GROWTH AND DEVELOPMENT

Theoretical approaches in the growth and development of infants and

toddlers
(A draft report)

Submitted by:

Group 4 (BSN 2-8)

Dagdag, Angel Kate

Gamurot, Maria Adela

Macabenta, Charmisse Klaine

Padilla, Aeroso Jillian

Valerio, Jucelle Anne

Submitted to:

Prof. Tiamzon
I. Introduction to Growth and Development
A. Concepts (definition)
 Health Promotion and Illness Prevention
 Health Restoration and Maintenance
 Patterns
B. Principles of Growth and Development
Growing up is a complex phenomenon because of the many
interrelated facets involved. Children do not merely grow taller and heavier
as they get older; maturing also involves growth in their ability to perform
skills, to think, to relate to people, and to trust or have confidence in
themselves.
The terms “growth” and “development” are occasionally used
interchangeably, but they are different. Growth is generally used to denote an
increase in physical size or a quantitative change. Growth in weight is
measured in pounds or kilograms; growth in height is measured in inches or
centimeters. Development is used to indicate an increase in skill or the ability
to function (a qualitative change). Development can be measured by
observing a child’s ability to perform specific tasks such as how well a child
picks up small objects such as raisins, by recording the parent’s description
of a child’s progress, or by using standardized tests such as the Denver II.
Maturation is a synonym for development.

- Growth and development are continuous processes from conception

until death. Although there are highs and lows in terms of the rate at
which growth and development proceed, at all times a child is growing
new cells and learning new skills. An ex- ample of how the rate of growth
changes is a com- parison between that of the first year and later in life.
An infant triples birth weight and increases height by 50% during the
first year of life. If this tremendous growth rate were to continue, the 5-
yr-old child, ready to begin school, would weigh 1600 lb and be 12 ft 6 in
tall.
- Growth and development proceed in an orderly sequence. Growth in
height occurs in only one sequence—from smaller to larger. Development
also proceeds in a predictable order. For example, the majority of
children sit before they creep, creep before they stand, stand before they
walk, and walk before they run. Occasionally, a child will skip a stage (or
pass through it so quickly that the par- ents do not observe the stage).
Occasionally, a child will progress in a different order, but most children
follow a predictable sequence of growth and development.
- Different children pass through the predictable stages at different
rates. All stages of development have a range of time rather than a
certain point at which they are usually accomplished. Two children may
pass through the motor sequence at such different rates, for example, that
one begins walking at 9 mo, another only at 14 mo. Both are developing
normally. They are both following the predictable sequence; they are
merely developing at different rates.
- All body systems do not develop at the same rate. Certain body tissues
mature more rapidly than others. For example, neurologic tissue
experiences its peak growth during the first year of life, whereas genital
tissue grows little until puberty.
- Development is cephalocaudal. Cephalo is a Greek word meaning
“head”; caudal means “tail.” Development proceeds from head to tail.
Newborns can lift only their head off the bed when they lie in a prone
position. By age 2 mo, infants can lift both the head and chest off the bed;
by 4 mo, the head, chest, and part of the abdomen; by 5 mo, infants have
enough control to turn over; by 9 mo, they can control legs enough to
crawl; and by 1 yr, children can stand upright and perhaps walk. Motor
development has proceeded in a cephalocaudal order—from the head to
the lower extremities.
- Development proceeds from proximal to distal body parts. This
principle is closely related to cephalocaudal development. It can best be
illustrated by tracing the progress of upper extremity development. A
newborn makes little use of the arms or hands. Any movement, except to
put a thumb in the mouth, is a flailing motion. By age 3 or 4 mo, the infant
has enough arm control to support the upper body weight on the
forearms, and the infant can coordinate the hand to scoop up objects. By
10 mo, the infant can coordinate the arm and thumb and index fingers
sufficiently well to use a pincerlike grasp or be able to pick up an object as
fine as a piece of breakfast cereal on a highchair tray.
- Development proceeds from gross to refined skills. This principle
parallels the preceding one. Once children are able to control distal body
parts such as fingers, they are able to perform fine motor skills (a 3-yr-
old colors best with a large crayon; a 12-yr-old can write with a fine pen).
- There is an optimum time for initiation of experiences or learning.
Children cannot learn tasks until their nervous system is mature
enough to allow that particular learning. A child cannot learn to sit, for
ex- ample, no matter how much the child’s parents have him or her
practice, until the nervous system has matured enough to allow back
control. Children who are not given the opportunity to learn
 developmental tasks at the appropriate or “target” times for that task
may have more difficulty than the usual child learn- ing the task later on.
A child who is confined to a body cast at 12 mo, the time the child would
normally learn to walk, may take a long time to learn this skill once free of
the cast at, say, age 2 yr. The child has passed the time of optimal learning
for that particular skill.
- Neonatal reflexes must be lost before development can proceed. An
infant cannot grasp with skill until the grasp reflex has faded nor stand
steadily until the walking reflex has faded. Neonatal reflexes are replaced
by purposeful movements.
- A great deal of skill and behavior is learned by practice. Infants
practice over and over taking a first step before they accomplish this
securely. If children fall behind in growth and development because of ill-
ness, they are capable of “catch-up” growth to bring them equal again
with their age group

