Growth and Development Stages

Learning Outcomes

• Key principle of growth and development has been identified
• Some major developmental theories that underlie developmental mechanisms have been explored
• Some physical growth, cognitive and psycho-social development from infancy to adolescence have been described
• Health risks and concerns relevant to developmental stages from infancy to adolescence have been synthesized
• Appropriate nursing interventions and considerations when caring for each age group have been analyzed

Growth and Development

• Involve stages
• Human growth and development are continuous, intricate, and complex
• Are based on timing and sequence of developmental tasks
• Individuals progress at highly individualized rates
• Understanding typical patterns allows nurses to predict, prevent, and detect changes in patients

Physical Growth

• Defines quantitative and measurable aspects of an individual's increase in physical measurements
• Indicators include changes in height, weight, teeth, skeletal structures, and sexual characteristics
• Influenced by genetics, also affected by socioeconomic status

Development

• Represents a progressive and continuous process of change leading to increased skill and capacity to function
• It results from complex interactions between biological and environmental influences
• Is qualitative in nature and difficult to measure
• Has predictable characteristics, such as progressing from simple to complex and general to specific

Nature vs Nurture

• Debates whether development is primarily influenced by genetic factors (nature) or environmental factors (nurture)

Factors Influencing Growth and Development

• Three major categories: genetic/natural, environmental, and interacting factors
• Genetic factors include heredity and temperament
• Environmental factors include family, peer group, health, nutrition, rest/sleep/exercise, living and political environment
• Interacting factors include life and prenatal experiences along with overall health

Other Influencing Factors

• Genetics, family dynamics, early attachment, and sense of security
• Accessibility of healthcare services and associated costs
• Affordability of quality food
• Sleep and exercise affect physical, mental and behavioral health
• Climate, life in developed/developing country, community life, socioeconomic status, and housing quality
• Municipal, provincial, and federal policies, and political unrest/war
• Exposure to life experiences/trauma
• Maternal health, prenatal care, nutrition, and/or substance use
• Any underlying health conditions

Traditions of Developmental Theories

• Describes an organized set of statements about a subject
• Serves as models intended to account for how and why people develop in certain ways
• Theories assist nurses in assessing and treating a patient's response to illness

Developmental Theories

• Include Organicism, Psychoanalytic/psychosocial, Mechanistic, Contextualism, and Dialecticism

Focus Theories

• Piaget's Theory of Cognitive Development
• Erikson's Theory of Psychosocial Development
• Kohlberg's Stages of Moral Development

Developmental Theories and Nursing

• No single one describes all aspects of growth and development so there are a number of theories available
• An individual's development within the context of family, relationships, and community
• Provides critical thinking skills to nurses that enables how and why people respond as they do

Cognitive Developmental Theories

• Focus on reasoning and thinking processes
• These processes affect how people perform intellectual operations
• These operations relate to how people learn to understand the world
• Mental processes and emotional behaviour are linked

Piaget's Theory of Cognitive Development

• Addresses children’s intellectual organization development and how the children think, reason, perceive, and make meaning of the physical world
• The four stages in Piaget's theory include:
  • Sensorimotor from birth to 2 years old
  • Preoperational from 2 to 7 years old
  • Concrete Operations from 7 to 11 years old
  • Formal Operations from 11 years to adulthood

Key Elements of Piaget’s Theory

• Infants develop patterns for dealing with the environment, acquire knowledge through sensory experiences, and explore objects; object permanence occurs during the sensorimotor stage
• Children learn to think using symbols and mental images and play is key; as language develops, it broadens children's ability to communicate
• Children perform mental operations, think about their actions, and that of others; they learn to cooperate and share new information about their actions
• Adolescents can think in an abstract and theoretical way and organize their thoughts; they can reason with other possibilities

Nursing Implications of Cognitive Development

• Offer the patient adaptation to new health challenges through support and information
• Providing positive feedback ensures challenges are overcome
• New challenges are better overcome

Moral Developmental Theories

• Focus on the development of moral reasoning and are a subset of cognitive theory
• Moral reasoning involves how people think about ethical/ moral conduct rules
• Distinguishing right from wrong and developing ethical values help create actions

Kohlberg's Theory of Moral Development

• A child's moral development is proportionate to their cognitive development
• Levels/stages do not occur at specific ages; people attains different levels of moral reasoning:
  • Preconventional
  • Conventional
  • Postconventional

Psychosocial Developmental Theories

• Explains development of personality, thinking, behaviour, emotions, and mental health
• This can occur with varying degrees of influence from both internal biological forces and external societal forces

Erikson's Theory of Eight Stages of Life

• Key points:
  • The psychosocial model covers the whole lifespan and not just adolescence and/ or childhood
  • Development as a process is in eight stages
  • Each stage builds upon the last

