Instructional Material for Introduction to G and D 2024.pdf

MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Instructional Material for Online Teaching and Learning Care of Mother, Child and Adolescent (Well Clients) NCM 107-A Department of Nursing...

MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Instructional Material for Online Teaching and Learning Care of Mother, Child and Adolescent (Well Clients) NCM 107-A Department of Nursing AY 2021-2022 1|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences CHAPTER 6. GROWTH AND DEVELOPMENT This chapter provides you information on the physical, cognitive, social, and emotional growth of children from infancy to adolescent period. It enables you also to review prominent theories of development and topics such as important milestones, health, nutrition, play, safety, parental and family concerns, and management of care. This chapter is divided into six (6) lessons. Each lesson has a time allotment of 3 hours except for lesson 6 with 2 hours only. Lesson 1. PRINCIPLES OF GROWTH & DEVELOPMENT Lesson 2. NURSING CARE OF A FAMILY WITH INFANT Lesson 3. NURSING CARE OF A FAMILY WITH TODDLER Lesson 4. NURSING CARE OF A FAMILY WITH A PRESCHOOL CHILD Lesson 5. NURSING CARE OF A FAMILY WITH SCHOOL-AGE CHILD Lesson 6. NURSING CARE OF A FAMILY WITH ADOLESCENT 2|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Lesson 1. PRINCIPLES OF GROWTH & DEVELOPMENT INTRODUCTION OF THE LESSON AND PRESENTATION OF OUTCOMES In this lesson, you are going to appreciate that learning the Growth and development of children of different ages is both challenging and rewarding. And that, your expertise to handle specific task and developmental milestone in each of the developmental stages is so important for you to render effective and efficient care and management to these children in need of you help. This lesson also is your springboard in understanding how children behave as they grow and accomplished all the task specific for their stage of development. Learning Outcomes: After mastering the concepts of this lesson, you must have: 1. Described the principles of growth and development; 2. Identified developmental stages according to major theorists; 3. Enumerated factors affecting growth and development; 4. Applied appropriate nursing concepts and actions holistically and comprehensively Warm-up-activity: Before you will go on with the learning inputs, let’s test your knowledge and understanding about growth and development by answering the following question. Since this is just a warm up activity you have just to write what you know so that we have a basis where we start our discussion. Question # 1. What comes to your mind when you hear the word growth and development? Question #2. Can you identify at least 1 theory of Growth and development and explain how this theory affects the growth and development of a child? 3|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences LEARNING INPUTS Growth denotes a net change in size, in proportion, disappearance of old features and acquisition of new ones. This changes are largely attributed to multiplication of cells and increase in the intracellular substance (quantitative change eg. Increase in height and weight). Growth does not continue throughout life. It stops when maturity has been attained. This is measured also by some units of measurement like kilograms (kgs.) or centimeters (cm). Development specify maturation of functions. It is related to the maturation and myelination of the nervous system and indicates acquisition of variety of skills for optimal functioning of the individual hence bring qualitative changes which are difficult to be measured. Also, development continues throughout life and is progressive and development is possible even without growth. Principles of Growth and Development You have to understand that these principles of growth and development will help you better appreciate why children are unique and behaving differently. 1. Growth and development are continuous, orderly sequential process. Although there are highs and lows in terms of the rate at which growth and development proceed, a child is growing new cells and learning new skills at all times. Also, growth in height occurs in only one sequence – from smaller to larger Patterns of Growth and development comes in different ways. cephalocaudal – head to toe development proximodistal – center to periphery gross to refined – related to proximo distal, once child is able to control body parts, he is able to perform fine motor skills general to specific – in motor development, the infant will be able to grasp an object with the whole hand before using only the thumb and forefinger 2. Each child grows at his own rate passing through predictable stages (eg. Two children may pass through the motor sequence at such different rate, the one begins walking at 9 months, whereas another starts at 12 months. They are both following the predictable sequence and are developing normally but they are merely developing at different rates) and body parts have asynchronous growth (meaning certain body tissues mature more rapidly than that others eg. Neurologic tissue experiences its peak growth during the first year of life, whereas genital tissue grows little until puberty.) 