THEORIES & FACTORSAFFECTING GROWTH AND DEVELOPMENT (KOHLBERG’S AND FOWLER’S THEORY) Submitted to : Mrs. B. Padmavathi madam Dept. of Pediatrics M.sc(N) CON-NIMS
INTRODUCTION: The period of growth and development extends throughout the life cycle. Changes occur is from conception to the adolescence. Growth and development is a process where the person thinks normally, eventually & takes a responsible place in society. It is important for a nurse to understand the early periods as well as the total life cycle of an individual to better understand the behaviour of parents and others who provide care of the child.
WHY IT IS IMPORTANT ?Knowledge of growth and development is important to the nurse for the following reasons: To know the expected growth of a child at a given age and certain kinds of behaviors. The nurse uses this knowledge to observe and assess each child in terms of norms or specific levels of development. To plan for the nursing management and to help in formulating the plan of total care of the child
To better understand the reason for particular condition & illness those occur in various age groups. To teach parent how to observe and to use their knowledge so that they may help their children achieve optimal growth & development. This seminar presents information helpful for adapting care to the needs of the children, factors affecting growth and development, types of classification of development and theories
TERMINOLOGY AND DEFINITIONS: GROWTH: Growth refers to an increase in physical size of whole or any of its part and can be measured in inches/ centimeters and in pounds/ kilograms. -According to the text book of Marlow; 6th edition- Growth of full size or maturity, as in the progress of an egg to the adult stage -Taber’s cyclopedia 20th edition-
DEVELOPMENT: Development refers to progressive increase in skill and capacity. -According to the text book of Marlow; 6th edition- Development, maturation or expansion of physical structures or cognitive & psychological abilities. The process may be normal, as in the development of a fetus or a child, or pathological, as in a cyst or a malignant tumor -Taber’s cyclopedia 20th edition-MATURATION: The term maturation is the synonym for development in reference to the development of traits carried through genes.
CHARACTERISTICS OF GROWTHAND DEVELOPMENT INDIVIDUAL DIFFERENCES READINESS FOR CERTAIN TASKS(CRITICAL PROCESS) RATE OF DEVELOPMENT SEQUENCE OF GROWTH AND DEVELOPMENT IRRELATEDNESS OF GROWTH AND DEVELOPMENT CHANGING IN GROWTH RATES OVER THE YEARS
PRINCIPAL OF GROWTH ANDDEVELOPMENT: Growth proceeds from the head down to the tail, or in a cephalocaudal direction. particularly evident during the period of first year of life after the birth, the head end of the child enlarge and develops before the tail end
Growth proceeds from the center, or midline, of the body to the periphery, or in a proximodistal direction. During the prenatal period, the limb buds develop before the rudimentary fingers and toes. During infancy, the large muscles of the arms and legs are subject to voluntary control earlier than the fine muscles of the hands and feet. This proximodistal development is bilateral and symmetric, for most of the parts and on both sides of the body.
As the child matures, general movements become more specific. Generalized muscle movements occur before fine muscle control is possible. At first, infants can make only random movements of the arms. Gradually they learn to use the whole hand in picking up a small object, than learn to pick it up with a pincer grasp i.e. between thumb and forefinger. As development progresses, the child can eventually learn to move just one finger or a thumb at a time.
STAGES OF GROWTH ANDDEVELOPMENT:- Prenatal period: Conception to birth, encompassing the embryonic period (conception to 8 weeks) and the fetal period(8 weeks -ending in birth). Newborn(Neonatal) period: from birth to 2 to 4 weeks Infancy: from 2-4 weeks to one year. Toddler: from 1-3 years of age. Early child hood (Preschool): From 3 to 6 years. Late child hood (School): From the puberty to the beginning of the adult life is called adolescence.
Factors affecting growth anddevelopment are 1. Hereditary 2. Sex 3. Race 4. Nationality 5. Environment
FACTORS INFLUENCING GROWTHAND DEVELOPMENT: HEREDITY: The heredity of a man and a woman determines that of their children. Embryonic life begins with the cytoplasm and nucleus of the fertilized ovum, genetically determine by both parents. The rate of growth is more alike among siblings than among unrelated persons. Some children are small not because of endocrine or nutritional disturbances but because of their genetic constitution.
