Growth and development

It is the process of physical maturation resulting an increase in size of the body and various organs. It occurs by multiplication of cells and an increase in in intracellular substance. It is quantitative changes of the body. According to Hurlock: Growth is change in size,

in proportion, disappearance of old features and acquisition of new ones

According to Crow and Crow (1962) : Growth refers to structural and physiological changes

Growth

It is the process of functional and physiological maturation of the individual. It is progressive increase in skill and capacity to function. It is related to maturation and myelination of the nervous system. It includes psychological, emotional and social changes. It is qualitative aspects According to Hurlock(1959) Development means a

progressive series of changes that occur in an orderly predictable pattern as a result of maturation and experience.

According to J.E. Anderson(1950) Development is concerned with growth as well as those changes in behavior which results from environmental situations.

According to Liebert, Poulos and Marmor (1979) Development refers to a process of change in growth and capability over time, as function of both maturation and interaction with the environment

Development

1. Cephalocaudal direction: The process of cephalocaudal direction from head down to tail. This means that improvement in structure and function come first in the head region, then in the trunk, and last in the leg region.

2. Proximodistal direction: The process in proximodistal from center or midline to periphery direction. development proceeds from near to far - outward from central axis of the body toward the extremities

Principle of Growth and Development

3. General to Specific : Development proceeds from general to specific. Growth occurs to large muscle movements to smaller

muscle movements. This resembles with the whole and part. We first see the whole then comes the parts. Infant grasps the object with his whole hand before

using thumb or forefinger.

4. Locomotion: It is related to the movement of the body. Every species follows a similar pattern. Each one has to pass through the stages accordingly. This is like : CREEPING >> CRAWLING >>

STANDING >> WALKING >> RUNNING5. Differentiality The tempo of development is not even. Individuals differ in the rate of growth and development.Boys and girls have different development rates. Each part of the body has its own particular rate of growth. Development does not occur at an even pace.

6. Development proceeds from the simple to more complex : Children use their cognitive and language skills to

reason and solve problems. Children at first are able hold the big things by using

both arms, In the next part able to hold things in a single hand, then only able to pick small objects like peas, cereals etc.

Children when able to hold pencil, first starts draw circles then squares then only letters after that the words.

7. Continuity: Growth and Development is a continues process

from conception to death. In the early years of life, development consists of

changes that lead the child to maturity not only of body size and functioning, but also of behaviour.

8. Sequentiality Every species, whether animal or human, follows a

pattern of development peculiar to it. This pattern in general is the same for all individuals.

Social and behavioural scientists increasingly have come to see development as a relationship between organism and environment in a transaction or collaboration.

Individuals work with and affect their environment, and in turn the environment works with and affects them.

FACTORS AFFECTING GROWTH AND DEVELOPMENT

1. Heredity - It is the process by which the features and characteristics are passed from parents to the child before the child is born. Thus features like the colour of the skin and eyes, the height, body build, intellect and talents, etc., are all fixed and no one can change them beyond a limit.2. Prenatal environment - This is the environment of the foetus in the womb. If the mother gets poor nutrition, is emotionally upset or smokes, drinks, or takes some medicine or suffers from certain diseases, the growth of the child can be adversely affected.

3. Nutrition - Proper nutrition is essential for the healthy development of the child. A malnourished child’s growth may be retarded or slow.4. Intelligence - Higher intelligence is associated with faster development while lower intelligence is associated with retardation in various aspects of development.5. Emotional climate of home - If there is a lot of discord/fights at home or the child is not given enough love and attention or there is physical/ mental abuse of the child, then the child’s development is adversely affected.

6. Health of the child - If the child frequently falls sick, suffers from some disorder, is disabled or has disturbed endocrine functioning, the development is likely to suffer.7. Level of stimulation - The amount of stimulation the environment provides to the child i.e., the opportunities for exploration of environment, opportunities of interaction with other people, etc., all influnence the rate of development.8. Socio-economic status - It also influences the development by deciding the kind of nutrition, stimulation, facilities, opportunities, genetic endowment the child gets.