Erikson's Stages of Life

• Stage 1 (birth to 1 year): Trust vs. Mistrust
• Stage 2 (1-3 years): Autonomy vs. Shame and Doubt
• Stage 3 (3-6 years): Initiative vs. Guilt
• Stage 4 (6-11 years): Industry vs. Inferiority
• Stage 5 (Adolescence): Identity vs. Role Confusion
• Stage 6 (Young Adulthood): Intimacy vs. Isolation
• Stage 7 (Middle Adulthood): Generativity vs. Self-absorption/Stagnation
• Stage 8 (Old Age): Integrity vs. Despair

Elements of Erikson's Stages

• An infant's trust begins during consistent, reliable care: the concept of trust is tested during scenarios such as hospitalization or experiencing the birth of a sibling (Stage 1)
• A toddler learns to be independent and begins to self-develop confidence. (Stage 2)
• The child learns to initiate activities and seek challenges which may cause the child to use fantasy and imagination to explore their environment (Stage 3)
• The child begins to develop a sense of competence in physical, cognitive and social areas; a failure to learn in these new skills potentially increases the risk of having inadequacy or inferiority (Stage 4)
• The child tries multiple roles which results in new social demands/opportunities and conflicts that separate them from their family (Stage 5)

Nursing Implications of Erikson's Theory

• The quality of early developmental experience is key
• Children affected by violence and who have trouble trusting others are at greater risk of experiencing poor intimate relationship
• Required trust elements may not be fully retrieved
• Nurses help the family, community, and societal supports necessary for supporting vulnerable children to achieve transitions
• Trauma-informed care

Periods of Development

• Periods include:
  • Prenatal: Conception to birth
  • Infancy: Birth to approximately 12-18 months
  • Early Childhood: 1 to 6 years
  • Middle Childhood: 6 to 12 years
  • Adolescence: 12 to 19 years

Selecting a Developmental Framework

• Ensures a care plan meets needs of the child
• Helps nurses plan and organize care
• All care planning promotes culturally safe, ethical, legal, and evidence informed care

Infant (1 month to 1 year of age)

• Physical changes
• Cognitive changes
  • Language
• Psychosocial changes
  • Separation
  • Play

Health Risks for infants

• Sudden infant death syndrome (SIDS)
• Falls and accidental injuries
• Bodily damage
• Aspiration/Suffocation
• Drowning
• Poisoning
• Child maltreatment
• Motor vehicles

Health Concerns for infants

• Nutrition - Supplementation
• Excessive feeding/ obesity
• Dentition
• Immunizations and sleep

Toddler (12-36 Months of Age)

• Develop physically through gross and fine motor skills
• Cognitive changes
  • Object permanence
  • Preoperational thought
  • Language Development
• Psychosocial development of a sense of autonomy

Todder Health Risks

• Falls and Injury
• Bodily Damage
• Poisoning
• Drowning
• Burns
• Aspiration and suffocation
• Motor Vehicles

Health Concerns for Toddlers

• Nutrition

Preschooler (ages 3-5)

• Physical changes
• Development of gross and fine motor skills.
• Cognitive changes:
• Artificialism
• Animism
• Immanent justice
• Language development
• Psychosocial development
  • Play

Preschooler's Health Risks:

• Falls, injuries, and drowning.
• Burns
• Choking and suffocation
• Poisoning
• Auto accidents
• Bodily harm

Health Concerns:

• Nutrition -Vision -Sleep

School-Age Child (ages 5-12)

• Physical changes with puberty
• Improved fine and gross motor skills
• Cognitive changes
  • Concrete operations
  • Classification
  • Language development
• Psychosocial
  • Moral development
  • Peer relationships
  • Sexuality

Health Risks for School Age Children

• Injuries
• Illness or Disease
• Falls
• Motor vehicle accidents
• Substance use and poisoning
• Bodily damage

Health Concerns for School Age Children

• Health education
• Safety
• Nutrition

Adolescence (ages12-19)

• Transition from child to adult
• Physical changes: sexual maturation and puberty
• Cognitive changes: formal operations
  • Reason abstractly
  • Introspective -Language skills

Psychosocial Changes in Adolescence

• A focus on Identity:
  • Gender
  • Group
  • Family
  • Vocational
  • Moral
  • Health

Adolescent Health Risks

• Injuries
• Issues related to mental health, including suicide
• Substance abuse
• Eating disorders
• Obesity/inactivity
• Early sexual exploration -Pregnancy -STIs

Adolescent Health Concerns

• Health education
• Rural communities
• LGBTQ2
• Indigenous adolescents

Building Healthy Habits Early

• Focus on nutrition and physical activity
• Getting enough sleep
• Literacy
• Oral health
• Immunizations
• Limiting digital Media

The Importance of Play

• Play reduces both stress and tension
• Alleviates anxiety
• Encourages freedom and expression
• Fosters safety and security
• Promotes growth
• Allows children to make choices

Technology

• Technology & Learning are related
• Technology and socialization are related
• Self-concept and self-identity are shaped via phone apps and social media

Care in Hospital

• Minimize separation from family
• Minimize trauma from hospitalization
• Use a child-life specialist
• Allow child to retain control of their environment
• Allow some flexibility
• Develop care based on child's development
• Communicate honestly and openly
• Practice family-centred care