GROWTH AND DEVELOPMENT

II. Infancy

A. Biological Development

a.1 Proportional Change

Infants have an average weight gain of 2 lbs. per month during the first 6 months. The average 1-
year old boy weighs 10 kg. (22 lbs.). While the average girl weighs 9.5 kg. (21 lbs). During the
first year, an infant increases 50% or a birth length of 20-30 inches.

a.2 Maturation of Systems

Organ systems also change and grow during infancy. The respiratory rate slows to 20 to 30 cpm.
Respiratory movement continues to be abdominal. The heart rate slows from 120 to 160 bpm to
100 to 120 bpm by 1 year. Pulse rate may slow with inhalation (sinus arrhythmia). The
gastrointestinal tract is immature. Infant’s immunologic system becomes functional at 2 months.
Kidneys are inefficient in eliminating waste.

B. Developmental Milestone

b. 1 Gross Motor

Infant is able to extend their head, legs, and spine when held in ventral position. And lying on
their stomach, they can turn head to move out of a difficult position. They can now roll over
from supine to prone. At 9 months they can now pull up to a standing position with support and
is able to cruise at 11 months.

b.2 Fine Motor

Fine motor skill is the use of hands and fingers in grasping an object. At 1 month, infants hands
are predominantly close. By 4 months the infant is able to do thumb opposition and “pincer
grasp” at 10 months. And on the 12th month they can draw a semi straight line and hold a cup
and spoon.

b.3 Language

The infant’s first means of communication is crying. They tend to be very talkative at 4 months
and does cooing, babbling, and gurgling. They say simple vowel sound like “goo-goo” at 5
months and usually speak their first word like “da-da” on the 9th month. And is able to speak two
words like “mama” with meaning on the 12th month.

C. Psychosocial Development

Developing a Sense of Trust (Erikson)

Phase I (birth to 1 year) is concerned with acquiring a sense of trust while overcoming a sense of
mistrust. Infants “trust” that their feeding, comfort, stimulation and caring needs will be met.
Failure to learn “delayed gratification” will lead to mistrust.

Erikson divided the first year of infants into two stages: oral and social stage. During the first 3 to
4 months, food intake is the most important social activity of infants. Primary narcissism (total
concern for oneself) is also at its height. During the second stage biting occurs. Infants learn that
they can hold unto what is their own and can fully control the environment.

D. Cognitive Development

Sensorimotor Phase (Phase)

The theory is used to explain cognition or the ability to know. Period from birth to 24 months is
termed the sensorimotor phase and is composed of six stages. Infancy involves four of these
stages. The use of reflexes (birth to 1 month) in which infant is a narcissistic and reflexive.
Primary circular reaction (1-4 months) in which the use of reflexes is gradually replaced by
voluntary activity and the beginning of separation of self from others. Secondary circular reaction
(4-8 months) where in infants can grasp idea that their actions can initiate pleasurable sensations.
Stranger anxiety is also evident. Coordination of secondary schemas and their application to new
situations (9-12 mos.) in which the concept of object permanence is developed and the beginning
of intellectual reasoning.

E. Social Development

e.1 Attachment

Or the close emotional bond between infant and caregiver is evident during the second half of the
year.

e.2 Play

During infancy the play of infant is primarily narcissistic and revolves around their body. From
3-6 months, infants play alone with a rattle or movable object over the crib or with someone
else. By 6 to 1 year, they play actual games such as “peek-a-boo” or “pat-a-cake”. And by 11
months, infant starts to cruise.

Temperament

Infant’s temperament or behavioral style influences the type of interaction that occurs between
child and other family members.

F. Coping with Concerns Related to Normal Growth and Development

Between 4 and 8 months the infant progresses through the first stage of separation anxiety. The
best approach for the stranger is to talk softly, meet the child at eye level, maintain a safe distance
and avoid sudden intrusive gestures. Parents are faced with the need to set limits so as not to spoil
their child. Parents may also use negative voice and stern eye-to-eye contact to discipline their
child. During infancy and early childhood there is no need to restrain the child’s sucking. But
these may lead to malocclusions if it persists past 4 years of age. At 6-8 months, the first primary
tooth erupts. To provide relief from gum pain give a frozen teether ring, and ice cubes wrapped in
clean cloth, or an oral gel.

G. Promotion of Health During Infancy

Human milk is the most desirable complete diet for the infant during the first 6 months. An
acceptable alternative to breast feeding is commercial iron-fortified formula. Solid food without
salt is introduced within 4-6 months. And at 10-12 months infant begins to wean from bottle and
can be offered with table foods.
 Sleep problems also vary among infants. The best way to prevent it is to establish bedtime rituals
that do not foster problematic patterns.

