1. Growth and Development

2. Definitions of Growth and Development n n Growth n n 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 n n Development n n 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 n n Occurs in an orderly sequence n n Development is Directional n n Individualized – each child is unique n n Development is interrelated n n Development becomes increasingly differentiated. n n 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 n n A rapid pace from birth to 2 years n n A slower pace from 2 years to puberty n n A rapid pace from puberty to approximately 15 years n n A sharp decline from 16 years to approximately 24 years when full adult size is reached

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

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

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

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

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

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

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

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

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

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

17. Denver Development Test II n n Screening test – not a measurement of intelligence n n 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. n n 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). n n Ages covered by the tests range from birth to six years.

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

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

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

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

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

24. 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? Parallel Play Usually Toddler

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

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

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

28. Types of 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.

29. Functions of Play n n Physical Development n n Cognitive Development n n Emotional Development n n Social Development n n Moral Development

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

32. Key Dietary Recommendations Key Dietary Recommendations n n Consume whole grains n n 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 My Pyramid Eat Right. Exercise Have Fun

34. Nutrition and Activity Nutrition and Activity n n Due to increase in childhood obesity, parents should encourage their children to increase daily physical activity. n n Plan regular periods of exercise n n 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 - 6-8 months

41. Infancy - 10-12 months

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

43. n n 1-3 monthsReflex smile that becomes more voluntary and reciprocal n n 3-4 monthsBabbling, crying more differentiated n n 4-6 monthsSquealing, playing with sound, identifying parent’s voice n n 6-8 monthsSingle-consonant babbling, increasing interest in sound n n 8-9 monthsStringing of vowels and consonants, use of some words n n 9-12 monthsVocabulary of two to three words, use of gestures Milestones in Infant Communication

44. TODDLER 1-3 years

45. Developmental milestones for Toddler

46. Summary of Key points - toddler n n Nursing Interventions n n Maintain toilet-training procedures. n n Encourage appropriate independent behavior. n n Give short explanations. n n Provide rewards for appropriate behaviors. n n Developmental milestones n n Walks up and down stairs; Kicks a ball. n n Undresses self. n n Scribbles on paper. n n 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 Summary of Key points - preschooler n n Nursing Interventions n n Encourage parents to be involved in care of child. n n Provide safe versions of medical equipment for playtime. n n Give clear explanations about procedures and illnesses. n n Milestones n n Uses scissors. n n Rides bicycle with training wheels. n n Throws a ball. n n Writes a few letters. n n 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 n n Nursing Interventions n n Provide for privacy and modesty. n n Explain treatments and procedures clearly. n n Encourage continuation of school work. n n Milestones n n Possesses reading ability. n n Rides a two-wheeled bike. n n Jumps rope. n n Plays organized sports. n n Mature use of language.

54. Adolescent age 12-21 years

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

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