SEX: Sex is determined in some countries at conception but it is not practiced in India. After birth the male infants are longer and heavier than female infants. Boys maintain this superiority until about 11 Years of age. Girls Mature earlier than boys, and are than taller on the average. During the prepubertal stage of growth and development, boys are again taller than girls. Bone development is more advanced in girls than in boys. Advance in osseous development is also demonstrated by the earlier eruption of permanent teeth in girls.
RACE:- Distinguishing characteristics called racial or subracial development in prehistoric humans. As too height, too short, tall do examples exist among all the races and subraces.
NATIONALITY:- Many of the recent immigrant’s arrivals and their descendants of families in whom short stature is normally seen in United States. Even with the influence of good nutrition and environment, these children may not achieve the same heights as their peers in growth patterns
ENVIRONMENTPRE NATALENVIRONMENT • INTELLIGENCE INTERNAL • HARMONAL INFLUENCE • EMOTIONSPOSTNATALENVIRONMENT • CULTURE • SOCIO-ECONOMY • NUTRITION • CLIMATE & SEASON EXTERNAL • ORDINAL POSITION • EXERCISE • DEVIATIONS FROM +VE HEALTH
The Harmful prenatal factors are:- The fetus may suffer from nutritional deficiencies when the mother’s diet is insufficient in quantity or quality, regardless of her socio-economic standards. Mechanical problems may be present leading to malposition in utero. The mother may suffer from metabolic endocrine disturbances, such as diabetes mellitus which affects the fetus. If the mother is suffering from infectious diseases the fetus may also be affected but there is less scientific proof. The fetus may also be affected by the treatment of radiation for cancer if the mother is undergoing.
The mother may suffer from any infectious diseases during gestation like TORCH infections 1st, 2nd and 3rd trimesters adversely influence the fetus. Erythroblastosis fetalis due to Rh incapability of the blood types of the mother and the fetus may have a serious influence upon the developing child. Faulty placental implantation may lead to nutritional impairment and anoxia.
Research has shown that smoking or the use of certain drugs such alcohol and phenytoin by the mother may result in prematurity or deformity of the child. If the mother has good prenatal care, many of these conditions can be prevented or treated thus ensuring a better prenatal environment for the fetus.
EXTERNAL ENVIONMENT:CULTURAL ENVIRONMENT: The effects of a particular culture on a child begin before birth . The nutrients the mother is expected to eat during pregnancy are culturally determined. Delivery of the baby is culturally determined. After child is born, the child is cared for according to the culturally sanctioned pattern of child rearing. The behaviour expected of the child at each stage of growth & development is culturally defined.
EXTERNAL ENVIRONMENTSOCIO ECONOMIC STATUS OF THE FAMILY:• The environment of the lower socio economic groups may be less favorable than that of the middle & upper groups.• Parents in unfortunate financial circumstances .• However public health & health education programs are gradually assisting such parents to provide better care for their children
EXTERNAL ENVIRONMENTNUTRITION: Nutrition is related to both the quantitative & qualitative supply of food elements such as proteins, fats, carbohydrates, minerals & vitamins. During periods of rapid growth such as prenatal period, infancy, puberty & adolescence need high amount of proteins & calories are needed
EXTERNAL ENVIRONMENT The effects of inadequate nutrition or the causes of under nutrition include: An inadequate nutrition intake both qualitatively & quantitatively. Physical hyper activity or lack of adequate rest. A physical illness that causes an increase in nutritional needs but at the same time results in poor appetite & poor absorption. An emotional illness that causes decreased food intake or inadequate absorption because of vomiting or diarrhea.
EXTERNAL ENVIRONMENT DEVIATIONS FROM NORMAL HEALTH: This may be cause by hereditary or congenital conditions, illness or injury & may result in altered levels of growth & development. Hereditary or congenital conditions may contribute to growth impairment or to an increase in height. Examples of conditions causing increase in height above normal include Marfan syndrome & klinefelter syndrome.