3. There is an optimum time for initiation of learning and new skills tends to predominate. Children cannot learn tasks until their nervous system is mature enough to allow that particular learning. Once the child learn new skills that skill become the pre- 4|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences occupation of the child. Infants practice over and over taking a first step before they accomplish this securely. 4. Neonatal reflexes must be lost before development can proceed. An infant cannot grasp an item with skill until the grasp reflex has faded nor can the infant stand steadily until the walking reflex faded. Neonatal reflexes are replaced by purposeful movements. 5. The many factors influencing growth and development are interrelated. They act upon and react with one another extensively and inseparably. Factors Influencing Growth and Development Generally, there are 2 primary factors that determine how each child grows and mature: genetic inheritance and environmental influences. This portion will help you to understand more how these factors will influence and contribute to the growth and development of the child. 1. Heredity/Genetic. The genetic make-up of each person is determined from the moment of conception: gender, intelligence, health, temperament: a. gender On the average, girls are born lighter and shorter than boys but boys keep their height and weight advantage until prepuberty. After prepuberty girls surge ahead because they begin their puberty growth spurt 6 mos. to 1 year earlier than boys but by the end of puberty, boys again tend to be taller and heavier than girls. This differences is reflected in different growth charts used for boys and girls b. health A child who inherits a genetically transmitted disease may not grow as rapidly or develop as fully as a healthy child depending on the type of illness and the therapy or care available for the disease. c. Intelligence Children with high intelligence do not generally grow faster physically (motor skills) than other children but they tend to advance faster in skills (read books, mental games). d. Temperament It is the manner of thinking, behavior or reacting to stimuli. It is not developed by stages but is an inborn characteristics. Some children may adapt quickly to new situations while others adapt slowly, some may react intensely while others passively 5|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences ❖ Categories of Temperament a. The easy child – easy to care for, adapts easily with new situations, with predictable and regular rhythm, have a mild to moderate intensity reaction, and with overall positive mood quality. (40-50% of children) b. Difficult child – with irregular rhythm, (-) mood quality and withdraw rather than approach new situations (10%) c. Slow to warm up child – fairly inactive, adapt slowly to new situations, and have a general negative mood. (15%) To further appreciate how temperament affects the growth and development of the child you can visit this website for the 9 temperamental traits https://childdevelopmentinfo.com/child- development/temperament_and_your_child/temp2/#content 2. Environment Financial worries and concern about space and material needs may intercede on genetics that may determine the extent of a child’s potentialities, whereas environment can hinder (environment is not always detrimental) or promote it. You may consider the following factors which seems to interpolate/interrelate and become the cause or effect of other factors: 2.1 Nutrition The amount of food and the type of food taken by the child is affected by culture and religion. Consider also that the child’s nutrition during the growing years has a major influenced on health and stature of the child. 2.2. Socio-Economic Status Because health care and good nutrition both cost money, children born into families of low socioeconomic may suffer from inadequate health maintenance leading to faulty diet/malnutrition/ no immunization and vulnerability to disease. 2.3 Race and culture Children of some races and nationalities tend to be taller/shorter. Also, fostering G & D in children are varied due to cultural variations. There are diseases which could be associated with different race such as sickle cell anemia that occurs mainly in African Americans, Thalassemia which is common in children of Mediterranean countries, and skin cancer that have high incidence in Caucasians. 2.4 Family Family is the most influential in terms of the growth and development of the child, the presence of a parent, family member most specially the love from a caregiver 6|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences will determine the the life of the child in the future. The parent-child relationship is so important because children who are loved thrive better so spending quality time with our children is so important. Family size, family structure and ordinal position in the family have some bearing on a child’s growth and development. 