Growth and Development

Growth- increase in physical size of a structure or whole.

-quantitative change.
- it can be measured ( cm, m, ft. inch, lb, kgs)

Two parameters of Growth

1. weight- most sensitive measure of growth, especially low birth rate.
Wt doubles 6 months
3x 1yr
4x 2-2 yrs

2. Height- increase by 1/mo during 1
st
6 months
- average increase in ht - 1
st
year = 50%
stoppage of ht coincide with eruption of wisdom tooth.

Development- increase skills or capability to function
- qualitative

How to measure development

1. Observe child doing specific task.
2. Role description of childs progress
3. DDST- Denver development screening test.
MMDST (Phil) Metro Manila Developmental Screening Test.
DDST measures mental

4 main rated categories of DDST
P-1. personal social-interaction
F-2. fine motor adaptive- ability to use hand movement
L-3. Language communication
G-4. gross motor skills- large body movement

maturation- same with development readiness

Cognitive development ability to learn and understand from experience to acquire and retain knowledge.
To respond to a new situation and to solve problems.

IQ test- test to determine cognitive development
Mental age x 100 = IQ
Chronological age

Average IQ 90-100
Gifted child- > 130 IQ


Basic Divisions of Life
I. Prenatal stage from conception- birth

II. Period of infancy
1. Neonatal- 1
st
28 days or 1
st
4 weeks of life
2. Formal infancy- 29 day 1 year

III. Early childhood
1. Toddler 1-3 yrs
2. Pre school 4-6 years

IV. Middle childhood
1. School age- 7 12 yrs

V. Late childhood
1. Pre adolescent 11 13 yrs
2. Adolescent 12 - 18 21

Principles of G & D
1. G&D is a continuous process
-begins form conception- ends in death
- womb to tomb principles
2. not all parts of the body grow at the same time or at same rate.
- asynchronism

Patterns of G&D
1. renal
digestive grows rapidly during childhood
circulatory
musculoskeletal

2. Neuromuscular tissue (CNS, brain, S. cord)
- grow rapidly 1-2 years of life
- brain achieved its adult proportion by 5 years.

3. Lymphatic system- lymph nodes, spleen grows rapidly- infancy and childhood to provide protection
-infection
- tonsil adult proportion by 5 years

4. Repro organ- grows rapidly at puberty

Rates of G&D
1. fetal and infancy most rapid G&D
2. adolescent- rapid G&D
3. toddler- slow G period
4. Toddler and preschool- alternating rapid and slow
5. school age- slower growth

fetal and infancy- prone to develop anemia

3. Each child is unique

2 primary factors affecting G&D
A. Heredity - R race
I intelligence
S sex
N - nationality

Females are born less in weight than males by 1 oz.
Females are born less in length than males by 1 inch

B. Environment
Q quality of nutrition
S socio eco. status
H health
O ordinal pos in family
P parent child relationship

Eldest- skillful in language and social skills
Younger- toilet trained self

4.G&D occurs in a regular direction reflecting a definitive and predictable patterns or trends.

Directional trends- occur in a regular direction reflecting the development of neuromuscular function.
These apply to physical, mental, social and emotional development and includes.
a. cephalo-caudal head to tail
- occurs along bodies long axis in which control over head, mouth and eye movements and
precedes control over upper body torso and legs.
b. proximo- distal Centro distal
- progressing form center of body to extremities.
c. Symmetrical- at side of body develop on same direction at same time at same rate.
d. Mass specific differentiation
- child learns form simple operations before complex function of move from a broad general pattern
of behavior. To a bore refined pattern.

B. Sequential- involves a predictable sequence of G&D to which the child no9rmally passes.
a. locomotion- creep than crawls, sit then stand.
b. socio and language skills- solitary games, parallel games
C. Secular- worldwide trend of maturing earlier and growing larger as compared to succeeding
generations.