Long term or chronic illnesses of any type may have adverse effects on growth & development. Certain illnesses like cystic fibrosis or mal absorption syndrome, an inability to digest & absorb food may lead to growth retardation. Congenital diseases or anomalies or chronic infections that are present during rapid growth periods & critical periods of development have a temporary or permanent delaying effects on the achievement of normal growth & development.
EXTERNAL ENVIRONMENT CLIMATE & SEASON: Climatic variations influence the infant’s health. It is important that parents may be unable to provide adequate refrigeration and extermination of flies & other insects The season of the year influences growth rates in height & weight, especially in older children. Weight gains are lowest in summer & autumn. The greatest gains in height among children occur in spring. The differences are mainly due to seasonal variations.
EXTERNAL ENVIRONMENTEXERCISES: Exercise, increases the circulation, promotes physiologic activity & stimulates muscular development. Fresh air & moderate sun shine favor health & growth. Prolonged exposure to sunlight may cause tissue damage of the skin & even more consequences if the child is unprotected from the rays of the sun
EXTERNAL ENVIRONMENTORDINAL POSITION IN THE FAMILY: The first born child in the family is an only child in a family who receives all the parental attention until the second child is born. The parents of the first born child are unusually inexperienced & may not know the successive stages of growth & development.
INTERNAL ENVIRONMENTINTELLIGENCE: The child of high intelligence is likely to be taller & better developed than is the less gifted child. Also, intelligence influences mental and social development.
INTERNAL ENVIRONMENTHARMONAL INFLUENCES: There is evidence that all the hormones in the body effect growth in some manner. Although 3 hormones are very important others also influence growth to an extent.a) Somatotropic harmone (STH) or growth hormone: Its major effect is on linear growth in height because it is essential in the proliferation of cartilage cells at the epiphyseal plates. The growth harmone stimulates skeletal and protein anabolism through the production of somatomedins or intermediary harmones.
HARMONAL INFLUENCE: An excess of growth harmone causes gigantism & lack results in dwarfism.
HARMONAL INFLUENCE:b) Thyroid harmone: Thyroxine (T4) & Tri Iodothyronine(T3) Thyrotrophic harmone(TH), produced by adenohypophysis stimulates the thyroid gland to release T3,T4,TH. These thyroid harmones stimulate the general metabolism & therefore are necessary for advanced linear growth whereas a deficiency produces cretinism with stunted physical growth & mental retardation.
HARMONAL INFLUENCE:c) Harmones that stimulate the gonads. The adenocorticotrophic harmone(ACTH):• ACTH is produced by the adenohypophysis, stimulate the hypothalamus, which in turn causes the adenohypophyses to secrete gonadotrophic harmones. The gonadotrophic harmone stimulate the interstitial cells of the testes to produce testosterone & the interstitial cells of the ovaries produce estrogen.
Testosterone stimulates the development secondary sexual characteristics & the production of spermatozoa in young man. Estrogen stimulates the development of secondary sexual characteristics & the results in precocious puberty, whereas the deficiency results in delay in development. Other harmones that less directly influence the process of growth & development include insulin, parathormone, cortisol, & calcitonin.
INTERNAL ENVIRONMENT EMOTIONS: Relationships with significant other persons, mother, father, sibling, peers & teacher play a vital role in the emotional, social, & intellectual development of the child. If the child is given the necessary care & love that promotes healthy development, otherwise growth & development retardation may occur. emotionally deprived children may receive adequate nutrition but do not gain weight as expected & are pale & unresponsive. If emotional deprivation continues & loving care is not given over a period of time, the children may have repeated illness, become emotionally ill, or die at an early age.
PHYSICAL GROWTH& DEVELOPMENT Physical growth & development can be divided into 3 areas Biological growth Motor development Sensory development
BIOLOGICAL GROWTH changes in general body growth: Changes results from different rates of growth in different parts of the body during consecutive stages of development eg :- the infants head constitutes 1/4th of the entire length of the body at birth, where as the adult’s head is only 1/8th of body length
BIOLOGICAL GROWTHLength or height: Some children reach adult heights in their early teens, but others continue to grow throughout late adolescence. The periods of rapid growth are infancy & puberty.