9. Sex - All children follow the same sequence of development. However, certain skills are faster in girls than in boys and some other skills are faster in boys than girls. For example, language acquisition is faster in girls and skills like jumping catching, throwing are faster in boys. Sex is also a factor that decides the potential of a child in physical development - boys grow up to be taller, heavier and more muscular than girls.

10. Good Health Habits: Keeping Clean-make cleanliness a habit. Take a bath daily. Wash your hands as often as needed. Brush your teeth. Be sure to clean your nose and ears. Keeping yourself clean can keep off some germs that caused diseases.11. Exercise: Your body also needs exercise. Exercise makes your muscles strong. It also improves your flexibility and makes your heart, lungs and other body parts work efficiently. Playing is also an exercise

• Knowing what to expect of a particular child at any given age.

• Gaining better understanding of the reasons behind illnesses.

• Helping in formulating the plan of care.

• Helping in parents’ education in order to achieve optimal growth & development at each stage.

Importance of Growth and Development for Nurses:

Types of growth: - Physical growth (Ht, Wt, head & chest

circumference) - Physiological growth (vital signs …)

Types of development: - Motor development - Cognitive development - Emotional development - Social development

Types of growth and development

Stages of Growth and Development• Prenatal - Embryonic (conception- 8

w) - Fetal stage (8-40 or 42

w)• Infancy

- Neonate- Birth to end of 1

month- Infancy

- 1 month to end of 1 year

• Early Childhood- Toddler

- 1-3 years- Preschool

- 3-6 years

• Middle Childhood- School age- 6 to 12 years

• Late Childhood

- Adolescent- 13 years to

approximately 18 years

Newborn stage is the first 4 weeks or first month of life. It is a transitional period from intrauterine life to extra uterine environment.

1- Newborn stage

Physical growth

- Weight = 2.5 kg - Wt loss 5% -10% by 3-4 days after birth - Wt gain by 10th days of life - Gain ¾ kg by the end of the 1st month

Normal Newborn Infant

• Boys average Ht = 50 cm • Girls average Ht = 49 cm • Normal range for both (47.5- 53.75 cm)

Head circumference33-35 cm Head is ¼ total body length Skull has 2 fontanels (anterior & posterior)

Height

•Vital signs - Temperature (36.3 to37.2C ).

- Pulse ( 120 to 160 b/min ).

- Respiration ( 35 to 50C/min) .

Physiological growth

• Creep well (use hands and legs).• Walk but with help. • Bring the hands together.

At 11 months , the infant can:

• Walk holding on furniture.• Stand erect with minimal support

At 10 months, the infant can:

• Stand-alone for variable length of time.• Site down from standing position alone.• Walk in few steps with help or alone (hands held at

shoulder height for balance).• Pick up small bits of food and transfers them to his

mouth

At 12 months , the infant can:

• His emotions are instable, where it is rapidly changes from crying to laughter.

• His affection for or love family members appears.• By 10 months, he expresses several beginning

recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety and affection.

• By 12 months of age, these emotions are clearly distinguishable.

Emotional development:

• He learns that crying brings attention.• The infant smiles in response to smile of

others.• The infant shows fear of stranger

(stranger anxiety).• He responds socially to his name.• According to Erikson, the infant develops

sense of trust. Through the infant's interaction with caregiver (mainly the mother), especially during feeding, he learns to trust others through the relief of basic needs.

Social development

• 1-2 months: coos• 2-6 months: laughs and squeals• 8-9 months babbles: mama/dada as sounds• 10-12 months: “mama/dada specific • 18-20 months: 20 to 30 words – 50%

understood by strangers• 22-24 months: two word sentences, >50

words, 75% understood by strangers• 30-36 months: almost all speech understood

by strangers

Speech Milestones

Toddlers

Weight:The toddler's average weight gain is 1.8 to 2.7

kg/year.Formula to calculate normal weight of children over

1 year of age is

Age in years X 2+8 = ….. kg.

e.g., The weight of a child aging 4 years = 4 X 2 + 8 = 16 kg

Physical growth

•During 1–2 years, the child's height increases by 1cm/month.