5.Behavioral in the most compressive indicator of developmental status.
6. universal language of child- play
7. great deal of skill and behavior is learned by practice. Practice makes perfect.
9. neonatal reflexes us must be lost before one can proceed.
-plantar reflex should disappear before baby can walk
-moro reflex should disappear before baby can roll
persistent primitive infantile reflexes- case of cerebral palsy

Theories of G&D
Developmental tasks- different form chronological age
-skill or growth responsibility arising at a particular time in the individuals life.
The successful achievement of which will ------- a foundation for the accomplishments of future tasks.

Theorists
1. Sigmund Freud 1856-1939 Austrian neurologists. Founder of psychoanalysis
- offered personality development
Psychosexual theory

a.) Oral Phase 0-18 months
- mouths site of gratification
-activity of infant- biting, sucking crying.
-why do babies suck?- enjoyment and release of tension.
-provide oral stimulation even if baby was placed on NPO.
-pacifier.
-never discourage thumb sucking.

b.) ANAL- 18 months-3 years
-site of gratification- anus
-activity- elimination, retention or defecation of feces make take place
- principle of holding on or letting go.
-mother wins or child wins
-child wins- stubborn, hardheaded anti social. (anak pupu na, child holds pupu, child wins)
-mother wins- obedient, kind, perfectionist, meticulous
OC-anal phase
-help child achieve bowel and bladder control even if child is hospitalized.

c.) Phallic- 3-6 years
site of gratification -genitals
activity- may show exhibitionism
-increase knowledge of a sexes
-accept child fondling his/her own genitalia as normal exploration
-answer Childs question directly.
Right age to introduce sexuality preschool

d.) Latent- 7-12 years
-period of suppression- no obvious development.
-Childs libido or energy is diverted to more concrete type of thinking
-helps child achieve (+) experience so ready to face conflict of adolescence

e.) Genital- 12-18 years
-site of gratification -genitals
-achieve sexual maturity
-learns to establish relationships with opposite sex.
-give an opportunity to relate to opposite sex.

ERIC ERICKSON- psychoanalysis theory
- stresses important of culture and society to the development of ones personality
- environment
- culture

stages of psychosocial
a.) trust vs mistrust 0-18 months.
-foundations of all psychosocial task
-to give and receive is the psychosocial theme
-know to develop trust baby
1. satisfy needs on time
- breastfeed
2. care must be consistent and adequate
-both parents- 1
st
1 year of life
3.) give an experience that will add to security- touch, eye to eye contact, soft music.

b.) Autonomy vs shame and doubt 18-3 years --- independence /self govt
develop autonomy on toddler
1. give an opportunity of decision making like offer choices.
2. encourage to make decision rather then judge.
3. set limits

c. initiative vs guilt- 4-6 years
-learns how to do basic things
-let explore new places and events
-activity recommended- modeling clay, finger painting will enhance imagination and creativity and
facilitate fine motor devt

d. industry vs inferiority 7-12 yrs
-child learns how to do things well
-give short assignments and projects


e. Identity vs role confusion or diffusion 12-18 yrs
- learns who he/she is or what kind of person he/ she will become by adjusting to new body image and
seeking emancipation form parents
-freedom form parents.

f. Intimacy vs isolation 20-40 yrs -looking for a lifetime partner and career focus

g. generatively vs stagnation 40- 60
45-65 yrs
h. ego integrity vs, despair 60-65



JEAN PIAGET- Swiss psychologists
-develop reasoning power

STAGES OF COGNITIVE DEVELOPMENT
A-Sensory motor 0-2 yrs
-practical intelligence- words and symbols not yet available baby communicates through senses and
reflexes.
(sub div.)

Schema Age Behavior
1.) neonate reflex 1 month All reflexes
2.) primary circular 1-4 months -Activity related to body
-repetition of behavior
ex. thumb sucking
3.) secondary circular reaction 4-8 months -activity not related to body
-discover obj and persons permanence
-memory traces present
-anticipate familiar events.
Coordination of secondary reaction 8-12
months
-exhibit goal directed behavior
-increase of separateness (will search of lost toy,
knows mom)
Tertiary circular reaction 12-18
months
-use trial and error to discover places and events
- invention of new means
-capable of space and time perception
(hits fork, spoon on table or drops fork)
Invention of new means there mental
combination
18-24
months
-transitional phase to the pre operational thought
period.