BIOLOGICAL GROWTH Weight: Weight is influenced by all the increments in size & is probably the best gross index of nutrition & health. Obesity may result from a glandular deficiency, but it is more likely due to over eating to a diet containing too much starch & fat and too little protein or lack of exercises.
BIOLOGICAL GROWTH Head circumference: The circumference of the head is an important measurement since it is related to intracranial volume. An increase in circumference permits an estimation of the rate of brain growth. This measurement has a relatively narrow normal range of a particular age group.
BIOLOGICAL GROWTHThoracic diameter: Chest measurements increase as the child grows & the shape of the chest changes. At birth the transverse & anteroposterior diameters are nearly equal. The transverse diameter increases more rapidly than does the anteroposterior diameter i.e the width becomes greater than the depth.
BIOLOGICAL GROWTH Abdominal & pelvic measurements: The abdominal circumference is not fixed by a bony cage as in the chest; consequently it is affected by the infant’s nutritional state, muscle tone, gaseous digestion & even the phase of respiration. The pelvic bi-cristal diameter (the maximal distance between the external margins of the iliac crest) is not affected by variations in posture & musculature & is a good index of a child’s slenderness or stockiness.
MOTOR DEVELOPMENTMotor development depends on the maturation of the muscular, skeletal & nervous systems. The sequences of skills follow the cephalocaudal & proximal direction.Motor development is termed as 1. Gross motor. 2. Fine motor
MOTOR DEVELOPMENTGross motor activities include turning, reaching, sitting, standing & walking.Fine motor development is the involvement of reflexes. The child learns to use hands & fingers for thumb apposition, palmer grasp, release, pincer grasp and so on.Motor development is not affected by sex, geographic residence, or level of parental education, although adequate nutrition & good health exert a positive influence. Motor development varies widely in young children.
SENSORY DEVELOPMENTThe sensory system is functional at birth, the child gradually learns the process of associating meaning with a perceived stimuli. As myelination of the nervous system is achieved, the child is able to respond to specific stimuli.
THEORIES OF GROWTH &DEVELOPMENT TYPES OF THEORIES OF GROWTH & DEVELOPMENT: Intellectual development or Jean piaget theory or cognitive development. Moral development or Jean piaget & Lawrence Kohlberg theory. Emotional development or Erik. H Erikson theory or psychosocial development. Development of sexuality or Sigmund Freud’s theory or psycho-sexual theory or development. Spiritual development or James. W Fowler’s theory. Language development. Development of self concept.
CATEGORIESCategories of development:Theoretical foundations of personality development: Psycho-sexual development (freud) Psycho-social development (Erickson)Theoretic foundations of mental development: Cognitive development (piaget) Language development Moral development (Kohlberg) Spiritual development(Fowler’s)Development of self concept: Body image Self esteem
THEORY OF “LAWRENCE KOHLBERG & JEAN PIAGET”:(Motor development)Moral development described by Kohlberg(1963) is based on cognitive developmental therapy & consist of following three levels. Kohlberg postulates six stages of potential moral development organized in three levels. Pre-conventional morality. Conventional morality. Post-conventional morality.
Level-1: pre-conventional morality :- The pre-conventional level of moral development parallels the pre-operational level of cognitive development & intuitive thought. Culturally oriented to the labels of good/ bad & right/ wrong, children integrate these in terms of physical pleasurable consequences of their actions. They avoid punishment & obey without question The elements of fairness, give & take, and equal sharing are evident, they are interpreted in a very practical, concrete manner without loyalty, gratitude or justice.
Stage 0: the good is what I like & want (0-2 years of age) The infants & younger toddlers are egocentric, liking or loving that which helps them and disliking or hating that which hurts them. Stage 1: punishment- obedience orientation (2-3 years). The older toddlers & young pre-school children believe that if they are not punished, their acts are right. If they are punished their acts are wrong. Children therefore, act to avoid displeasing those who are in power. This is the stage where mothers repeatedly say “NO-NO”.