•The toddler's height increases about 10 to 12.5cm/year.

Height:

Age in years X 5 + 80 = cm.

e.g., the length of 2 years old child = 2 X 5 + 80 = 90cm

Formula to calculate normal height

• The head increases 10 cm only from the age of 1 year to adult age.

• During toddler years, chest circumference continues to increase in size and exceeds head circumference.

Head and chest circumference:

• By 2 years of age, the toddler has 16 temporary teeth.

• By the age of 30 months (2.5 years), the toddler has 20 teeth

Teething:

Pulse: 80–130 beats/min (average 110/min).

Respiration: 20–30C/min.Bowel and bladder control: Daytime control of bladder and bowel control by 24–30 months.

Physiological growth:

• 1 year old: transfer objects from hand to hand• 2 year old: can hold a crayon and color vertical

strokes• Turn the page of a book• Build a tower of six blocks

• 3 year old: copy a circle and a cross – build using small blocks

Fine Motor - toddler

At 15 months, the toddler can:• Walk alone.• Creep upstairs.• Assume standing position without falling.• Hold a cup with all fingers grasped around it.

At 18 months:• Hold cup with both hands.• Transfer objects hand-to hand at will.

Gross - Motor of toddler

At 24 months:

•Go up and down stairs alone with two feet on each step.

•Hold a cup with one hand.•Remove most of own clothes.•Drink well from a small glass held in one hand.

Continuous

At 30 months: the toddler can:•Jump with both feet.•Jump from chair or step.•Walk up and downstairs, one foot on a step.

•Drink without assistance.

• 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

Issues in parenting – toddler (emotional development)

• Up to 2 years, the toddler uses his senses and motor development to different self from objects.

• The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive development (2-4 years), where he is still egocentric and can not take the point of view of other people.

Cognitive development:

• The toddler is very social being but still egocentric.• He imitates parents.• Notice sex differences and know own sex.• According to Erikson,• The development of autonomy during this period is

centered around toddlers increasing abilities to control their bodies, themselves and their environment i.e., "I can do it myself".

Social development:

Pre-School

Definition:-It is the stage where child is 3 to 6 years of age. The growth during this period is relatively slow.

Preschool stage

Physical growth:- Weight: The preschooler gains approximately 1.8kg/year.

Height: He doubles birth length by 4–5 years of age.

Physiological growth •Pulse: 80–120 beat/min. (average 100/min).

•Respiration: 20–30C/min.

•Blood Pressure: 100/67+24/25.

• 3 year old: copy a circle and a cross – build using small blocks

• 4 year old: use scissors, color within the borders• 5 year old: write some letters and draw a person

with body parts

Fine Motor – Older Toddler

• Buttoning clothing• Holding a pencil• Building with small blocks• Using scissors• Playing a board game• Have child draw picture of himself

Fine motor and cognitive abilitiespre-school

Preschooler up to 4 years of age is in the pre-conceptual phase. He begins to be able to give reasons for his belief and actions, but not true cause-effect relationship.

Cognitive development

• Fears the dark• Tends to be impatient and selfish

• Expresses agression through physical and verbal behaviours.

• Shows signs of jealousy of siblings.

Emotional Development of Preschooler

• Egocentric• Tolerates short separation• Less dependant on parents• May have dreams & night-mares• Attachment to opposite sex parent• More cooperative in play

Social development in preschoolers

According to Erikson theory:• The preschooler is in the stage where he develops a sense of initiative, Where he wants to learn what to do for himself, learn about the world And other people.

Social development

School-Age

School-age period is between the age of 6 to 12 years. The child's growth and development is characterized by gradual growth.

Normal school-age child:

Weight:•School–age child gains about 3.8kg/year.

•Boys tend to gain slightly more weight through 12 years.

•Weight Formula for 7 - 12 yrs = (age in yrs x 7 )– 5 2

Physical growth

Height:•The child gains about 5cm/year.•Body proportion during this period: Both boys and girls are long-legged.