Preoperational thought 2-7 years

Schema age Behavior
Preconceptual 2-4
yrs
-thinking basically complete literal and static
-egocentric- unable to view others interrupt
-concept of dying is only now
-concept of distance is only as fat as they can see.
-concept of amenism inanimate object is alive
-not aware of concept of r3eversibility- in every action theories an opposite
reaction or cause and effect
Initiative 4-7
yrs
Beginning of causation



Concrete Operational thought 7-12 years
1. able to find solution to everyday problems which systematic reasoning.
2. have concept of reversibility- cause and effect
3. have concept of longer uation constancy despite of transformation.
4. 4. activity recommended- collecting and classifying
5. stamps stationeries, dolls, rubber band markers.

Formal Operational thought 12 and up.
1. Cognition achieved its final form
2. can deal with past present and future
3. have abstract and mature thoughts.
4. can find solutions to hypothetical problems with scientific reasoning.
5. activity ------- will sort out opinions and current events.

KOHLBERG- recognized the theory of moral devt as considered to closely approximate cognitive stages of
devt
-sabay with cognitive dev;t

Stages of Moral devt
Infancy premoral, prereligious, amoral stage

AGE STAGE DESCRIPTION
Pre-conventional Level 1
2-3 yrs 1 -Punishment/ obedience oriented (heteronymous
morality) child does right cause a parent tells him or
her to and to avoid punishment
4-7 2 -Individualism. Instrumental purpose and exch. Carries
out action to satisfy own needs rather than society.
-Will do something for another if that person does
something for the child.
Conventional Level
7-10 3 -Orientation to interpersonal relations of mutuality.
Child followers rules cause of a need to be a good
person in own eyes and eyes of others.
10-12 4 -Maintenance of social order fixed rules and authority.
Child finds ff. rules satisfying. Follows rules of authority
figures.
Post-
conventional
Level III
Above 12 yrs 5 -Social contract, utilitarian level making perspectives.
Followers standards of society.
6 Universal ethical principle orientation. Follows
internalized standards of conduct.


E. DEVT MILESTONES-major markers of growth and devt
1. Period of infancy- universal language of child-play
a.) Play- Infancy- solitary plays
-solo, mom interactive
-facilitate motor and sensory devt
-safety- important age appropriate
solitary play- mobile, teeter, music box, rattle
b.) fear of infancy- stranger anxiety begin 6-7 months peak 8 months diminishes 9 months

1 month- dance reflex disappears looks at mobile

2 months- holds head up when in prone,
social smile,
baby coos doing sound
cry with tears
-closure of frontal fontanel 2-3 months
head lag when pulled to sitting position.

3 months- holds head and chest up when prone
follows obj. past midline
grasp and tonic neck reflex fading
hand regard (looks at hand)
4 months turns form front to back
head control complete
needs space to turn
Laugh aloud, bubbling sounds

5 months- turn both ways roll over
-teething rings
-handles rattle well
-moro reflex disappears ( 4-5 months)

6 months- reaches out in anticipatory of being picked up
-sits with support
-uses palmar grasp
-eruption of 1
st
temp teeth 6-8 months 2 lower incisors
-say vowel sounds ah, oh
-handles bottle well

7 months- transfer obj. hand to hand
-likes obj that are good size

8 months- sits without support
-peak of stranger anxiety
-planters reflex disappears 8-9 months in prep for walking

9 months - creeps or crawls
-neat finger grasp reflex
- combine 2 syllables mama and papa
- needs space for creeping

10 months pull self to stand
-understands no
-responds to own name
-peak a boo, pat a cake
-can clap

11 months- cruisse
- stands with assistance

12 months- stand alone take 1
st
step
-walk with assistance
-drink from cup, cooperate in dressing
-says 2 words mama and dada
-pots and pans, pull tay, nursery rhymes

