Theories & Principles of Growth & Development PDF

Theories & Principles of Growth & Development: ( all children pass through predictable stages of growth & development ) Importance of Knowing Growth & development to the Roles of a Nurse: ❖Health promotion & illnes...

Theories & Principles of Growth & Development: ( all children pass through predictable stages of growth & development ) Importance of Knowing Growth & development to the Roles of a Nurse: ❖Health promotion & illness prevention. ❖Health Restoration & Maintenance. Principles of Growth & Development: Growth & development are continuous processes from conception until death. Growth & development proceed an orderly sequence. Different children pass through predictable stages at different rates.All body systems do not develop at the same rate. Development is cephalocaudal Development proceeds from proximal to distal body parts. Development proceeds from gross to refine skills. There is an optimum time for unification of experiences on learning. Neonatal reflexes must be lost before development can proceed. A great deal of skill behavior is learned by practice.  Factors Affecting Growth & Development: A. Genetic Influences= a child will not grow taller, smarter, than what is his genetic composition dictates. Considerations concerning genetic influences: 1. Gender: Females: born weighing less and measuring less in length than boys. Boys: more taller & heavier than girls during pre puberty. Growth Spurt: for females- 6 mos to 1 year earlier than boys end of puberty ( 14 to 16 years ),males show a tendency to be taller and heavier than females. 2. Race & Nationality : affects height & weight. 3. Intelligence: children with high intelligence do not generally grow faster physically because they tend to advance in books than in physical skills. 4. Health: a child who is chronically ill may not grow as well as a healthy child. B. Environmental Influences: a. Quality of Nutrition: quality of nutrition during growing years has a large Influence on eventual health & stature. b. Socio economic Level: family born in a family with incomes below poverty line does not receive adequate health supervision or good nutrition. c. Parent child relationship: children with interrupted love may have interference with their desire to eat, improve & advance. d. Ordinal position in the family: position of the child in the family will have some bearing on his growth & development. e. Health: diseases coming from environmental sources have a strong influence on growth & development. f. Discipline: setting rules or road signs so that the child knows what she is expected to do. g. Play: A medium through which children develop increasing cognitive, psychomotor & social capabilities. Types of Play Age Description 1. Observation Infant -child watches play intently, not actively engaged 2. Parallel Toddler - two children play side by side but attempts to Interact with each other. 3. Associative pre schooler- children play in a similar activity, a little organization of responsibilities. 4. Cooperative School Age – children play with an organized structure or Compete for desired goal or outcome. 5. Independent All ages - a child plays alone in a different manner from any other child present. Theories of Development by Freud, Erickson, Kohlbergs, Piaget Family with an Infant: Growth & Development of an Infant: ( birth to 12 months ) Physical Growth ( the physiologic changes that occur in the infant year reflect both the increasing maturity and growth of body organs ). A. Weight= most infants double their birth weight at 4 to 6 months and triple it by one year. = during the first 6 months, average weight gain is 2lb per month. = during the 2nd 6months, average weight gain 1lb per month. = average 1 year old boy= weighs 10kg = average 1 year old girl= weighs 9.5 kg B. Height= an infant increases in height during the first year by 50% or grows 20 to 30 inches = infant growth is more apparent in the trunk during the early months. = during the second half of the first year, it becomes more apparent in the legs = at the end of the first year, child’s legs may appear disproportionately short, bowed C. Head circumference= increases rapidly reflecting rapid brain growth during infant period. = by the end of first year, brain has reached 2/3 of the adult size. = some brains are asymmetric until 2nd half of the 1st year ( due to sleeping position ) = persistence asymmetry may suggest the child is not receiving enough stimulation or is spending majority of time lying on bed.  = ( Place the infant on his back to sleep and prone when playing, this head distortion gradually corrects itself as the child sleep less and spends more time with the head in an erect position ). D. Body Proportion= changes from that of a newborn to a more typical infant appearance. = the mandible become more prominent as bone grows = by the end of infant period, the lower jaw is prominent & remains through out life. = circumference of the chest is generally less than the head at birth by about 2cm. = abdomen remains protuberant until the child has been walking. = cervical, thoracic and lumbar vertebral curves develops as infants hold up their head, sit and walk. = lengthening of the lower extremities during the last 6 months of infancy readies the child for walking and changes the appearance from baby like to toddler like.  