2.5 Prenatal Influences Prenatal nutrition, lifestyle, exposure to certain diseases (TORCH) of the mother plays a great role in the growth and development of the child. Also, differences in emotionality of Newborn have attributed in part to differences in emotional stress experienced by their mother’s during pregnancy. Different Aspect of Development 1. Physical Growth. This includes changes in body size like the increase in height, weight and the development of muscle control. As the child grows it is expected that there is different rates of growth in different parts of the body. 2. Mental Development. This is the test of intelligence, problem solving, and general understanding of what to do in a given situation. The potential mental ability is inherited and fixed a birth but the rate and extent of development is influenced by the child’s environment. Intelligence quotient – numeric expression of one’s intellectual level as measured against the average group * formula: mental age Chronological age X 100 Example: A 6 year old child (chronological) who passes all items that an average 6 year old will pass, will have a score of 6/6 x 100 = 100% (IQ) A 6 year old child who passes no more items than the average 4 year old child, the IQ is 4/6 x 100 = 66 A 6 year old child who passes items that a 10 year old child normally passes, IQ is 10/6 x 100 = 166 7|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences You can interpret the IQ of the child using this guide: IQ of 140 and above = gifted child IQ of 90-109 = average child Below = retardation Borderline MR = 71-84 moron 50-75 with mental age Mild MR = 50-70 between 7 and 12 (stupid) Moderate MR = 35-49 Severe MR = 20-34 profound = below 20 3. Emotional Development. Different stages exhibit different emotional development (eg. infant cries when toy is taken away) which is continuous process in each of the stages. ❖ Emotional Intelligence. First defined in 1900 by psychologist Peter Saloney and John Mayer. According to them this is the ability to monitor one’s own and other’s feelings and emotions, to discriminate among them and to use this information to guide one’s thinking and action. It is not the opposite of cognitive skills, rather they interact dynamically with cognitive and physical skills in order for a person to become highly functioning, well rounded individual. Also, emotional intelligence is important for individual success. 3 General Parenting Styles a.Dictatorial – parents are strict about rules they set; parents believe that children’s rule is mainly listening to adults and complying with expectations (children tend to become unhappy, withdrawn and have difficulty trusting others) b. Permissive – parents are passive when it comes to setting limits; they do not have strong and clear demands on children c. Authoritative – parents are able to balance their style so that they are nurturing and yet they set firm and clear limits. They guide but do not control. 4. Social Development. The acquisition of the ability to behave in accordance with social expectations Measurement Tools for Growth and Development 8|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Some aspects have standardized measurement derived from studies to keep track of the progress of Growth & Development. 1. Chronological Age. Using the birth date as reference, developmental tasks related to certain age group is assessed (make use of different Developmental Theories) 2. Assessment of Cognitive Development – Mental Age. Measured by a variety (at least 2 separate testing session) standardized Intelligence Test (IQ). 3. Denver Developmental Screening Test (DDST)/Metro Manila Development Screening Test (MMDST) 4. Growth Parameters. Measurement of height and weight and compared against acceptable norms (growth chart), bone age thru X-ray to determine degree of ossification Theories of Growth and Development Theory. This is a systematic statement of principles that provides a framework for explaining a phenomenon. Developmental theories. These are theories that provide road maps for explaining human development. Developmental Task. The skill or learning process that an individual must accomplish at a particular time in his life 1. SIGMUND FREUD’S theory of PSYCHOSEXUAL DEVELOPMENT Believes that early childhood experiences form the unconscious motivation for actions in later life. He theorized that personality develops in five (5) overlapping stages from birth to adulthood and believes that sexual energy is centered in specific parts of the body at certain stage. And that unresolved conflict and unmet needs at a certain stage will lead to becoming fixated. Three Structures of Personality ID – pleasure principle, primitive drives EGO –reality principle, balances the ID and SUPER-EGO SUPER-EGO – conscience and ego ideal Table 1. Freud’s Five Stages of Psychosexual Development Stage AGE Center of Pleasure/Gratification Oral Phase 0-1 yr. (infant) Mouth – infants are so interested in oral stimulation or pleasure Anal phase 1-3 yrs. (toddlerhood) Anal region – children’s interest focus on the anal region as they begin toilet training. 