearranged or
are strange; or when persons or places
are unfamiliar)
Accidents because they are naturally
active, mobile & curious –(set limits &
exert external control) .
LOVE & CONSISTENCY are the 2 most
important concepts in child rearing.
EGOCENTRIC – uses “ MINE “ for everything
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Issues in parenting - toddlers
Stranger anxiety – should dissipate by age 2 ½ to 3
years
Temper tantrums: occur weekly in 50 to 80% of
children – peak incidence 18 months – most
disappear by age 3
Sibling rivalry: aggressive behavior towards new
infant: peak between 1 to 2 years but may be
prolonged indefinitely
Thumb sucking
Toilet Training
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Toddlers
Characteristic traits
o Loves toilet training
o Failure of toilet training – unreadiness
Clues for readiness
Can stand, squat alone
Can communicate toilet needs
Can maintain dry for 2H
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NUTRITION
Decrease in appetite because of the
slow growth rate
Picky eaters, dawdling with meals
1, 300 kcal/day
Allow self feeding
Allow choice between 2 types of food
Offer finger food, appetite of 3 year
olds is more capricious than that of 1
year olds
Risk of aspiration
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DAILY CARE
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REACTION TO ILLNESS and NURSING
INTERVENTIONS
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Hygiene – allow choice of bath time toy,
allow to put toothpaste
Stimulation
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NOTES:
1. Accidents are the chief cause of death in
toddlers. Most accidental deaths in children
under age 3 years are related to MOTOR
VEHICLE ACCIDENTS.
2. When caring for a toddler in the hospital,
the nurse should prevent SEPARATION
ANXIETY by encouraging rooming-in. To
help the toddler deal with frustration & loss
of autonomy, the nurse should provide the
toddler with a POUNDING BOARD or
PUNCHING BAG.
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3. SECURITY OBJECT – something a toddler
becomes strongly attached to like doll, stuffed
animal, pillow or blanket; if separated from the
security object, the toddler usually reacts with
extreme frustration & anxiety.
4. The DENVER DEVELOPMENT SCREENING
TEST is used to screen the development of toddlers.
( ex. Most toddlers can remove their own clothes
between 12 & 18 mos. And put their own clothes
between 19-24 mos.
5. Turn pot handles in when on stove top.
6. Poisoning: most common in 2 year olds
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Consider every non food substance a
hazard and place out of child’s sight/
reach.
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PRE SCHOOL 3-5 yo
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DEVELOPMENTAL MILESTONE
PRESCHOOL ( 3-6 y )
Physical Growth First permanent teeth are molar
Visual acuity 3y = 20/30 ; 4 y = 20/20
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Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself
Pre-school tasks
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NUTRITION
Slow/Steady growth
Decreased appetite
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DAILY CARE
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Red flags: preschool
Lack of socialization
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Pool Safety
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Preschooler characteristic traits
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PRE-SCHOOL
Communication
Offer choices
Speak in simple sentences
Be concise and limit length of explanation
Allow asking question
Described procedure about to be performed
Use play to explain procedure & activities
Allow handling equipment
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REACTIONS/CONCERNS IN
ILLNESS AND NURSING
INTERVENTIONS
- fear of the dark – allow dim light and
parent to sit beside child
- Fear of body mutilation - Prepare for
and explain procedure; reassure
- Fear of injury, pain and the unknown -
Encourage expressive play/medical
play
- Fear of separation/abandonment –
relate time and space to familiar
situations
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- nutrition – food in animal/alphabet
shapes
- dressing change – allow to measure,
cut tape, see incision site
- medication – allow to choose “chaser”
- hygiene – allow choice of toys, wash
hands and face
- pain – allow pain expression, handle
syringe, analgesic
- stimulation
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School Age 6– 12 yo
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DEVELOPMENTAL MILESTONE
SCHOOL AGED ( 6-12 y )
Physical Growth Ht = 2 inch/yr
Vision completely matured
Lymphoid tissue hypertrophy
Ability to perform complex movement
7 y = complete Myelinization
Gross & Fine
motor
9-12 y = uses tool and equipment , follows direction
enthusiastic at work & play.
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School Years: fine motor
Writing skills improve
Fine motor is refined
Fine motor with more focus
Building: models – legos
Sewing
Musical instrument
Painting
Typing skills
Technology: computers
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School performance
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Red flags: school age
School failure
Lack of friends
Social isolation
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School Age: gross motor
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School Age
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School Age: cognitive
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SCHOOL
Communication
Establish limits
Provide reassurance to help in alleviating
fears and anxieties
Engage in conversations that encourage
thinking.
Use medical play technique
Use photographs, books, doll and videos to
explain procedures
Explain in clear terms
Allow time for composure & privacy.
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Traits
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DAILY CARE
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CONCERNS
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REACTION TO ILLNESS
AND NURSING INTERVENTIONS
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1. nutrition – allow choices
2. dressing – ask opinions on bulk of
dressing and where to apply tape
3. medicine – teach name and action,
allow to choose form if possible
4. pain – allow expression of pain, explain
source and cause
5. stimulation
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ADOLESCENT (13-20 y)
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13 to 18 Year Old
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Adolescent
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Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide
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Adolescents
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Adolescent Teaching
Relationships
Sexuality – STD’s / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons
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Adolescents
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Adolescent
Fear
Obesity
Acne
Homosexuality
Death
Replacement form friends
SIGNIFICANT PERSON : Opposite sex
Traits
o Idealistic
o Rebellious
o Reformers
o Conscious with body image
o Adventure some
Problem :
o Vehicular accident, smoking, alcoholism, drugs
o Premarital sex
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GROWTH AND DEVELOPMENTAL
MILESTONES
13 yo – sports
15 yo - enjoys privacy
- stays in room
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Pubertal development:
a. Female: pubertal changes start between
ages 8 and 13 years and changes take place
for 3 to 4 years. Breast development
commonly precedes pubic hair development.
Most girls reached adult height midway
through puberty.
b. Male: pubertal changes start between age 9
½ and 13 ½ years and changes take place for
about 3 years. Testicular enlargement is
usually the first sign of male pubertal
development. Most boys reached adult height
during the latter half of puberty.
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Pubertal development
sign of sexual maturity
BOYS GIRLS
Testicular
enlargement Breast bud
(9 ½ y) (thelarche)
Pubic/axillary
hair Pubic hair
Growth spurt
Voices Growth spurt
changes
Menarche
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Hospitalized patient :
What will I do ????
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DEVELOPMENTAL STAGES
Hospitalized Pediatric patients
Infant & toddlers ( 0-3 y )
Separation anxiety
o Protest – crying, screaming, kicking, verbal
attack
o Despair- withdrawn, depressed
o Detachment-only after lengthy separation
C. loss of control
Toddler Parallel
1-3 years plays alongside, but not with another;
has not learned sharing yet
Preschool Associative
3-6 years plays in random without group goal;
follows a leader
School Age Cooperative
6-12 years
Adolescence Competitive
13-20 years
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PLAY
Infancy Toddler Preschool School age Adolescence
(0-1y) (2-3y) (3-6y) (6-12) (13-20y)
Solitary Parallel Cooperative Competitive Competitive
-Rene Descartes-
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-end-
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