Toddler- parallel play- 2 toddlers playing separately
-provide with similar toys
-squeaky frog to squeeze
waddling duck to pull
trucks to push-push pull toy
building blocks, pounding peg
toys to ride on
fear- separation anxiety
begin 9 months
peak 18 months

3 phases of separation anxiety (in order)
1. P- protect
2. d despair
3. d- denial

-dont prolong goodbye
-say goodbye firmly to develop trust- say when ul be back






15 months plateau stage
walks alone
lateness in walking- mild mental retardation
-puts small pellets into small bowl
-holds spoon well
- seats self on chair
-creeps up stairs
- 4 - 6 words

18 months- height of possessiveness
favorite word- mine
bowel control achieved (bowel 1
st
before bladder)
-no longer rotates spoon
-can run and jump in place
walks up and down stairs holding railing or persons hand
-1-20 words
-name, body part
-puts both feet on 1 step before advancing.

24 months- terrible two
-can open doors by turning door knobs
-unscrew lids
-can walk upstairs alone using both feet on same step at same time
-50-200 words ( 2 words sentences)
-daytime bladder control achieved ( daytime 1
st
- next nighttime bladder control)

30 months or 2 years makes simple lines or stroke for crosses with a pencil
-can jump down from chairs
-knows full name
- copy a circle
- holds up finger to show age
- temp teeth complete

post molar- last temp teeth to appear
how many deciduous teeth -20
beginning of toothbrush 2-2 yrs
tooth brushing with little assistance 3 yrs
tooth brushing alone 6 yrs
right time to bring to dentist- when temp teeth complete

36 months or 3 yrs- trusting 3
- unbutton buttons (unbutton before learn to button)
-draw a +
- learns how to share
-knows full name and sex (gender identity)
- speaks fluently
-nighttime bladder control
-300-900 words
-ride a tricycle

Characteristic Traits of toddler
negativistic- NO! -way to search for independence
limit questions
modify questions to a statement
2.) rigid, ritualistic and stereotype
ritualism- for mastering
3.)Temper tantrums- head banging, screaming, stamping feet, holds breath
ignore behavior
scaffoid abdominal-due to underdeveloped abdominal muscles
physiologic anorexia- due to preoccupation with environment- food jag that last for
short period of time
loves rough and tumbling play
loves toilet training-
failure of toilet training- unreadiness

Clues of toilet readiness:
1.) can stand, squat walk alone
2.) can communicate toilet needs
3.) can maintain dry for 2 hours

Pre schoolers- associative or cooperative play
1.) bahay-bahayan play house
2.) role playing
3.) fear-body mutilation or castration
fear of dark places witches
fear of thunder and lightning
fear of ghosts

Milestones
4years old- furious 4 , noisy, aggressive, stormy
-can button buttons
-copy a square
-jumps and skips
-laces shoes
-vocabulary 1,500
-knows four basic colors

5 years old- frustrating 5
-copy a triangle
-draw a 6 part man
-imaginary playmates
-2,100 words

Character Traits of Pre-schooler:
1.) curious, creative imaginative, imitative
2.) 2. favorite words- why and how
3.) complexes- word identification to parent of same sex and attachment to parent of opposite
sex
ex. Oedipal complex- boy to mom
Electra complex- girl to dad

Cause of incest marital discord

Death-sleep only

Behavior problems Preschool

1. telling tall tales-over imagination
2. imaginary friend- to release tension and anxieties
3. sibling rivalry- jealousy to newly delivered baby.
4. regression- going back to early stage
-thumb sucking (should be oral stage only)
-baby talk
-bed wetting
-fetal position
5. masturbation- sign of boredom
-divert attention- offer a toy

School Age
Play- competitive play
Ex. Tug of war, track and field, basket ball

Fear. 1.) school phobia
-orient to new environment
2.) displacement from school
-teacher and peer of same sex
3. loss of privacy
-wants bra
4.) fear of death
-7-9yrs death is personified
-death- permanent loss of life

Significant Development
a. boys- prone to bone fracture
b. mature vision 20/20

6 years- temp teeth begin to fall
perm teeth appear- 1
st
molar
1
st
temp teeth- 5 months
1
st
perm teeth- 6 yrs
-yr of constant motion
clensy mout
recognize all shapes
-1
st
grade teacher becomes authority figure
-nail biting
-begin interest in God.