9|P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Phallic 3-6 yrs. (preschool) Genitalia – children’s pleasure zone shifts from anal to genitals – masturbation Latency 6-12 yrs. (school age) Sexual impulse is repressed Genital 12 and after (adolescent) Full sexual maturity 2. Erik Erikson’s theory of PSYCHOSOCIAL DEVELOPMENT He establishes eight (8) psychosocial stages in an individual’s life span. Each stage signals a task that must be achieved and he believes that the greater the achievement, the healthier the personality of the individual. He theorized that developmental tasks are viewed as a series of crises and the successful resolution is supportive to the development of healthy personality and individual is able to move to next stage with particular strength, while failure to resolve the task is damaging to the ego. Also he emphasize that failure to achieve a task influences the individual’s ability to achieve the next task. Table 2. Erik Erickson’s Eight Stages of Psychosocial Development Stage/Developme Age Of Positive Resolution Of Negative Resolution ntal Task Trust vs. Mistrust 0-1 yr. Infancy Autonomy 1-3 yrs. vs. toddlerhood shame and doubt Initiative 3-6 yrs vs. Preschool Guilt Industry 6-12 yrs vs School-age inferiority Identity vs. Role 12-18 yrs Confusion Adolescence Intimacy vs. 18-25 yrs Isolation Young adulthood Generativity vs. 25-60 yrs. Stagnation Middle adulthood Integrity vs. 60 years onwards despair Old adulthood 3. Jean Piaget’s Theory of COGNITIVE DEVELOPMENT She is a Swiss psychologist who believes that cognitive development is a sequential, orderly process in which a variety of new stimuli must exist before intellectual abilities can develop. She defined four (4) phases of development and each phase consists of sub-units with their own characteristics as child advances from one phase to the next, thinking process is recognized until become closer to adult thinking. This theory focuses on the way children learn to think, reason, and use language. 10 | P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Three (3) Primary Abilities: 1. ASSIMILATION - the process of changing a situation or one’s perception of it to fit one’s thoughts/ideas 2. ACCOMODATION - the process of change whereby cognitive processes mature sufficiently to allow the person to solve those that are unsolvable before 3. ADAPTATION - the ability to handle the demands made by the environment. Piaget’s Four (4) Phases of Cognitive Development 1. sensorimotor (0-2 years) 2. preconceptual/preoperational (2-7) 3. concrete operational (7-11) 4. formal operational (11-adulthood) Table 3. Jean Piaget Stages of Cognitive Development Stage Age Child Activity / Behavior 1. SENSORIMOTOR Substages: 1.1 Neonatal Reflexes 0 - 1 mo. - entirely reflexive 1.2 Primary Circular Reaction 1-4 mos. - beginning intention of behavior is present - pleasure is gained through repetition of the behavior. - begins to be aware of the environment as the infant begins to connect cause and effect. - learns from unintentional behavior. 1.3 Secondary Circular Reaction 4-8 mos. - memory traces are present and anticipates familiar events - can plan activities to attain specific goals - Object Permanence – the knowledge that something continues to exist even when out of sight, begins when the infant remembers where a hidden object is likely to be found; it is no longer “out of sight, out of mind.” 1.4 Coordination of Secondary 8-12 mos. - recognizes shapes and sizes, imitates others. Schemes increased sense of separateness *experimentation and exploration predominate as the toddler tries out actions to learn results *capable of space perception, time perception, and permanence 1.5 Tertiary Circular Reactions 12-18 mos. - object permanence now FULLY DEVELOPED 11 | P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences - language provides a new tool for the toddler 1.6 Mental Combination 18-24 mos. to use in understanding the world. - uses memory and imitation to act - Initiates when model is out of sight. - can solve basic problems II. PRECONCEPTUAL 2-4 yrs. - vocabulary and comprehension increase greatly but child is egocentric thinking is basically concrete and literal - static thinking - no awareness of reversibility - concept of time is now, concept of distance is as far as he / she can see II.1 INTUITIVE THOUGHT 4-7 yrs - child relies on transducive reasoning - thinks of one idea at a time - words express thought III. CONCRETE OPERATIONAL 7-11 yrs - concept of “conservation” is learned - child can reason quite well if concrete - objects are used in teaching or experimentation - aware of reversibility and decentering - begins to understand relationships IV. FORMAL OPERATIONAL 11 yrs.- - adult like thinking adulthood - fully mature intellectual thought is attained - uses rational thinking - reasoning is deductive and futuristic 4. Lawrence Kohlberg’s Theory of MORAL DEVELOPMENT This theory focuses on the way children gain knowledge of right and wrong and moral development progresses through three levels and six stages. Table 4. Lawrence Level of Moral Development Level Stage Age I. PRECONVENTIONAL 1. Punishment and Obedience Orientation 2-3 yrs - externally established rules fear of punishment is reason for conformity / determine right or wrong behavior actions - egocentric focus II. CONVENTIONAL 1. Instrumental Relativist Orientation 4-7 yrs – concerns with – conformity is based on egocentric and maintaining expectations narcissistic needs – instrumental purpose and exchange 12 | P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences and rules of family, group, or society – societal focus 2. Interpersonal Concordance Orientation 7-10 yrs III. POSTCONVENTIONAL – behavior is based on concerns about – lives autonomously and other’s reactions defines moral values and – follows rules because of the