Review of Growth and Development

Review of Growth and Development

Theories of Growth and Development

Growth refers to an increase in size; development refers to acquisition of skills. Growth and development occur simultaneously and interdependently. Maturation is the total process that involves the unfolding of the child’s potential, regardless of practice. The two major influences on growth and development are heredity and environment. Hereditary characteristics are those that are transmitted by genes. All other factors that affect the unborn child are environmental.

There are five universally recognized basic assumptions about growth and development. Growth and development:

1. Progress in an orderly manner from simple to complex

2. Are continuous processes

3. Occur at highly individualized rates

4. Affect all body systems and stages

5. Together form a total process

Each individual has a unique behavior known as personality. Different theories of personality development help the nurse promote individuals’ health and provide health care. These personality theories describe stages of development. These stages are generally progressive; that is, it is necessary to complete an earlier stage before moving on to the next. However, at times, the individual may temporarily regress to an earlier stage.

Freud described five stages of psychosexual development: oral, anal, phallic, latency, and genital stages.

Erikson developed a theory of psychosocial development that covers the entire life span. Certain tasks need to be accomplished in each of the eight stages: trust versus mistrust, autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority, identity versus role confusion, intimacy versus isolation, generativity versus stagnation, and ego integrity versus despair.

Piaget’s theory focuses on cognitive development, which proceeds through four stages: sensorimotor, preoperational, concrete operational, and formal operational. Maslow believed that human behavior was motivated by human needs placed on a hierarchy from the most basic to the most complex. These needs begin with the physiological and progress to safety, belonging, self-esteem, and self-actualization.

Kohlberg’s theory of moral reasoning identified three levels of moral development: preconventional, conventional, and postconventional. Moral development progresses within an orderly sequence. However, one does not attain the highest level of moral reasoning.

Important Things to Know:

Describe the five common characteristics of growth and development.

Growth and development occur in an orderly pattern from simple to complex; one task must be accomplished before the next one is attempted. For example, infants must learn head control before they can learn to sit. Growth and development are continuous process.

Compare Freud’s psychoanalytic and Erikson’s psychosocial theories of development.

Freud described five stages of psychosexual development: oral, anal, phallic, latency, and genital stages.

Describe Jean Piaget’s theory of cognitive development.

Piaget’s theory focuses on cognitive development, which proceeds through four stages: sensorimotor, preoperational, concrete operational, and formal operational.

Describe Kolberg’s theory of moral development.

Kohlberg’s theory of moral reasoning identified three levels of moral development: preconventional, conventional, and postconventional. Moral development progresses along an orderly sequence. However, one does not attain the highest level of moral reasoning.

Describe Maslow’s theory of human needs.

Maslow believed that human behavior was motivated by human needs placed on a hierarchy from the most basic to the most complex. These needs begin with the physiological and progress to safety, belonging, self-esteem, and self-actualization,characterized by spurts of growth and periods of slow steady growth. For example, infancy is a period of very rapid growth; after infancy, the rate of growth slows down until adolescence. Growth and development progress at highly individualized rates that vary from child to child. Individuals have their own growth timetable, and one child’s pattern of growth should not be compared to another’s. Growth and development affect all body systems but at different time periods for specific structures. Although many organs mature and develop throughout childhood, the reproductive organs mature at puberty. Growth and development form a total process that affects the person physically, mentally, and socially.

Name the two major influences on an individual’s growth and development.

Genetics and environment are the two major influences on growth and development.

Birth to One Year

Inherited characteristics are determined at the time of conception. Any substance that can adversely affect the developing child is called a teratogen. The period from fertilization to birth is called the prenatal period. Immediately following fertilization, the new structure is called a zygote. It is termed a blastocyst at the time ofimplantation. The developing structure is referred to as an embryo for the first few weeks and a fetus thereafter. Labor begins about 280 days after conception. There are three distinct stages of labor: dilation; expulsion, or the birth of the baby; and delivery of the placenta. The length of each of these stagesvaries with the individual. Immediately after the delivery of the infant, the umbilical cord is clamped. This action ends fetal circulation and marks theinfant’s first breath. The Apgar score is the first assessment of the newborn done at 1 and 5 minutes after birth. The Apgar score indicates thegeneral neurological status of the newborn and assesses infant color, reflex irritability, heart rate, respiratory rate, and muscle tone. The head is large in comparison to the rest of the body. The skull bones are soft to permit passage of the head through the birth canal. The anterior fontanel should close by 12 to 18months, whereas the posterior fontanel closes by the 4th month.