Stage 2 : Instrumental hedonism and concrete reciprocity (4 to 7 years of age). Children focus on the pleasure motive. They consider those actions right that meet their own needs or those of other. They carry out rules to satisfy themselves
Level II CONVENTIONAL MORALITY This level corrects the behaviour and the authority, if the behaviour not acceptable the children feel guilty. Stage 3: Orientation to interpersonal relations of mutuality (7 or 8 to 9 years). Children of early school age are becoming socially sensitive and want to gain the approval of others. If their actions help them gain the approval of their family, peers, teachers they are right. Disturbed relationships result their actions are wrong.
Stage 4: Maintenance of social order, fixed rules, and authority (10-12 years of age). Children want to do what is right and what they consider to be their duty. They obey rules for their own sake. Children see justice as reciprocity between the individuals and the social system.For example they assume responsibility on the school safety patrol and when carrying out their duties, show respect for those in authority. They want to maintain order among their peers.
LEVEL – III POST CONVENTIONAL, AUTONOMOUS, (OR) PRINCIPLED LEVEL: Stage 5: Adolescence & adulthood. Adolescent make choices on the basis of principles that have been thought about, accepted & internalized. What ever actions conform to these principles are considered right inspite of the praise or blame of others. 5(a) : Social contract, utilitarian law making prespective. 5 (b) : Higher law and conscience orientation. They are concerned that good laws be created that will maximize the individual’s welfare. They do not want something without paying for it, and if they belong to group they work towards its goal.
Stage 6 : Universal ethical principle of orientation. This is the level of highest moral value, and period in which individual can motivate, evaluate themselves. They have reached the level of self-actualization.
FOWLER’S THEORY (SPIRITUALDEVELOPMENT) Spiritual beliefs are closely related to the moral and ethical portion of the child’s self concept. Fowler (1974) has identified seven stages in the development of faith, four of which are closely associated with and parallel cognitive and psychosocial development in child hood.
The stages of spiritual development are: stage 0 : Primal faith (undifferentiated infancy) : This stage of development encompasses the period of infancy during which children have no concept of right or wrong, no beliefs, and no convictions to guide their behaviour.
Stage 1 : Intuitive projective faith (early child hood): Toddler hood is primarily a time of imitating the behaviour of others. Children imitate the religious gestures and behaviors of others without comprehending any meaning or significance to the activities. During the preschool years children assimilate some of the values and beliefs of their parents. Parental attitude toward moral codes and religious beliefs convey to children what they consider to be good and bad.
Stage 2: Individuating Reflexive : Adolescents become more skeptical and begin to compare the religious standards of their parents with those of others. They attempt to determine which to adopt and incorporate into their own set of values. They also begin to compare religious standards with the scientific view point. It is a time of searching rather than reaching.
LANGUAGE DEVELOPMENT The rate of speech development varies from child to child and directly related to neurologic competence and cognitive development. Gestures precedes speech, and in this way a small child communicate satisfactorily. As speech develops, gestures recedes but never disappears entirely. At all the stages of language development, children’s comprehension vocabulary is greater than their expressed vocabulary. And this development reflects a continuing process of modification that involves both the acquisition of new words and the expanding and refining of word meanings previously learned.
Language development The first parts of speech used are nouns, sometimes verbs and combination words such as (bye-bye). Responses are usually structurally incomplete during the toddler period, although the meaning is clear. Next they begin to use adjectives and adverbs to qualify nouns and verbs. Later pronouns and gender words are added (such as “he” and “she”). By the time children enter school, they are able to use simple, structurally complete sentences that average five to seven words.
DEVELOPMENT OF SELF CONCEPT The term self concept includes all the notions, beliefs, and convictions that constitute an individual’s self knowledge and that influence that individuals relationships with others. It is not present at birth but develops gradually as a result of unique experiences with in the self, with significant others and with the realities of the world.
BODY IMAGE Body image refers to the subjective concepts and attitudes that individuals have toward their own bodies. It consists of the physiologic, psychological and social nature of one’s image of self. Body image is a complex phenomenon that evolves and changes during the process of growth and development.
SELF ESTEEM Self esteem is the value that on individual places on oneself. Self esteem is described as the affective component of the self, where as self concept is the cognitive component. The term self-esteem refers to a personal, subjective judgment of one’s worthiness derived-from and influenced by the social groups in the immediate environment and individual’s perceptions. Self esteem changes with development.