BODY SYSTEMS a. Cardiovascular system: HR slow from 120 to 160 to 100 to 120 by the end of the first year : pulse rate may begin to slow with respiration : slightly elevated blood pressure b. Circulatory System: infants are prone to develop a physiologic anemia at 2 to 3 months. : haemoglobin in infants are easily converted from fetal to adult haemoglobin at 5 to 6 months of age. : infants experience a decrease in serum iron levels at 6to 9months as the last of iron stores established in utero are used. c. Respiratory System: slows from 30 to 60 breaths perminute to 20 to 30 breaths/ min by the end of the first year. : upper respiratory tract infections occurs readily due to tubal cavity remains small. d. Gastrointestinal system: immature in it’s ability to digest food & mechanically move it along. : the ability to digest protein is present at birth, the amount of amylase necessary to digest complex carbohydrates is deficient until the 3rd month. : Lipase necessary for digestion of saturated fat is decreased in amount in the entire year. e. Liver : remains immature possibly causing inadequate conjugation of drugs. = inefficient formation of carbohydrates, protein & vitamins for storage. f. Kidneys: remains immature and not as efficient in eliminating body wastes as in the adult. g. Endocrine system: remains immature in response to pituitary stimulation such as insulin production from the pancreas. Without these hormones to be functioning effectively, the infant may not be able to respond to stress effectively. h. Immune system : becomes functional by at least 2 months of age, an infant can produce IgG & IgM antibodies by one year. : other immunoglobuilins are not plentiful until preschool, the reason why infants must be protected from infection. :The ability to adjust to cold is mature by age 6 months. i. Teeth: the first baby tooth usually erupts at age 6 months, followed by a new month one monthly. : some newborns ( 1 in 2000) may be born with teeth called natal teeth or have teeth erupts at first 4weeks of life known as neonatal teeth. : the mandibular central incisor are the teeth most frequently involve in this early growth :permanent teeth erupts at the age of 6 to 7 years old. : Deciduous teeth are essential for protecting growth of dental arch.  MOTOR DEVELOPMENT 1 YEAR OLD > Cephalocaudal development and gross to fine motor development. Control proceeds from head to trunk to lower extremities in progressive, predictable sequence. Infants should evaluated in 2 major areas; a. Gross motor dev’t. – ability to accomplish large body movements. b. Fine motor dev’t – which is measured by observing or testing prehensile ability or ability to coordinate hand movements. To evaluate gross motor development: in four position; a. Ventral suspension- newborn allows the head to hang down with little effort at control.ex. Landau reflex b. Prone position- when lying on their stomach, newborn can turn their head to move it out of a position raised. c. Sitting position d. Standing position  Fine motor development; 1 month old- still have a strong grasp reflex and so hold their hands in fist so tightly it is difficult to extend the fingers  Developmental Milestones A. Language development 1 month- child begins to make small, cooing (dovelike) sounds by the end of the first month. 2 months-differentiate a cry ex. Hungry or wet. 3 months- response to a nodding,smiling face. 4 months- infants is very talkative, laughs loud 5 months – simple vowel sounds 6-7 months – learn the art of imitating sounds 9 months- first word da da 10 months- masters a word bye bye 12 months learn to have two words. Play --- often ask what toy their child would enjoy, because they can fix their eyes on an object. 1 month- interested in watching a mobile over their crib or play pen, it should be black and white or brightly colored and light. Hearing is the second sense that is source of pleasure for the child, listening to music. 2 months- infants continues to spend a great deal of time just watching the people around him or her. 3 months – handles small blocks or small rattles 4 months – children need a playpen or sheet spread on the floor so they have the opportunity to exercise their new skill or rolling over. 5 months – child is ready for a variety of objects to handle such as plastics rings,blocks it should be big that the child cannot possibly swallow them. 6 months- infants enjoy teething ring to chew on at this time 7 months – interested in brightly colored balls 8 months – sensitive the differences in texture 9 months – child needs experience of creeping, they want to go inside and outside the pen. 10 months – infants are ready for peek a boo and will spend long time playing the game. 11 months – spend little time doing anything else during the month 12 months – child enjoy putting things in and taking things out.  