Growth and Development

Definitions of Growth and Development 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 continuous, orderly series of conditions that leads to activities, new motives for activities, and patterns of behavior

Principles of Growth and development

Principles of G&D Occurs in an orderly sequence Development is Directional Individualized – each child is unique Development is interrelated Development becomes increasingly differentiated. Development becomes increasingly integrated and complex

Patterns of Growth and Development Cephalocaudal Pattern (head to toe) Proximodistal Pattern (from center outward)

Periods of greatest growth A rapid pace from birth to 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

Factors that Influence Growth and Development Genetics Environment Culture Nutrition Health status Family Parental attitudes Child-rearing philosophies

Genetic influences on growth and development pattern, rate, rhythm and extent: governed by genes interplaying with environment intrauterine life extremely important in growth and healthy development of the child

Environmental influences family composition family position in society family socioeconomic status knowledge of the family availability of healthy diets housing diseases present in family and child

Cultural influences Must be considered when assessing growth and development Customs vs. work demands from different cultures

Nutritional influences Begins during the prenatal period LBW/preterm can result from poor prenatal nutrition Socio-economics may impact growth

Health status of the child Certain diseases may affect g & d Endocrine and cardiac status included here

Family / Parental Attitudes / Child-rearing Philosophy Critical in growth and development, esp. emotional growth Intellectual growth must be included here as well Chronic illness can be combated with a loving environment and close family relationships

Theories of Growth and Development Theorists Piaget Freud Erickson Just review these theorists and their theories – focus mainly on Erickson

Methods to Evaluate Growth charts: compare to norms compare to self over time xrays teeth height, weight, head circumference size of head and legs: length of bones

Methods to Evaluate Development Denver Development Test – II Play

Denver Development Test II Screening test – not a measurement of intelligence Used to - identify children whose development deviates significantly from that of other children warranting further investigation to determine if there exists a problem requiring treatment. Test covers - four general functions: personal social (such as smiling), fine motor adaptive (such as grasping and drawing), language (such as combining words), and gross motor (such as walking). Ages covered by the tests range from birth to six years.

Denver Development Test II Nursing Implications Before beginning – inform parents purpose of test. Be sure to stress it is not an IQ test. Administer test in a comfortable environment that contains only items needed for testing After testing, share information with the parent.

Play Therapy

Importance of Play Allows child the learn about themselves and relate to others….it is work for the child

Classification of Play Functional or Practice play Involves repetitive muscle movements Infant plays with objects making use of their properties to produce pleasurable effects Symbolic play Child incorporates some object, uses a theme, and then play the role that each player will have Games Includes rules and usually played by more than one person Mainly used by school-age child and helps to learn boundaries, teamwork, taking turns, and competition

Social Aspects of Play Solitary play Parallel Play Associative play Cooperative Play Onlooker Play

Solitary Play Independent play Child plays alone with toys that are very different from those chosen by other children in the area. Begins in infancy and goes through toddler age

Parallel Play Two children are displaying typical parallel play since they enjoy playing near other children, but are NOT engaging in social interactions with each other. Which cognitive and motor skills are these children developing? Usually Toddler

Associative Play Group play without group goals Even though playing with same toys, there is lack of formal organization Mostly seen in toddler - preschooler

Cooperative Play Preschoolers have well-developed language, motor, and social skills, and they can work cooperatively together on an art project, as this group is doing.

Onlooker Play Child observes others playing. Although the child may ask questions of the players, the child does not attempt to join the play

Types of Play Dramatic Play – act out roles and experiences that happened to them Familiarization Play Allows children to handle materials in non-threatening way. Helpful in preparing child for procedures.