7 yrs- assimilation age
-copy a diamond
-enjoys teasing and playing alone
-quieting down period

8 yrs- expansive age
-smoother mouth
-loves to collect objects
-count backwards

9 yrs coordination improves
-tells time correctly
-hero worship
-stealing and lying are common
-takes care of body needs completely
-teacher finds this group difficult to handle

10 yrs- age of special talent
-writes legibly
-ready for competitive games
-more considerate and cooperative
-joins orgs.
-well mannered with adult
-critical of adults

11-12 yrs pre adolescents
-full of energy and constantly active
-secret language are common
-share with friends secrets
-sense of humor present
-social and cooperative

Character Traits School Age
1. industrious-
2. modest
3. cant bear to lose- will cheat
4. love collections- stamps

Signs of sexual maturity
GIRLS:
I-inc size breast and genitalia (pelarche- 1
st
sign sexual mat.
W- widening of hips
A- appearance axillary, pubic ( adrenarch)
M- menarche- last sign sexual mat. Girls

BOYS:
A-appearance axillary, pubic hair ( 1
st
sign sexual mat)
D-deepening voice
D- development of muscles
I--inc in testes and penis size
P- prod of viable sperm ( last sign sexual maturity)

Adolescent
Fear
1. obesity
2. acne
3. homosexuality
4. death
5. replacement from friends
6. significant person- opp sex.

Significant devt
1. experiences conflict bet his needs for sexual satisfaction and societies expectation
2. change of body image and acceptance of opp/sex
3. nocturnal emission wet dreams
4. distinctive odor- due to stimulation apocrine glands
5. sperm is viable by 17 yrs
6. testes & scrotum increase until age 17
7. breast and female genitalia increase until age 18

Personality Traits Adolescents
1. idealistic
2. rebellious
3. reformers
4. conscious with body image
5. adventuresome

Problems:
1. vehicular accident
2. smoking
3. alcoholism
4. drug addiction
5. pre marital sex






IMMEDIATE CARE OF NEWBORN
1
st
days of life

1. initiation and maintenance of respiration
2. establishment of extra uterine circulation
3. control of body temp
4. intake of adequate nourishment
5. establishment of waste elimination
6. prevention of infection
7. establishment of an infant parent relationship
8. devt care that balances rest and stimulation or mental devt


1.) Initiation and maintenance of respiration
2
nd
stage of labor- initial airway
-initiation of a /w is a crucial adjustment
-most neonatal deaths with in 24 h caused by inability to initiate a/w
-lung function begins after birth only

How to initiate a/w
a.) remove secretions bulb syringe

B. Catheter Suctioning
1.) place head to side to facilitate drainage
2,) suction mouth 1
st
before nose
-neonates are nasal breathers
3.) period of time
-5-10 sec suctioning, gentle and quick
prolonged and deep suctioning can lead to hypoxia, laryngo spasm, brady cardia due to stimulation
vagal nerve

4.) evaluate for patency
-cover nostril and baby struggles theres a need for additional suctioning

C. If not effective, requires effective laryngoscopy to open a/w. After deep suctioning an endotracheal
tube can be inserted and oxygen can be administered by an (+) pressure bag and mask with 100%
oxygen at 40-60b/m.

Nsg alert:
1. No smoking
2. Always humidify to prevent drying of mucosa
3. Over dosage of oxygen can lead to scarring of retina leading to blindness ( retro lentalfibrolasia or
retinopathy of prematurity)
4. When mecomium stained (greenish) never administer oxygen with pressure ( O2 pressure will
push mecomium inside)

2.) Establishing extra uterine circulation
- circulation is initiated by lung expansion or pulmo ventilation and completed by cutting of cord.