By the end of the discussion the nurses will be able to:

• Define Growth and Development.

• Know the importance of Growth and Development in Nursing care for children.

• Be familiar with the Principles and factors affecting growth and development.

• Growth and Development is usually referred to as a unit. This expresses the sum of numerous changes that take place during the lifetime of an individual.

• Refers to a physiologic increase in size through cell multiplication or differentiation.

• Known as quantitative change which is measurable.

• Measured by: Growth in weight – lbs. or kg.

Growth in height – inches or cm.

DEVELOPMENT• Used to indicate an increase in skill or the

ability to function (a qualitative change)

• Measured by: Completing specific tasks, recording parent’s description of child’s progress, or by using standardized tests

(e.g. Denver II)

Psychosexual Development

• refers to developing instincts or sensual pleasure (Freudian theory)

PsychosocialDevelopment

• refers to Erikson’s stages of personality development.

MoralDevelopment

• The ability to know what is right and what is wrong and to apply this in real life situations (Kohlberg’s theory).

CognitiveDevelopment

• The ability to understand from experience , to acquire and retain knowledge, to respond to a new situation, and to solve problems.

• an increase in competence and adaptability; aging; usually used to describe a qualitative change.

• Synonymous with Development

• process by which early cells and structures are systematically modified and altered to achieve specific characteristics physical and chemical properties.

1. To learn what is expected from a particular child at a particular age.

2. To assess the normal growth and development of children.

3. To detect deviations from normal growth and development (i.e. physical and psychological abnormalities) and to understand the reasons of particular conditions and illnesses.

4. To ascertain the needs of the child according to the level of growth and development.

5. To plan and provide holistic nursing management to the child based on developmental stages.

6. To teach and guide the parents andcaregivers to anticipate the problems and torender tender loving care to their children.

7. To develop a rapport with the child toenhance the provision of health care and tohelp to build healthy lifestyle for optimumhealth for the future.

• These patterns or trends are basic to allhuman beings, but each human beingaccomplishes these in a manner and timeunique to that individual.

• CEPHALOCAUDAL or head to tail

– The head of the organism develops first andis very large and complex, whereas the lowerend is small and simple and takes shape at alater period.

e.g. infants achieve structural control of the head before theyhave control of the trunk and extremities

• PROXIMODISTAL or near to far

– applies to the midline to peripheralconcepts.

e.g. early embryonic development of limbbuds, which is followed by rudimentaryfingers and toes.

a. Head to tail

B. Near to far

• DIFFERENTIATION

– describes the development from simpleoperations to more complex activities andfunctions.e.g. early embryonal cell withvague, undifferentiated functions progress to animmensely complex organism composed ofhighly specialized and diversifiedcells, tissues, and organs.

– there is a definite, predictable sequence witheach child normally passing through every stage.

e.g.

Crawl before they creep, creep before theystand, and stand before they walk.

The child babbles, then forms words andfinally, sentences; writing emerges fromscribbling.

– there is a fixed, precise order to development, itdoes not progress at the same rate or pace.

• Rapid growth before and after birth levels offthroughout early childhood.

• Growth is slow during middlechildhood, markedly increases at the beginningof adolescence and levels off in early adulthood.

• General

• Neural

• Genital

• Lymphoid

• Total growth of muscles, skeleton and various internal organs.

• Growth spurt is found in infancy and puberty.

• Growth of the spinal cord, meninges, and optic apparatus.

• At birth head size is about 65 – 70%, 2 years old 90% and at 8 years old it is close to the adult size which is maintained without regression.

• Dormant during childhood but at puberty grow faster causing various changes with appearance of secondary sex characteristics.

• Lymphoid tissues contained in the lymph nodes, thymus, spleen, tonsils, adenoids and blood lymphocytes.

• Growth is rapid during infancy and highly accelerated during mid-childhood to protect against infection.

• Reaches its peak at age 12 years and stop growing or regress.

PRINCIPLE

- A fundamental, primary or general law or truth from which others are derived.

1. Growth and Development are continuous processes from conception until death.

2. Growth and Development proceed in an orderly sequence.

3. Different children pass through thepredictable stages at different rates.

4. All body systems do not develop at the samerate.

5. Development is cephalocaudal.

6. Development proceeds from proximal todistal body parts.

7. Development proceeds from gross to refinedskills.

8. Neonatal reflexes must be lost beforedevelopment can proceed.

9. There is an optimum time for initiation of experiences or learning.

10. A great deal of skill and behavior is learned by practice.

Two Primary Factors:

• Genetic

• Environmental

• different characteristics such as height, body structure, color of skin and eyes etc. depend on inherited genes.