Functions of Play Physical Development Cognitive Development Emotional Development Social Development Moral Development Play enhances the child’s growth and development and contributes to these areas: Physical development: they do as they see….story about learning fine and gross motor activitiy. They repeat certain movements and these in turn aid in the development of body control. For instances, jumping, grashing, walking Cognitive Development: they increase their problem-solving abilities through games and puzzles. Reading to the very young child increases their desire to see pictures, and eventually they can repeat a sequence in a familiar story….examples? Emotionsal development: learning that mom will be back; play can provuide a way of escape for an emotionally frightening situation; also increases the child’s self-awareness by role playing. Social development: learning to play with others, sharing, joy of interacting with others and behaviors that involve others. Peers eventually replace the importance of parents as the child matures. Moral development: they begin to learn which behaviors are acceptable and which are not…the extremely moralistic children are those school-aged, esp. as they approach middle school. They momic what they have learned at home; what is done at home, or taught, is the morally right thing to do. They learn that taking turns is rewarded and cheating is not. This is when they have on their report cards “good citizenship” or “respects others”. Some schools recognize “principal pride” awards, or ___traits, whereby the child is recognized for integrity, attentiveness, respect for others, etc. And is attached to the record of grades.

Nutrition

Nutritional Assessment A nutritional assessment is an essential component of the health examination of infants and children.

Key Dietary Recommendations Consume whole grains Children 2-8 should consume 2 cups of low-fat milk or equivalent milk products and children 9 years and older should consume 3 cups Limit juices, eat fruit and vegetables each day Watch fat intake. Polyunsaturated and monounsaturated fatty acids such as fish, nuts, and vegetable oils should be the primary source

My Pyramid Eat Right. Exercise Have Fun

Nutrition and Activity Due to increase in childhood obesity, parents should encourage their children to increase daily physical activity. Plan regular periods of exercise Make exercise a fun and habitual activity.

Growth and Development Milestones

INFANT BIRTH TO 12 MONTHS

Physical Growth and Development Milestones During Infancy Birth to 1 month

Infancy 2-4 months

Infancy – 4-6 months

Infancy - 6-8 months

Infancy - 10-12 months

Summary of key points - Infant Nursing Interventions Encourage parents to hold and stay with infant. Provide opportunities for sucking. Provide infant with toys that give comfort or stimulate interest Developmental milestones Rolls over; Sits up; Stands. Able to say one to two words. Uses pincer grasp well.

Milestones in Infant Communication 1-3 months Reflex smile that becomes more voluntary and reciprocal 3-4 months Babbling, crying more differentiated 4-6 months Squealing, playing with sound, identifying parent’s voice 6-8 months Single-consonant babbling, increasing interest in sound 8-9 months Stringing of vowels and consonants, use of some words 9-12 months Vocabulary of two to three words, use of gestures

TODDLER 1-3 years

Developmental milestones for Toddler

Summary of Key points - toddler Nursing Interventions Maintain toilet-training procedures. Encourage appropriate independent behavior. Give short explanations. Provide rewards for appropriate behaviors. Developmental milestones Walks up and down stairs; Kicks a ball. Undresses self. Scribbles on paper. Has a vocabulary of 1000 words and uses short sentences.

Pre-schooler 4-5 years of age

Milestones for the Preschooler

Summary of Key points - preschooler Nursing Interventions Encourage parents to be involved in care of child. Provide safe versions of medical equipment for playtime. Give clear explanations about procedures and illnesses. Milestones Uses scissors. Rides bicycle with training wheels. Throws a ball. Writes a few letters. All parts of speech well-developed.

School-age Child 6-12 years old

Developmental Milestones – School-age

Summary of Key points – School-age Nursing Interventions Provide for privacy and modesty. Explain treatments and procedures clearly. Encourage continuation of school work. Milestones Possesses reading ability. Rides a two-wheeled bike. Jumps rope. Plays organized sports. Mature use of language.

Adolescent age 12-21 years

Adolescent Psychosocial development Independence Identity Peers Language use Exploration and rebellion Need for privacy Sexuality Cognitive development Formal operations Abstract thinking

Summary of Key points – Adolescent Nursing Interventions Provide privacy. Interview and examine adolescent without parents present, if possible. Encourage adolescent participation in treatment and decision making. Encourage visitation of peers. Milestones Fine motor skills well-developed. Gross motor skills improve due to growth spurts. Able to apply abstract thought and analysis.