Growth and Development in Nursing

Growth and Development from a Nursing Perspective

• Growth refers to physical maturation resulting in an increase in the body's size and organ size. It's a quantitative change, occurring through cell multiplication and increased intracellular substance.

• Development encompasses functional and physiological maturation, including psychological, emotional, and social changes. It's a qualitative process, a progressive series of changes that occur in an orderly pattern due to maturation and experience.

• Principles of Growth and Development:

  • General to Specific: Development progresses from general, gross movements to more specific, fine motor skills. Cognitive and language skills develop in a methodical manner, from simple to complex. (e.g., holding a large object, then a small one, then eventually using a utensil). The sequence remains the same for each child, but developmental rate varies between individuals.
  • Cephalocaudal: Development proceeds from head down to tail. The structures in the head mature first, followed by the trunk and then the legs. (e.g., Infants gain control of their neck before they can control their legs).
  • Proximodistal: Development proceeds from the center of the body or core areas outwards towards the extremities. (e.g., The spine usually develops first, followed by the extremities, and lastly, fingers and toes).
  • Development is Cumulative: Development builds on prior skills. New skills are integrated into existing frameworks.
  • Development is a result of interaction of Maturation and Learning: Development is a product of both genetic and environmental influences
  • Growth pattern of every individual is unique

• Factors Influencing Growth and Development:

  • Genetic Factors: Sex, Race, Nationality
  • Prenatal Factors: Intrauterine environment (e.g., maternal malnutrition, infection, substance abuse, illness), hormones
  • Postnatal Factors: Socioeconomic status, climate and season, play and exercise, birth order, intelligence, hormonal influence, childhood illness, cultural influence, physical environment, psychological environment

Growth and Development Theories

• Erikson's Psychosocial Development Theory: Erikson proposed a lifespan model of development, with five stages up to 18 and three beyond, emphasizing the adolescent period as crucial for identity formation. His theory looks at the impact of social experiences over a whole lifetime. Identity of one's ego grows and fails with emerging conflicts.

  • Trust vs. Mistrust (infancy, birth-18 months): Babies develop trust if their needs are met; otherwise, they may mistrust the world.
  • Autonomy vs. Shame and Doubt (toddlerhood, 18 months-3 years): Toddlers develop independence in self-care tasks; otherwise, they might feel ashamed or doubt their abilities.
  • Initiative vs. Guilt (preschool, 3-5 years): Preschoolers explore and plan activities; conversely, they might feel guilty about overstepping boundaries.
  • Industry vs. Inferiority (school-age, 5-11 years): Children develop skills and feel a sense of pride in their accomplishments, or inadequacy.
  • Identity vs. Role Confusion (adolescence, 11-18 years): Adolescents develop a sense of their identity; conversely, they may encounter role confusion.
  • Intimacy vs. Isolation (Young Adulthood, 18-40 years): young adults develop relationships and a sense of intimacy; conversely, they might feel isolated.
  • Generativity vs. Stagnation (Middle Adulthood, 40-65 years): Middle-aged adults contribute to the next generation; conversely, they might feel stagnant.
  • Integrity vs. Despair (Late Adulthood, 60+ years): Older adults reflect on their life accomplishments, finding integrity or despair.

• Piaget's Cognitive Theory: Piaget, a developmental psychologist, studied how children learn throughout their development. He believed a child's cognitive structure increases with development. This involves four stages of cognitive development:

  • Concepts of Piaget's Theory:

• Schemas: Internal representations of the world (e.g., concept of ball).

• Assimilation: Using existing schemas to deal with new objects or situations (e.g., recognizing a new ball as a ball).

• Accommodation: Changing or altering existing schemas in the light of new information (e.g., figuring out different types of balls).

• Equilibration: Balance between assimilation and accommodation, resulting in adjustments in children's thought processes.

• Stage 1: Sensorimotor (birth-2 years.): Knowledge limited to sensory perceptions and simple motor activities.

• Stage 2: Preoperational (2-7 years.): Developing language and concepts; more complex mental representation; unable to use 'operations' (e.g. logic).

• Stage 3: Concrete Operational (7-12 years.): Appropriate use of logic.

• Stage 4: Formal Operational (12+ years.): Individual's thought becomes increasingly flexible and abstract; capable of logical and methodical problem- solving.

• Maslow's Hierarchy of Needs: Maslow, an American psychologist, studied outstanding individuals and believed human needs are unchanging and genetic in origin. These needs are arranged in a hierarchy, from basic physiological needs to more complex psychological needs.

  • Physiological Needs: Basic needs essential for survival (e.g., air, food, water)
  • Safety Needs: Security in the environment (e.g., stability in employment, health care).
  • Love and Belonging Needs: Emotional connection and acceptance (e.g., relationships, belonging).
  • Esteem Needs: Self-respect and confidence (e.g., recognition, achievements).
  • Cognitive Needs: Knowledge and understanding (e.g. intellectual curiosity).
  • Aesthetic Needs: Appreciation of beauty and symmetry.
  • Self-Actualization Needs: Fulfillment of potential (e.g. personal growth, contribution).
  • Transcendence Needs: Helping others self-actualize.