MOTOR, FINE MOTOR DEVELOPMENT, SOCIALIZATION, LANGUAGE & PLAY ( please see table 28.2 pages 778-779) Development of Senses: proceeds step by step during infant year. Vision: 1 month - regards an object in the midline of their vision. ; they study human face with a fixed stare (mother-baby bonding) : 2 months - focus well & follow objects with the eyes. : teach parents to make a point of initiating eye to eye contact with new born as a method of stimulating vision as well as stimulating socialization. : 3 months- can follow an object across their midline : typically hold their hands infront of their face : 4 to 5 months- recognizes familiar objects such as bottle, rattles or toys. : Follow their parents movements. : 6months- still experience difficulty in establishing eye coordination. 4 to 5 months- recognizes familiar objects such as bottle, rattles or toys. : Follow their parents movements. 6months- still experience difficulty in establishing eye coordination. 7 months- children pat their image in a mirror. : transfer toys from one hand to the other. Nurses role: in a hospital setting, assess that an infant is receiving visual stimulation. 10 months- infants look under a towel or around a corner for a concealed object. = Nurses role: in a hospital setting, assess that an infant is receiving visual stimulation. HEARING Hearing: 1 month- quiets momentarily with a distinctive sound such as a bell or a rubber toy. : 2 months- hearing awareness becomes acute. Infants stop activity at a spoken word. : 3 months- infants turn their heads to attempt to locate a sound. : 4 months- when infants hear a distinctive sound, they turn & look in that direction. : 5 months- they demonstrate they can localize sounds downward & to the sides. : 6 months- progressed to being able to locate sounds made above them. : 10 months: they can recognize their name and listen when spoken to. : 12 months- can locate sound in any direction and turn toward it. : a vocabulary of two words, mama & dada demonstrates an infant can hear. = infants enjoy soft, musical sounds or soft cooling voices, they are startled by harsh loud bangs sounds.  TOUCH = An infant needs to be touched so he or she experiences skin to skin contact. = clothes should feel comfortable rather than rough = diapers should be dry rather than wet. = teach parents to handle infants with assurance and gentleness. = Remind the parents that right now child is a baby eventually will become a man = mother may carry infant to her breast to provide warmth and physical contact. Taste= infants have an acute sense of taste by spitting out taste they don’t enjoy. = urge parents to make mealtime a time for fostering trust as well as supplying nutrition. Smell= infants can smell accurately 1 to 2 hours after birth. = they respond from irritating smell by drawing back from it. Emotional Development. 1 month : show they can differentiate faces & other objects. They quiet best & eat best for the person who has been their primary caregiver. 2 months: infant smiles back to a person who smiles at him. 3 months: infant readily smile at a sight of an infants face, laughs loud at a funny face. 4 months: when a person playing the infant leaves the infant is likely to cry o show he enjoyed the interaction. 5 months: infants show displeasure when an object is taken from her. 6 months: able to recognize people who takes care of them & strangers. 7 months: begins to show obvious fear of strangers. : parents must learn that a positive development. 8 months: “ stranger anxiety “ infant does not go willingly from a mothers hand to a nurse’s. 12 months: most children overcome their fear of strangers & are alert responsive again when approached.  Cognitive Development= 1month:an infant uses simple reflex activity. People oriented. 3months: enters cognitive stage identified by Piaget as “ primary circular reaction” : infant explores objects by gasping them with hands or mouthing them. : Ex. Infant reaches a mobile toy across the crib & stares at the colourful toys. 6months: “ secondary circular reaction” they can grasp the idea their actions can initiate pleasurable sensations. : Ex. Infants reaches toy with his hand & reaches again realizing that his hand can do it. 10 months: discover object permanence, becoming aware an object of sight still exists. : they are now ready for a peek a boo once they gained the concept of permanence. : they know their parents still exists even when hiding from a blanket. : stage of cognitive development is called coordination of secondary schema. 