• Abnormal genes from ancestors may produce different familial diseases

e.g. Thalassemia, hemophilia, galactosemia..

• Growth and Development are alsoaffected by children’s chromosomalabnormalities

e.g. Down’s syndrome, Turner’ssyndrome, Klinefelter syndrome.

GENDER

• On average Girls are born lighter (By an once or two) and shorter (by an inch or two) than boys.

• In prepuberty girls surge ahead because they begin their growth spurt 6 mos. to 1 year earlier than boys.

• By the end of puberty (14-16 years), boys again tend to be taller and heavier than girls.

RACE AND NATIONALITY

• Growth potential of different racial groups is different in varying extent.

INTELLIGENCE

• A child with high intelligence tend to advance faster in skills, but do not generally grow faster physically than other children.

• Usual reaction pattern of an individual, or an individual’s characteristic manner of thinking, behaving, or reacting to stimuli in the environment. (Chess & Thomas, 1995)

• An inborn characteristic set at birth.

1. Activity – level of physical motion during activity such as sleep, eating, play, dressing and bathing.

2. Rhythmicity –Regularity in the timing of physiologic functions such as hunger, sleep and elimination.

3. Approach-Withdrawal – nature of initial responses to a new stimulus such as people, situations, places, foods, toys and procedures. (Approach responses are positive and are displayed by activity or expression. Withdrawal responses are negative expressions or behaviors)

4. Adaptability – ease or difficulty with which the child adapts or adjusts to new or altered situations.

5. Threshold of Responsiveness (Sensory Threshold) – amount of stimulation such as sounds or light required to evoke a response in the child.

6. Intensity of reaction – energy level of the child’s reactions, regardless of quality or direction.

7. Mood – Amount of pleasant, happy, friendly behavior compared with unpleasant, unhappy, crying, unfriendly behavior exhibited by the child in various situations.

8. Distractibility – ease with which a child’s attention or direction of behavior can be diverted by external stimuli.

9. Attention span and persistence – length of time a child pursues a given activity (attention) and the continuation of an activity in spite of obstacles (persistence)

• The EASY CHILD “easy to care for”

• Predictable rhythmicity

• Approach and adapt to situations readily

• Mild to moderate intensity of reaction

• Over all positive mood quality

* 40% - 50% are rated by their parents as being in this category

• SLOW-to-WARM-UP CHILD

• Fairly inactive

• Respond only mildly and adapt slowly to new situations

• General negative mood

*About 15% of children display this pattern

• The DIFFICULT CHILD

• Irregular in habits• Negative mood quality • Withdraw rather than

approach new situations

*Only about 10% of children fall into this category

• Difficult or slow to warm up children are more vulnerable to the development of behavior problems in early and middle childhood.

• Any child can develop behavior problems if there is dissonance between the child’s temperament and the environment.

• Early identification of temperament provides a useful tool for caregivers in anticipating probable areas of difficulty or risks associated with development.

• Researches on the effect of a child’s temperament in parent-child interactions, parent’s self-esteem, marital harmony, mood and over all satisfaction of parents. Temperament and the ability to perform tasks successfully (mastery motivation)

NURSING IMPLICATION

• Highly active infants are much more difficult for new parents to learn to care for especially if they demonstrate irregular physiologic rhythms. Nurses must help in requiring more planning and creative distraction measures with the parents.

• The way a child will react in the futuredepends on the way a child reacts today.Parents should advised to bring theirchildren’s characteristics into attention tohelp them understand their child and layfoundations for beginning to accept andrespect their child as an individual.

• Noticing a child’s temperamentalcharacteristics when they are admitted to ahospital will help nurses anticipate a child’sprobable reactions to procedures.

• Prenatal Environment

• Postnatal Environment

• MATERNAL MALNUTRITION

– Dietary insufficiency and anemia lead to intra-uterine growth retardation.

- LBW and preterm babies have poor growth potentials.

• MATERNAL INFECTIONS

–HIV, HBV, STORCH etc. may transmit to the fetus via placenta and affect fetal growth.

–Congenital anomalies and congenital infections may occur.

• MATERNAL SUBSTANCE ABUSE

– Intake of teratogenic drugs, tobacco intakeand alcohol abuse (Thalidomide, phenytoinetc.) by the pregnant woman in the firsttrimester affects the organogenesis andlead to congenital malformations or fetalgrowth restrictions.