• Kohlberg's Theory of Moral Development: Kohlberg, a psychologist studied moral development, noting that moral reasoning goes beyond self-interest to societal and internalized standards. He identified three levels of moral development.

  • Pre-conventional Morality: Believing rules are external to the self (focus on reward and punishment)
  • Conventional Morality: Obeying rules and social norms to gain approval (focus on societal law and order).
  • Post-conventional Morality: Self-chosen rules and ethical principles
  • Stages in each Level

Prenatal Developmental Stages

• Fetal Period: The fetal stage lasts from approximately week nine through delivery (about 40 weeks). This is a period of rapid growth and development for all systems. Physical and fetal development occur from conception to development. There are clear markers in each week of development for the pregnant person.
  • Embryonic Development: Weeks 1-2. Major organs form

Neonates and Infants (Birth-1 Year)

• Neonate: Birth to 28 days. Characterized by poor physiological regulation and adaptation, high morbidity and mortality. Health needs focus on nutrition, proper care, and disease prevention.

• Infant: 1 month to 1 year. Characterized by rapid growth and development (fastest brain growth), high nutritional and energy requirements. This stage features a significant drop in passive immunity, and morbidity/mortality related to congenital anomalies, low birth weights, accidents or falls. Prevention of infection, nutrition and appropriate care are essential.

Toddler (1-3 years)

• Growth slows; intelligence develops rapidly; curious and active; separation anxiety is common.
  • Health needs include proper nutrition, disease prevention, and accident avoidance

Preschooler (3-6 years)

• Health needs include providing a variety of foods, and ensuring adequate nutrition; prevention of illnesses, accidents, and providing instruction on good habits. Growth slows, but intelligence and language develop further. Imitation of adults, and independence developing with simple, age-appropriate tasks are also important markers.

School-age (6-12 years)

• Growth relatively steady, and with increased intelligence and a desire for knowledge. Decreased incidence of illnesses compared to previous stages. Health needs include nutrition, disease and accident prevention, and good habits.

Adolescent (12-18 years)

• Second fastest period of growth and development (important growth spurt). Peers are most important; puberty begins; significant peer pressure. High risk behaviours, accidents, and mental health issues including depression and suicide are crucial concerns.
• Health needs include nutrition; disease and accident prevention, promoting good habits

Assessment of Growth and Development

• Weight: Is one of the reliable indicators of growth. Weight doubles by five months, triples by one year, and continues to increase in a regular manner.
• Length/Height: Yearly measurements show decrease that ends when a child hits puberty
• Body Mass Index (BMI): Assessing normal growth and deviations (e.g. malnutrition, obesity) through measurements.
• Head Circumference: Related to brain growth and intracranial volume. Averages are measured at specific age markers.
• Fontanels Closure: Indicators of normal brain development; early closure may indicate craniostenosis.
• Chest Circumference: Assesses growth and nutritional status.
• Mid-upper Arm Circumference (MUAC): Assessing nutritional status for younger children.
• Eruption of teeth: Time of tooth eruption varies between children. Primary and permanent teeth follow a patterned schedule but variability is expected.

Nutritional Needs of Children

• Nutrition: Process by which living organisms obtain food for growth, metabolism, and repair.
• Food: Any substance consumed to provide nutritional support; varies across cultures and ages.
• Macronutrients: Carbohydrates, fibre, fat, essential fatty acids (e.g., omega-3 and 6), protein, and water.
• Micronutrients: Minerals (e.g., calcium, phosphorus, potassium, sodium, cobalt, copper, chromium, iron, magnesium, selenium, zinc) and vitamins (e.g., Vitamin D, vitamin C).

General recommendations

• Encourage small, frequent, healthy meals, especially for infants and toddlers.
• Ensure diversity of food groups
• Involve children in choosing foods.
• Encourage a healthy lifestyle by providing healthy options for snack and regular meals.
• Prevent unhealthy habits, and limit TV and excessive screen time while eating.

Theories of Adolescent Development

• Different theories guide the understanding of adolescents, emphasizing physical development; cognitive abilities; psychosocial, and emotional changes. There are various theoretical approaches to understanding these developmental periods, and these changes often highlight the importance of these factors.

Factors Affecting Adolescent Health

• Socioeconomic circumstances.
• Family relationships.
• Community and peer groups.
• Education/Employment Opportunities
• Health care system.
• Media.
• Employers.
• Government policies/laws
• Gender biases

Methods Of Assessment

• Anthropometric : Measures body dimensions.
• Biochemical : Laboratory or blood tests to investigate nutritional status.
• Clinical : Physical examination to identify nutritional deficiencies.
• Dietary : Evaluating food diaries and assessing food choices.

Explore the concepts of growth and development from a nursing perspective. This quiz covers the principles of growth, the distinction between physical maturation and developmental processes, and the sequential nature of these changes. Test your understanding of how these concepts apply to patient care.