C. Factors Influencing Growth and Development

 Genetics

From the moment of conception when a sperm and ovum fuse,

the basic genetic makeup of an individual is cast. Although each child
is unique, certain gender-related characteristics will influence growth
and development. In addition to physical characteristics such as eye
color and height potential, inheritance determines other
characteristics such as learning style and temperament. An individual
may also inherit a genetic abnormality, which could result in disability
or illness at birth or later in life.

 Gender
 Health
 Intelligence

 Temperament
Temperament is the usual reaction pattern of an individual, or
an individual’s characteristic manner of thinking, behaving, or
reacting to stimuli in the environment (Chess & Thomas, 1995).
Unlike cognitive or moral development, temperament is not
developed by stages but is an inborn characteristic set at birth.
Understanding that children are not all alike—some adapt quickly to
 new situations and others adapt slowly, and some react intensely and
some passively—can help parents better understand why their
children are differ- ent from each other and help them care for each
child more constructively.

 Reaction Patterns
 Activity Level
 Rhythmicity
 Approach
 Adaptability
 Intensity of reaction
 Distractibility
 Attention span and persistence
 Threshold of response
 Mood Quality

 Environment

Although children cannot grow taller than their genetically

programmed height potential allows, their adult height may be
considerably less than genetic potential if their environment hinders
their growth in some way. For example, a child could receive
inadequate nutrition because of a family’s low socioeconomic status; a
parent could lack childcare skills or not give a child enough attention;
or a child could have a chronic illness (O’Shea et al., 2007). Many
illnesses lower children’s appetite; others, such as certain endocrine
disorders, directly alter their growth rate. Having a parent who
abuses alcohol or other substances can cause such inconsistency in
care it affects mental health (Fitzgerald & Das Edien, 2007; Motz,
Leslie, & DeMarchi, 2007).
Environmental influences, however, are not always
detrimental (Dooley & Stewart, 2007). For example, children with
phenylketonuria, an inherited metabolic disease, can achieve normal
growth and development in spite of their genetic makeup if their diet
(a part of the environment) is properly regulated. The following
 environmental influences are those most likely to affect growth and
development.
 Socioeconomic Level
 Parent-Child Relationship
 Ordinal Position in the Family
 Health

 Nutrition

In the past 20 years, nutrition has become a major focus of

health promotion and disease prevention in the United States because
the quality of a child’s nutrition during the growing years (including
prenatally) has a major influence on health and stature (Rolfes, Pinna,
& Whitney, 2009). Poor maternal nutrition may limit the growth and
intelligence po- tential of a child from the moment of birth. Children
whose diets lack essential nutrients show inadequate physical growth.
A lack of energy and stamina prevents children from learning at their
best intellectual level.
 Food Guide Pyramid Guidelines for a Healthy Diet
 Eat a variety of foods.
 Balance the Food You Eat With Physical
Activity-Maintain or Improve Your Weight
 Choose a Diet With Plenty of Grain Products,
Vegetables, and Fruits.
 Choose a Diet Low in Fat, Saturated Fat, and
Cholesterol.
 Choose a Diet Moderate in Sugars
 Choose a Diet Moderate in Salt and Sodium
 If Drinking Alcoholic Beverages, do so in
Moderation.
 Components of a Healthy Diet
 Protein
 Carbohydrate
 Fat
 Vitamins
 Minerals

D. Theories of Development
 A theory is a systematic statement of principles that pro- vides a
framework for explaining some phenomenon. Developmental theories
provide road maps for explaining human development.
A developmental task is a skill or a growth responsibility arising at a
particular time in an individual’s life, the achievement of which will provide a
foundation for the accomplishment of future tasks. It is not so much
chronologic age as the completion of developmental tasks that de- fines
whether a child has passed from one developmental stage of childhood to
another.