Average birth weight is 7.5 lb. The average length for the newborn is 20 in. Boys tend to be slightly larger than girls. The newborn’s skin is thin and delicate and varies in pigmentation. Common characteristics and skin conditions include the following: vernix caseosa, milia, lanugo, Mongolian spots, and physiological jaundice. The newborn has the ability to swallow, digest, metabolize, and absorb nutrients. The first stool is passed within 10 hours after birth and is calledmeconium.

Primitive reflexes that are evident in the normal newborn include protective reflexes such as swallowing, gagging, sneezing, blinking, rooting, Moro, grasp, Babinski, and tonic neck. The normal ranges for neonate vital signs are as follows:axillary temperature, 97.7° to 99.5° F (36.5° to 37.5° C); pulse,120 to 140 beats per minute; blood pressure, 65/40 mm Hg (Dinamap); and respirations, 30 to 60 beats per minute. Gross motor skills involve the large muscles of the extremities.

Growth and development follow an orderly pattern progressing downward from the head to the feet. This pattern is known as cephalocaudal.

Fine motor control refers to the use of the hands and fingers. This follows the proximodistal directional pattern where shoulder movements are mastered before hand and finger movements.

Erik Erikson believed that at the time of birth the infant must master the critical task of trust to foster psychosocial development. Cognitive development is evidenced by the cause-and-effect method the infant uses to respond to its new environment. Infants begin to communicate with their caregivers soon after birth by smiling and babbling. By mimicking words, infants begin to build a vocabulary. By the time babies are 1 year old, their vocabularies should consist offour to six words.

The newborn’s nutritional needs can be met by either breast milk or formula. Generally, solids are not offered before the first 5 months to prevent food allergies or food intolerance. In adding new foods to an infant’s diet, it is best to add one new food at a time over the course of several days. The typical newborn sleep pattern includes periods of light sleep marked by stirring movements and noises. Newborns typically sleep 20 out of 24 hours. SIDS, or crib death, hasbeen associated with infant sleep patterns. This condition occurs most frequently in the first 5 months of life. To decrease the risk of SIDS, it is recommended that healthy infants be put to sleep on their backs and sides, not on their stomachs.

Play activities help infants explore and learn about their environments. Play during infancy is solitary. Infants need brightly colored toys, free of small parts that could be accidentally ingested or aspirated. Most injuries and deaths at this stage of development occur from preventable accidents. Supervision can help to decrease accidents and ensure safety.

Health promotion is aimed at helping infants achieve optimal growth and development. This can be accomplished through good health practices and regular medical checkups.

Important Things to Know:

List three factors that promote a healthy pregnancy.

Quality of the women’s diet, a balance of rest and exercise, and good health practices and proper health supervision all help to promote a healthy pregnancy.

Name four factors that may have an adverse affect on pregnancy.

Tobacco, alcohol, many drugs, and viruses are a few of the teratogens that adversely affect the unborn.

Describe the steps in prenatal development from fertilization to implantation.

Following fertilization, the zygote undergoes a series of cellular divisions and forms a cell mass known as a morula. The morula continues to divide and change as it travels down the fallopian tube to the uterus, where it implants itself in the uterine wall. At the point of implantation, the entity is called a blastocyst. The total process, from fertilization to implantation, takes about 7 days. After implantation, the multi-celled structure, which is referred to as an embryo, continues todevelop. By the end of the 8th week of development, all essential structures are formed, and the embryo is now termed a fetus.

Describe physical development for infants from 1 to 2 months.

The head is large in comparison to the rest of the body. The skull bones are soft to permit passage of the head through the birth canal. The anterior fontanel should close by 12 to 18 months, whereas the posterior fontanel closes by the 4thmonth. Average birth weight is 7.5 lb. The average length forthe newborn is 20 in. Boys tend to be slightly larger than girls. The newborn’s skin is thin and delicate and varies in pigmentation.

Describe skin manifestations such as vernix caseosa, lanugo, Mongolian spots, milia, and acrocyanosis.

Vernix caseosa is a white cheese-like covering that protects the infant’s skin. Lanugo refers to fine hair covering the body. Mongolian spots are flat, irregular, pigmented areas sometimes found in the lumbosacral region. Milia refers to small clusters of pearly white spots found mostly on the infant’s nose, chin,and forehead. Acrocyanosis refers to a blue color of the newborn’s hands and feet.

List five reflexes present at birth.