need to be principles that are “good” distinct from personal 3. Law-and-Order Orientation 10-12 yrs identification with group – maintenance of social order, fixed rules and values authority – universal focus older than 12 4. Social Contract Logistic Orientation – believes a higher moral principle applies and not only social rules 5. Universal Ethical Principle Orientation – decision and behaviors are based on internalized rules and on self-chosen ethical and abstract principles that are universal, consistent, and comprehensive 5. Robert Havighurst’s Theory of DEVELOPMENTAL TASK Theorizes that LEARNING is essential to life and that human being continues to LEARN throughout life. Table 5. Havighurst Developmental Tasks AGE PERIOD TASKS 1. Infancy & Early Childhood - learn to walk, to take solid food, control elimination of body wastes, sex difference, sexual modesty, relate emotionally to parents, siblings & others, to distinguish right from wrong (develop conscience); achieve physiological stability, from physical & social concepts of reality. 2. Middle Childhood - Learn physical skills necessary for ordinary games, to get along with age mates’ appropriate masculine and feminine social role; develop wholesome attitude toward self, skills in reading, writing, calculating, concepts necessary for everyday living, morality, values, personal independence. 3. Adolescence - Achieve mature relationship with peers of both sexes, masculine/feminine social role, acceptance of one’s body image, emotional independence of parents and others adults economic independence, selection and preparation for marriage and family life, 13 | P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences intellectual skills and concepts necessary for civic competence, socially responsible behavior, set of values and an ethical system. 4. Early Adulthood - Select a mate; learn to live with significant others; start family; rear children; manage a home; begin occupation; assume civic responsibility; identify with a social group. 5. Middle Age - Achieve adult civic & social responsibility; establish & maintain an economic standard of living; assist children to become responsible; happy adults; develop leisure activities; relate to spouse on a more intense basis; accept & adjust to physiological changes of middle age; adjust to accept own aging parents. 6. Later Maturity - Accept and adjust to decrease physical strength and health; adjust to retirement; lower income; aging and inevitable death of self and spouse; establish affiliation with age group; meet social and civic obligations; live in satisfactory physical environment. CENTRAL ACTIVITIES Activity 1. Application of the Principles of Growth and Development ❖ Reflect and analyze the given situation: A mother of a 10 month old infant was bothered by the activity of her daughter considering that children like her age can perform such task of walking. As a prudent nurse how can you explain to the mother the situation relating the principles of growth and development. Activity 2. Application of the Factors Affecting Growth and Development To answer the question you may search and read: https://childdevelopmentinfo.com/child- development/temperament_and_your_child/temp2/#content then answer: Althea’s mother describes her 3 year-old twins as being totally different from each other. One is shy and quiet; the other is aggressive and persistent. The nurse recognizes that she probably views which child as easier to care for? What anticipatory guidance could you give her to help her better understand these differences in temperament in her children? 14 | P a g e  MARIANO MARCOS STATE UNIVERSITY College of Health Sciences Activity 3. Application of the Theories of Growth and Development For additional information on the Theories of Growth and Development visit the following websites: https://www.verywellmind.com/child-development-theories-2795068 https://www.simplypsychology.org/Erik-Erikson.html https://www.khanacademy.org/test-prep/mcat/individuals-and-society/self- identity/v/eriksons-psychosocial-development 1. React: What do you think is the best theory that we can use in Growth and Development. Why do you say so? Support your answer. 2. Using your knowledge on the different theories, complete the table on the previous page (p.10) by Erick Erickson Psychosocial Development as to Positive and Negative Resolution. Wrap-up-activity: Children who are not given the opportunity to learn developmental task at the appropriate or “target” times for a task may have more difficulty than the usual child learning the task later on. And If children fall behind in growth and development because of illness, they are capable of ‘catch up” growth to bring them equal again with their age group. In this section you have reviewed the Principles of Growth and development. You can use the following questions to help you reflect on what you have covered. 1. What is growth and development? 2. What are the principles of growth and development? 3. What are the factors affecting growth and development? 4. What are the theories of growth and development? 5. How are these theories affects the growth and development of the child? Post-Assessment You will be given a 20-item quiz for the Lesson 1. Please wait for the schedule of the evaluation quiz. 15 | P a g e