 Freud’s Psychoanalytic Theory

Sigmund Freud (1856–1939), an Austrian neurologist and the
founder of psychoanalysis, offered the first real theory of personality
development (Edmundson, 2007). Freud based his theory on his
observations of mentally disturbed adults. He described adult
behavior as being the result of instinctual drives that have a primarily
sexual nature (libido) that arise from within the person and the
conflicts that develop be- tween these instincts (represented in the
individual as the id ), reality (the ego), and society (the superego). He
described child development as being a series of psychosexual stages
in which a child’s sexual gratification becomes focused on a particular
body part.
 Infant “Oral Phase”
 Toddler “Anal Phase”
 Preschooler “Phallic Phase”
 School-Age Child “Latent Phase”
 Adolescent “Genital Phase”

Criticisms of Freud’s Theory

To construct his theory, Freud relied on his knowledge of people

with mental illness or looked at circumstances that led to mental illness.
This “looking at illness” rather than “looking at wellness” perspective
limits the applicability of the theory as a health promotion measure,
although the behaviors he discussed are as observable as ever.

 Erikson’s Theory of Psychosocial Development

Erik Erikson (1902–1996) was trained in psychoanalytic
theory but later developed his own theory of psychosocial
development, a theory that stresses the importance of culture and
 society in development of the personality (Erikson, 1993). One of the
main tenets of his theory, that a person’s social view of self is more
important than instinctual drives in determining behavior, allows for
a more optimistic view of the possibilities for human growth.
 The Infant – Trust vs. Mistrust
 The Toddler – Autonomy vs. Shame or Doubt
 The Preschooler – Initiative vs. Guilt
 The School-Age Child – Industry vs. Inferiority
 The Adolescent – Identity vs. Role Confusion
 The Young Adult – Intimacy vs. Isolation
 The Middle-Aged Adult – Generativity vs. Stagnation
 The Older Adult – Integrity vs. Despair

Criticism of Erikson’s Theory

Erikson’s main contribution to human development was the creation

of stages so that development can be broken down into separate phases for
study. A criticism of his theory is that life does not occur in easily divided
stages, and trying to divide it that way can create superficial divisions.

 Piaget’s Theory of Cognitive Development

Jean Piaget (1896–1980), a Swiss psychologist, introduced
concepts of cognitive development or the way children learn and
think that have roots similar to those of both Freud and Erikson and
yet separate from each (Wadsworth, 2003). Piaget defined four stages
of cognitive development; within each stage are finer units or
schemas. Each period is an advance over the previous one. To
progress from one period to the next, children reorganize their
thinking processes to bring them closer to adult thinking.
 The Infant – sensorimotor stage
 The Toddler
 The Preschooler
 The School Age Child
 The Adolescent

Criticism of Piaget’s Theory

Piaget has been criticized because he used only a small sample

of subjects (his own children) to develop his theory. Because children
today begin activities to learn reading much earlier than they did at
the time the theory was devised, the age groups and “norms” may no
 longer be accurate. Learning computer skills at an early age may be
changing both the rate and type of children’s cognitive development.

 Kohlberg’s Theory of Moral Development

Recognizing where a child is at according to these stages can
help identify how children may feel about an illness such as whether
children think it is fair that they are ill. Recognizing moral reasoning
also helps determine whether children can be depended on to carry
out self-care activities such as administering their own medicine or
whether children have internalized standards of conduct so they do
not “cheat” when away from external control. Moral stages closely
approximate cognitive stages of development, because children must
be able to think abstractly (be able to conceptualize an idea without a
concrete picture) before being able to understand how rules apply
even when no one is there to enforce them.
 The Infant
 The Toddler
 The Preschooler
 The School-Age Child
 The Adolescent

Criticism of Kohlberg’s Theory

Kohlberg’s theory is frequently challenged as being male- oriented

because his original research was conducted entirely with boys. Carol
Gilligan (1993), a sociologist, has suggested that girls may not score well on
 Kohlberg’s scale because, being more concerned with relationships than
boys, they make moral decisions based on individual circumstances, a
different criterion for decision making.

E. Role of Nurses in Growth and Development of Children

An assessment of children’s growth and development should be
included in all children’s nursing care plans as whether they are growing and
developing within usual parameters is a significant mark of wellness.