12 months: infants are capable of reproducing interesting events and producing new events again. Ex. The activity of falling & picking. THE NURSING ROLE IN HEALTH PROMOTION OF AN INFANT & FAMILY: ( Infants are very dependent on their caregivers for safety, learning & emotional development) A. Promoting Achievement of Task: Trust versus Mistrust: = this period facilitates the infants formation of trust. = When an infant is hungry, a parents makes sure he is fed, when his diaper is wet, the parent makes sure, he is dry again. = trust arises primarily from a sense confidence one can predict what is coming next, it implies establishing some schedule. Ex: breakfast, bathing, play, nap, lunch. = the rhythm of care must be given largely by one person. B. Promoting Infant Safety: = accidents are leading cause of death from one month to 24 age. = often happened because parents underestimate or overestimate child’s ability. C. Aspiration precaution: Ex. Parents underestimate the infant’s ability to grasp & place objects in their mouth. =Nurse’s role: educate care givers & parents appropriate toys to play. D. Fall Prevention: falls are a second major cause of infant accidents. =Nurse’s role: care givers must be educated that no infants must left unattended on a raised surface. : teach parents that infants are capable of rolling by 2 months. : they must be placed in a safe crib with high side rails when sleeping. E. Car Safety: Place the infant in a car seat not very close to the airbags. F. Safety with Siblings: more fun to play at 3 months, brothers & sisters grow more interested in interacting with them. Nurse’s role: remind parents that children under 5 years of age, are not knowledgeable to be left unattended. G. Bathing & Swimming Safety: Babies can support their back. Nurse’s role: cautioned parents not never to left infant unattended in a tub. H. Promoting Health of an Infant: Recommended Dietary reference Intakes for an Infant: = entire first year of life, high protein, high calorie intake is needed. = calories intake can be gradually reduced during the year from a level of 120 kg of body weight at birth to 100. Kg at the end of one year. I. Loss of Extrusion Reflex. Techniques for feeding solid food.. Quantities & types of food. Establishing of Health eating patterns.. Weaning. Self Feeding Adequate intake of a vegetarian diet. Promoting Infant Development in Daily Activities: Bathing Diaper area care, Care of the teeth Dressing, Sleep , Exercise q. Promoting Healthy family Functioning r. Parental Concerna & problems Related to Normal Infant Development. Teething. Thumb Sucking. Use of Pacifiers Head Banging Sleep Problems Constipation Colic Loose Stools Diaper Dermatitis Family With a Toddler( 1 to 3 years period ) Growth & Development of a Toddler: Physical Growth:( While they are making great strides developmentally, their physical growth begins to slow) Weight, Height & head circumference: a child gains about 5 to 6 lb a year during the toddler period. : as subcutaneous or baby fat begins to disappear toward the end of 2nd year, : The child change from a plump baby to a leaner, more muscular girl or boy. : appetite decreases yet sufficient nutritional intake is necessary. : head circumference increases only about 2 cm during the second year compared to 12 cm during the first year. : by 2 years chest circumference has grown greater than that of the head. Body Contour: tends to have prominent abdomen, pouchy belly because though they are walking well, their abdominal muscles are not strong enough to support abdominal content. : forward curve of the spine ( lordosis) as they walk longer, this be corrected naturally.  Toddler Body Systems ( continue to mature ) 1. Respirations slow slightly but continue to be mainly abdominal 2. Heart rate slows from 110 to 90 bpm, BP increases to about 99/64mm hg. 3. Brain develops to about 90% of it’s adult size. 4. In respiratory system, the lumens of vessels enlarge progressively so the threat ofrespiratory infection becomes less. 5. Stomach secretions become more acid, therefore gastrointestinal infection also become less common. 6. Stomach capacity increases to the point that a child can eat three meals a day. 7. Brain develops to about 90% of it’s adult size. 8. Control of the urinary & anal spincter becomes possible with complete myelination of the spinal cord. 9. Ig G & Ig M becomes mature at 2 years. The passive immunity obtained curing intrauterine life is no longer operative. Teeth= 8 new teeth ( the canines & the first molars) erupt during the 2nd year. = all 20 deciduous teeth are generally present by 2.5 to 3 years of age DEVELOPMENTAL MILESTONES ( see table on developmental milestones). Emotional Development: Autonomy : the developmental task is autonomy vs shame & doubt. : Children who have learned to trust themselves & others during the infant year are better prepared to develop a sense of autonomy and to develop a sense of independence. : Ex. A child’s refusal to accept putting on shoes may be seen as disobedience but is a positive sign of autonomy. Socialization: once toddlers are walking well, they become resistant to sitting on laps & being cuddled, not a lack of desire for socialization but of being independent. : fifteen month old are still enthusiastic about interacting with people providing those people are willing to follow them where they want to go. : 18 months, they imitate what the parents are doing : by 2 or more years, children learn to identify gender differences.  