The presence of certain reflexes indicates a normal neurological system and also helps approximate gestational age. Several reflexes are protective. These include blinking,sneezing, swallowing, and gagging. Other reflexes present include Moro or startle, rooting, grasp, Babinski, and tonic neck. Rooting and sucking help the infant secure food.

Name the normal ranges for vital signs for the newborn.

The normal ranges for neonate vital signs are as follows: axillary temperature, 97.7° to 99.5° F (36.5° to 37.5° C); pulse 120 to 140 beats per minute; blood pressure, 65/40 mm Hg (Dinamap); and respirations, 30 to 60 beats per minute

Compare the patterns of fine and gross motor acquisition.

Gross motor skills involve the large muscles of the extremities. Growth and development follow an orderly pattern progressing downward from the head to the feet. This pattern is known as cephalocaudal. Fine motor control refers to the use of the hands and fingers. This follows the proximodistal directional pattern,in which shoulder movements are mastered before hand and finger movements.

Give an example of cognitive development for this stage.

Cognitive development is evidenced by the cause-and-effect method the infant uses to respond to its new environment.

State the process of language acquisition during infancy.

Infants begin to communicate with their caregivers soon after birth by smiling and babbling. By mimicking words, infants begin to build a vocabulary. By the time babies are 1 year old, their vocabularies should consist of four to six words.

Describe the nutritional needs of developing infants.

Describe the advantages and disadvantages of breast-feeding and bottle-feeding.

The advantages of breast-feeding are that immune factors are transferred from the mother to the baby, it promotes infant mother bonding, it hastens uterine involution, it is lower in saturated fat and easier to digest, and it decreases the incidence of allergies. It is also less expensive and requires less time in preparation.

Bottle-feeding requires more preparation, it is more costly, it is higher in saturated fat, and it is not as easily digested. Bottle-feeding, however, does free up a mother’s time, allows a father to feed and bond, and means that the mother’s diet will not affect the baby’s diet.

Distinguish between the stools of breast-fed and formula-fed infants.

Breast-fed infants have stools that resemble light, seeded mustard. Stools of formula-fed infants are commonly semisolid and tan or yellow in color.

State the normal sleep patterns for the neonate.

The typical newborn sleep pattern includes periods of light sleep marked by stirring movements and noises. Newborns typically sleep 20 out of 24 hours.

List three interventions used to promote infant safety.

Supervision can help to decrease accidents and ensure safety. Proper use of car seats and safety restraints helps prevent injuries.

Name the immunization schedule for the newborn.

Within 2 months of birth, hepatitis B; diphtheria, tetanus, pertussis; influenzae type B; inactivated polio; and pneumonococcal vaccines are given.

List two concerns for health promotion during the infancy period.

Health promotion can be accomplished through good health practices and regular medical checkups.

Toddlers

Toddlerhood refers to the period of development from 12 months to 3 years of age. Growth rates slow down compared to the rate of growth during infancy. Growth during this period results in the body appearing more proportionate, with a taller, more slender look.Bone development continues with a gradual hardening, or ossification. By 2-1/2 years of age, toddlers usually have a complete set of deciduous teeth (20). Children at this age must visit the dentist for dental examinations and treatments to help ensure healthy teeth later in life.

Gradually, visual acuity will improve and can be enhanced with use of large objects held at close range. Hearing is fully developed and should be tested during periodic examinations. Heart rate, respiratory rate, and blood pressure readings will slow down during the toddler period. Gross and fine motor skills are developing further. By the end of toddlerhood, the child will gain skills related to walking, eating, toileting, dressing, and communicating independently.

Development of gross motor skills depends on growth and maturation of muscles, bones, and nerves. Teaching new skills is of little value until a state of readiness is reached. Fine motor skills achieved during this stage relate to self feeding, dressing, and playing. By end of this stage, children should be actively participating in dressing, washing, and brushing teeth. Toilet training can be successful once the child has achieved a degree of maturity in sphincter muscles, nerves, and language development. Autonomy (independence) is a primary psychosocial task of toddlers. It encourages toddlers to make decisions, especially in their activities of daily living.

Two-year-olds need guidance and discipline. Caregivers should be consistent and repeatedly reinforce limitations. Limit setting should not deny children freedom but give them greater opportunity to explore. Piaget suggested that toddlers interpret new experiences based on memories of previous happenings. This is referred to as preoperational thought.

Moral development occurs as children imitate their parent’s moral behavior and teachings.

Language acquisition develops along with memory and cognition. Young toddlers use one-word sentences. Three-year olds have a vocabulary of approximately 3000 words and use multiple words is a sentence.