1. Growth and Development

2. 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

3. Principles of Growth and development

4. 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

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

6. 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

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

8. 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

9. 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

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

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

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

13. 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

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

15. 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

16. Methods to Evaluate Development
Denver Development Test – II
Play

17. 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.

18. 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.

19. Play Therapy

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

21. 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

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

23. 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

24. 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

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

26. 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.

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

28. 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.

29. 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.

30. Nutrition

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

32. 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

33. My Pyramid Eat Right. Exercise Have Fun

34. 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.

35. Growth and Development Milestones

36. INFANT
BIRTH TO 12 MONTHS

37. Physical Growth and Development Milestones During Infancy Birth to 1 month

38. Infancy 2-4 months

39. Infancy – 4-6 months

40. Infancy months

41. Infancy months

42. 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.

43. 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

44. TODDLER
1-3 years

45. Developmental milestones for Toddler

46. 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.

47. Pre-schooler
4-5 years of age

48. Milestones for the Preschooler

50. 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.

51. School-age Child
6-12 years old

52. Developmental Milestones – School-age

53. 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.

54. Adolescent age
12-21 years

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

56. 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.