Play Behavior: play beside the children next to them not with them. : this side by side play is called parallel play is not unfriendly but is a normal developmental sequence. : parent must provide duplicate toys to avoid fight. : toys they enjoy most are those they can play with themselves & require action. ( trucks they can make go, sqeaky frogs they can squeeze, waddling ducks they can pull, blocks they can stack, toy telephone they can talk.) : The above toys are toys children can control, giving them a sense of power in manipulation, an expression of autonomy : 15month old are still in put in, take out stage : 18month old child is walking securely enough to enjoy pull toys : age 2, toddlers begin to spend time imitating adult actions in their play such as wrapping a doll and putting it to bed, setting a table. : By the end of toddler period, they love to play rough housing Nurses role: Encourage parents to schedule this type of outdoor activity. Cognitive Development: = A toddler enters the 5th & 6th sensori motor thought. ( between 12 & 18th months ) known as tertiary circular reaction stage, describing in this as a little scientist because of their interest in trying to discover new ways to handle objects. = 15 months they follow a different path to obtain the object. = stage 6 ( between 18 & 24 mos ), toddlers are able to try out various actions mentally rather than having to actually perform them. They are also able to remember an action & imitate it later known as “ deferred imitation”, they can do such thing as pretending they drive a car. Object permanence becomes complete. = at the end of toddler period, they enter a second major period of cognitive development Known as “ pre operational thought “, they deal more constructively with symbols than they did while still in the sensorimotor. = they begin to use a process termed assimilation. This causes them to use toy the wrong way. PLANNING & IMPLEMENTATIONFOR HEALTH PROMOTION OF TODDLER & FAMILY Promoting Toddler Safety= accidental ingestions are the type of accidents frequent among toddlers.( most cases; ingestion from cleaning products. = second most common accident is aspiration or ingestion of small objects such as watch or hearing aids, pencil erasers or crayon Nurse’s role: urge parents to put all poisonous products & small objects to keep out of reach of crawling toddlers. : other accidents occur frequently include motor vehicle accidents, burns, falls, & play ground injuries. These occur because a toddler’s motor ability jumps ahead of her judgement. Nurse’s role: teach parents to be alert to know what their toddler is doing at all times. = 15 month old can climb over the side rails of their cribs & enjoy climbing Nurse’s role: to teach parent to move child on a regular bed or a safety gate on a door of the room is another way to keep them safe & contained. = at the age of 2 age, they begin to imitate housework or repairing a car. Nurse’s role: make sure the child does not use real cleaning compound Promoting Nutritional Health of a Toddler: – Toddler Nutrition= children consume 1, 300 k cal daily. Protein & carbohydrate needs are often easily met during the toddler period. = Diets high in sugar should be restricted = Fats should generally not restricted for toddlers under 2 years of age =Calcium & Phosporous intake is important for bone mineralization. = Milk should be whole milk until age 2 years after which 2% mlik can be introduced.  – Promoting Adequate Intake with a Vegetarian Diet: = vegetarian diets are adequate for toddlers if parents are well informed about needed vitamins & minerals. = The use of fortified soy milk prevents fluid, protein, B12 & calcium difficiences. Promoting Toddler Development in Daily Activities: 1. Dressing 2. Sleep 3. Bathing 4. Care of the Teeth Promoting Healthy Family Functioning Parental Concerns Associated with the Toddler Period: Toilet Training= the biggest task the toddler achieve = an individualized task for each child = it should begin & be completed according to child’s ability to accomplish it. = Before a child is toilet trained, they must have reached 3 developmental levels, one physiologic & the other 2 cognitive: = They must have control of rectal & urethral sphincters, usually achieved at the they walk well. =. They must have a cognitive understanding of what means to hold urine stools until they can release them at a certain place & time. = They must have a desire to delay immediate gratification for a more socially accepted action. = toilet training must start this early because cognitive & socially, children do not understand what is being asked of them until 2 to 3 years. Nurse’s role: teach parents not to underestimate the difficulty of the task they are expecting their child to achieve. = some toddlers smear or play with feces often at about same time that toilet training is started. Nurse’s role: Teach parents to accept to accept this behaviour for what it is: enjoyment of the body & of self & the discovery of a new substance. After a child is fully trained, this activity rarely persist. Ritualistic Behaviour = They enjoy ritualistic pattern. They will use only their spoon at mealtime, only their washcloth at bath time or they will not go outside unless mother or father locates their favourite cap. Negativism Discipline Separation Anxiety Temper tantrums See table 29.6 for Nursing interventions to help Physically Challenged or Chronically III Child develop a sense of Autonomy.