Immunization is also introduced to infants to provide active or passive immunity. Common

immunizations are DPT (Diptheria, pertusis, tetanus), Polio vaccine, MMR (Measles, mumps,
rubella), HBV (Hepatitis B virus), VZIG (Varicella Zoster Immune Globulin), and HIB
(Haemophilus Influenza Type 2).

H. Injury Preventions

Injuries are a major cause of death during infancy. Constant vigilance, awareness, and
supervision are essential to protect child from aspiration of foreign objects, suffocation, motor
vehicle injuries, falls, poisoning, burns and drowning.

V. School Age (6-12 yrs. old)

A. Biological Development

a.1 Maturational Systems

School age child grow slowly but steadily. Girls usually grow
faster than boys and commonly surpass them in height and weight. This is why girls are
usually taller at this age. Children will grow an average weight gain of 3-5 lbs. (1.3-2.2 kg.) or
4.5-6.5 lbs. (2.3 kg.). The average gain height is 1-2 inches (2.5-5 cm.). At 10 yrs. old, brain
growth is complete as evidenced by the refinement of fine motor coordination. This stage is
also known the “loose tooth stage” since all the teeth are lost. Middle childhood may be called
“Ugly Duckling” when new secondary teeth appear small than the face. An average child has
28 teeth. Pulse rate decreases to 70-80 bpm while BP arises to 112/60 mmHg. Stomach and
bladder capacity increases.

a.2 Prepubescence

It is the period that begins toward the end of middle childhood and ends with the 13th birthday.
Onset of puberty occurs at 10 year old for girls and 12 year old for boys.

C. Cognitive Development

The transitional stage, a period from five to seven years, is where children shifts from
preschooler’s preoperational thought to concrete operational thought, or the ability to reason
through any problem that they can actually visualize. Duuuring this stage concepts of
decentering (ability to project the self into other people’s situation), accommodation (ability to
adapt thought process to fit what is perceived), conservation (ability to appreciate that a change
in shape does not mean a change in size), classification skills, reversibility (ability to think that
a clay can be reshaped into its original form), reciprocity (ability to deal with two dimensions at
the same time), arrangement of objects, and combination skills (ability to manipulate numbers
and learn skills of addition,etc.) are learned.

D. Moral and Spiritual Development

Children at this age are in the stage of preconventional reasoning starts as early as 5 years old for
some. They concentrate on niceness and fairness and they can’t see yet that stealing hurts their
neighbors; this is the highest level of moral reasoning. They begin to learn rituals and the meaning
behind their religious practice. They also expect that when they pray to God, their payers should
be answered as soon as possible. They are still limited to their ability to understand others views,
 they may interpret something as being right because it is good for them. When they reach 10-13
years old, they will arrive at conventional level thereby increasing the desire to please others.

E. Social Development

In this period, the child becomes increasingly involved in more complex activities and decision
making. At age 6, they play in group, except when they are tired. At 7, they expect that promises
must be kept because they view this as definite, firm commitments. At 8, they seek the company of
other children. At 9, they value their peer group seriously. This is known as the “gang age”
because they usually form clubs. At age 10, they want to have their own room, or at least a dresser.
At 11, they are increasingly interested with the opposite sex. At 12, they feel more comfortable in
social situations. Although peer group is highly influential and necessary to normal child
development, parents are still the primary influence in shaping children’s personalities, setting
standards for behavior and establishing value system

F. Play

Play becomes more competitive and complex during school age period, however when they
discover reading as an enjoyable activity, that open doors to other worlds, they will begin to spend
quite time with books.

G. Developing Self-Concept

Children’s self concept is composed of their own critical assessment plus what they interpret as the
opinion of family members.

H. Body Image

Their body image is what they think about their bodies, and when they are teased or criticized the
effect can be lasting.

I. Coping with Concerns Related to Normal Growth and Development

Typical parental concerns during school-age period include dishonest behavior, lying, cheating,
stealing and school- related stress. It is difficult for many parents to cope with dishonest behavior
by their children. Parents should be helped to understand the importance of their own behavior as
role models and of being truthful in their relationship with children. They need to be aware of the
types of behaviors they model for their children. However, to help children cope with the stress in
their lives, the parent, teacher, or health worker must be able to recognize signs that indicate a
child is undergoing stress. Children need to be taught how to recognize signs of stress in
themselves and help the, plan a means for dealing with any stress.

J. Promotion Of Health During The School Years

The schools years are an ideal time for children to begin to take responsibility for their own health.
Children can be taught to take a more active role in relationships with health care providers. It is
important to impress on children and their parents the value of a diet balanced to promote growth.
During the school years children sleep approximately 9 ½ hours. School nurses should also be alert
for opportunities to teach correct brushing of teeth.