Dentition:•Permanent teeth erupt during school-age period, starting from 6 years, usually in the same order in which primary teeth are lost.

•The child acquires permanent molars, medial and lateral incisors.

•Pulse: 90+15 beats/min (75 to 105).•Respiration: 21+3C/min (18–24).•Blood Pressure: 100/60+16/10.

Physiological growth:

• Writing skills improve• Fine motor is refined• Fine motor with more focus

• Building: models – logos • Sewing• Musical instrument• Painting • Typing skills• Technology: computers

School Years: fine motor

At 6–8 years, the school–age child:• Rides a bicycle.• Runs Jumps, climbs and hops.• Has improved eye-hand coordination.

• Prints word and learn cursive writing.

• Can brush and comb hair.

Motor development

At 8–10 years, the school–age child:• Throws balls skillfully.• Uses to participate in organized sports.• Uses both hands independently.• Handles eating utensils (spoon, fork, knife)

skillfully. At 10–12 years, the school–age child:• Enjoy all physical activities.• Continues to improve his motor coordination.

•8 to 10 years: team sports

•Age ten: match sport to the physical and emotional development

School Age: gross motor

At 7-11 years, the child now is in the concrete operational stage of cognitive development. He is able to function on a higher level in his mental ability.Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.

School Age: cognitive development

The school–age child:• Fears injury to body and fear of dark.• Jealous of siblings (especially 6–8 years old child).• Curious about everything.• Has short bursts of anger by age of 10 years

but able to control anger by 12 years.

Emotional development

The school–age child is :• Continues to be egocentric.• Wants other children to play with him.• Insists on being first in every thing• Becomes peer oriented.• Improves relationship with siblings.• Has greater self–control, confident, sincere.• Respects parents and their role.• Joints group (formal and informal).• Engage in tasks in the real world.

Social development

13 to 18 Year Old

• Physical growth • Physiological growth • Secondary sex characteristics• Cognitive development • Emotional development• Social development

Adolescent age

Adolescence is a transition period from childhood to adulthood. Its is based on childhood experiences and accomplishments.

It begins with the appearance of secondary sex characteristics and ends when somatic growth is completed and the individual is psychological mature.

Definition of adolescent:

Physical growth:Weight:

• Growth spurt begins earlier in girls (10–14 years, while it is 12–16 in boys).

• Males gains 7 to 30kg, while female gains 7 to 25kg.Height:

• By the age of 13, the adolescent triples his birth length.

• Males gains 10 to 30cm in height.• Females gains less height than males as they

gain 5 to 20cm.• Growth in height ceases at 16 or 17 years in

females and 18 to 20in males

Pulse: Reaches adult value 60–80 beats/min.

Respiration: 16–20C/minute.The sebaceous glands of face, neck and chest become more active. When their secretion accumulates under the skin in face, acne will appear.

Physiological growth:

1- Secondary sex characteristics in girls:

• Increase in transverse diameter of the pelvis.• Development of the breasts.• Change in the vaginal secretions.• Growth of pubic and axillary hair.• Menstruation (first menstruation is called

menarche, which occurs between 12 to 13 years).

Appearance of secondary sex characteristics

2- Secondary sex characteristics in boys:

• Increase in size of genitalia.• Swelling of the breast.• Growth of pubic, axillary, facial and chest hair.• Change in voice.• Rapid growth of shoulder breadth.• Production of spermatozoa (which is sign of

puberty).

Cognitive development:Through formal operational thinking, adolescent can

deal with a problem.

Emotional development:This period is accompanied usually by changes in

emotional control. Adolescent exhibits alternating and recurrent episodes of disturbed behavior with periods of quite one. He may become hostile or ready to fight, complain or resist every thing.

Social development:He needs to know "who he is" in relation to family

and society, i.e., he develops a sense of identity. If the adolescent is unable to formulate a satisfactory identity from the multi-identifications, sense of self-confusion will be developed according to Erikson:-

Adolescent shows interest in other sex. He looks for close friendships.