• MATERNAL ILLNESS

–Pregnancy Induced Hypertension, anemia, heart disease, hypothyroidism, DM, CRF etc. have adverse effect on fetal growth. Iodine deficiency may lead to mental retardation of the baby in later life.

• HORMONES– Excess insulin

stimulates

fetal growth leading to large size fetus with excessive birth weight due to macrosomia.

• GROWTH POTENTIAL

– Indicated by the child’s size at birth

– Smaller the child at birth, the smaller she/he likely to be in subsequent years.

• NUTRITION

–A major focus in health promotion and disease prevention.

–A Child’s nutrition during the growing years has a major influence on his or her health and stature (Dudek, 2005)

• Nutrition also plays a vital role in the body’s susceptibility to disease because poor nutrition limits the body’s ability to resist infection.

e.g. Lack of Calcium could leave a child prone to Rickets.

• Poor nutrition also plays a major role in the development of chronic illness.

– 10 leading causes of death in adults, most have been linked to dietary excess:

• Diseases of the heart

• Diseases of the vascular system

• Diabetes Mellitus

• Malignant Neoplasms

• Eat a variety of foods.

– Choices from all food groups: dairy, meat and poultry, fruits and vegetables, cereals and grains.

• Balance the food you eat with physical activity to maintain and improve your weight.

– Urge parents to be certain their children receive all the nutrients they need for substantial growth and a balanced lifestyle of physical activity.

• Choose a diet with plenty of grain products, vegetables and fruits.

– Foods with starch and fiber are more beneficial for the GI function.

– Intake of Fiber has been linked to lowered incidence of constipation and colon cancer in later life.

• Choose a diet low in fat, saturated fat and cholesterol.– Fat intake does not have to be restricted for the

first 2 years of life.

! OLESTRA (synthetic fat in some foods) – do not recommend to parents until further study is completed. There is a danger of fat-soluble vitamins being excreted and lost with the product.

• Choose a diet moderate in sugars.

– Can contribute to dental caries and obesity.

– Refined sugar “empty calories”

• Choose a diet moderate in salt and sodium

– Taste for salt is acquired. If infants are fed unsalted or lightly salted foods they do not develop a desire for heavily salted foods.

• If you drink alcoholic beverages do so in moderation.

– Adolescents are at increased risk for establishing unhealthy patterns for alcohol use.

PROTIEN – major component of bones, skin, hair and muscle and is responsible for a wide variety of essential functions in the body.

e.g. beans, pasta, fish

CARBOHYDRATE – main and preferred fuel of the body to supply energy. Essential to functioning of most body systems, the neurologic system in particular.

• Sugar- short-term Starch- sustained!

FAT – Also a source of energy. It can be an immediate energy source or can be stored if not used, then released when energy is required.

• In infants, fat deposits also serve as insulating material for subcutaneous tissues. Fat also ensures myelination of nerve fibers.

VITAMINS – Organic compounds that are essential for specific metabolic actions in cells. Does not produce energy but are needed by cells to do so.

• VIT A,C,D,K and E – supplied by fortified dairy products, fortified cereals, plant oils and fish oils.

MINERALS – necessary to build new cells and regulate body processes.

• E.g. Fluid and electrolyte balance, nerve transmission and muscle contraction.

• > 100 mg – Macronutrient

• < 100mg – Micronutrient

• PHYSICAL ENVIRONMENT

–Housing, Living conditions, safety measures, environmental sanitation etc.

• PSYCHOLOGICAL ENVIRONMENT

– Familymembers, neighbors, friends, peers, and teachers are important factors forpromoting emotional, social, andintellectual development.

• CULTURAL INFLUENCES

–The childrearing practices, food habit, traditional beliefs, social taboos, standard of living etc.

• SOCIO-ECONOMIC STATUS

–Children born into families of lowsocioeconomic means may not receiveadequate health supervision or goodnutrition.

• PLAY AND EXERCISE

–Play and exercise promotephysiological activity and stimulatemuscular development.

• ORDINAL POSITION IN THE FAMILY

–Position of a child in the family and size of the family.

e.g. Oldest child or only child generally excels in language development because conversations are mainly with adults.

THANK YOU FOR

LISTENING!

References:

• Maternal and Child Nursing 5th Edition by Adele Pillitteri

• Pediatric Nursing: Caring for Children and Their Families by Potts and Mandleco

• Essentials of Pediatric Nursing 7th Edition by Hockenberry

• Pediatric Nursing 2nd Edition by Datta