By the end of the discussion the nurses will be
• Define Growth and Development.
• Know the importance of Growth and
Development in Nursing care for children.
• Be familiar with the Principles and factors
affecting growth and development.
• Growth and Development is usually referred
to as a unit. This expresses the sum of
numerous changes that take place during the
lifetime of an individual.
• Refers to a physiologic increase in size through
cell multiplication or differentiation.
• Known as quantitative change which is
• Measured by: Growth in weight – lbs. or kg.
Growth in height – inches or cm.
• Used to indicate an increase in skill or the
ability to function (a qualitative change)
• Measured by: Completing specific tasks,
recording parent’s description of child’s
progress, or by using standardized tests
(e.g. Denver II)
• refers to developing instincts or sensual
pleasure (Freudian theory)
• refers to Erikson’s stages of personality
• The ability to know what is right and what is
wrong and to apply this in real life situations
• The ability to understand from experience ,
to acquire and retain knowledge, to respond
to a new situation, and to solve problems.
• an increase in competence and adaptability;
aging; usually used to describe a qualitative
• Synonymous with Development
• process by which early cells and structures
are systematically modified and altered to
achieve specific characteristics physical and
1. To learn what is expected from a particular
child at a particular age.
2. To assess the normal growth and
development of children.
3. To detect deviations from normal growth and
development (i.e. physical and psychological
abnormalities) and to understand the
reasons of particular conditions and illnesses.
4. To ascertain the needs of the child according
to the level of growth and development.
5. To plan and provide holistic nursing
management to the child based on
6. To teach and guide the parents and
caregivers to anticipate the problems and to
render tender loving care to their children.
7. To develop a rapport with the child to
enhance the provision of health care and to
help to build healthy lifestyle for optimum
health for the future.
• These patterns or trends are basic to all
human beings, but each human being
accomplishes these in a manner and time
unique to that individual.
• CEPHALOCAUDAL or head to tail
– The head of the organism develops first and
is very large and complex, whereas the lower
end is small and simple and takes shape at a
e.g. infants achieve structural control of the head before they
have control of the trunk and extremities
• PROXIMODISTAL or near to far
– applies to the midline to peripheral
e.g. early embryonic development of limb
buds, which is followed by rudimentary
fingers and toes.
– describes the development from simple
operations to more complex activities and
e.g. early embryonal cell with vague,
undifferentiated functions progress to an
immensely complex organism composed of
highly specialized and diversified cells, tissues,
– there is a definite, predictable sequence with
each child normally passing through every stage.
Crawl before they creep, creep before they
stand, and stand before they walk.
The child babbles, then forms words and
finally, sentences; writing emerges from
– there is a fixed, precise order to development, it
does not progress at the same rate or pace.
• Rapid growth before and after birth levels off
throughout early childhood.
• Growth is slow during middle childhood,
markedly increases at the beginning of
adolescence and levels off in early adulthood.
• Total growth of muscles, skeleton and various
• Growth spurt is found in infancy and puberty.
• Growth of the spinal cord, meninges, and
• At birth head size is about 65 – 70%, 2 years
old 90% and at 8 years old it is close to the
adult size which is maintained without
• Dormant during childhood but at puberty
grow faster causing various changes with
appearance of secondary sex characteristics.
• Lymphoid tissues contained in the lymph
nodes, thymus, spleen, tonsils, adenoids and
• Growth is rapid during infancy and highly
accelerated during mid-childhood to protect
• Reaches its peak at age 12 years and stop
growing or regress.
- A fundamental,
general law or
1. Growth and Development are continuous
processes from conception until death.
2. Growth and Development proceed in an
3. Different children pass through the
predictable stages at different rates.
4. All body systems do not develop at the same
5. Development is cephalocaudal.
6. Development proceeds from proximal to
distal body parts.
7. Development proceeds from gross to refined
8. Neonatal reflexes must be lost before
development can proceed.
9. There is an optimum time for initiation of
experiences or learning.
10. A great deal of skill and
behavior is learned by
• different characteristics such
as height, body structure,
color of skin and eyes etc.
depend on inherited genes.
• Abnormal genes
from ancestors may
• Growth and Development are also
affected by children’s chromosomal
e.g. Down’s syndrome, Turner’s
syndrome, Klinefelter syndrome.
• On average Girls are born lighter (By an once
or two) and shorter (by an inch or two) than
• In prepuberty girls surge ahead because they
begin their growth spurt 6 mos. to 1 year
earlier than boys.
• By the end of puberty (14-16 years), boys
again tend to be taller and heavier than girls.
RACE AND NATIONALITY
• Growth potential of different racial groups is
different in varying extent.
• A child with high
intelligence tend to
advance faster in skills,
but do not generally
grow faster physically
than other children.
• 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)
• An inborn characteristic set at birth.
1. Activity – level of
during activity such
as sleep, eating,
play, dressing and
2. Rhythmicity –
Regularity in the
timing of physiologic
functions such as
hunger, sleep and
3. Approach-Withdrawal – nature of initial
responses to a new stimulus such as people,
situations, places, foods, toys and
procedures. (Approach responses are positive
and are displayed by activity or expression.
Withdrawal responses are negative
expressions or behaviors)
4. Adaptability – ease or difficulty with which
the child adapts or adjusts to new or altered
5. Threshold of Responsiveness (Sensory
Threshold) – amount of stimulation such as
sounds or light required to evoke a response
in the child.
6. Intensity of reaction – energy level of the
child’s reactions, regardless of quality or
7. Mood – Amount of pleasant, happy, friendly
behavior compared with unpleasant,
unhappy, crying, unfriendly behavior
exhibited by the child in various situations.
8. Distractibility – ease with which a child’s
attention or direction of behavior can be
diverted by external stimuli.
9. Attention span and persistence – length of
time a child pursues a given activity
(attention) and the continuation of an
activity in spite of obstacles (persistence)
• The EASY CHILD “easy to
• Predictable rhythmicity
• Approach and adapt to
• Mild to moderate intensity
• Over all positive mood
* 40% - 50% are rated by
their parents as being in
• Fairly inactive
• Respond only mildly
and adapt slowly to
• General negative
*About 15% of children
display this pattern
• The DIFFICULT
• Irregular in habits
• Negative mood quality
• Withdraw rather than
*Only about 10% of
children fall into this
• Difficult or slow to warm up children are
more vulnerable to the development of
behavior problems in early and middle
• Any child can develop behavior problems if
there is dissonance between the child’s
temperament and the environment.
• Early identification of temperament provides a
useful tool for caregivers in anticipating
probable areas of difficulty or risks associated
• Researches on the effect of a child’s
temperament in parent-child interactions,
parent’s self-esteem, marital harmony, mood
and over all satisfaction of parents.
Temperament and the ability to perform tasks
successfully (mastery motivation)
• Highly active infants are much more difficult
for new parents to learn to care for especially
if they demonstrate irregular physiologic
rhythms. Nurses must help in requiring more
planning and creative distraction measures
with the parents.
• The way a child will react in the future
depends on the way a child reacts today.
Parents should advised to bring their
children’s characteristics into attention to
help them understand their child and lay
foundations for beginning to accept and
respect their child as an individual.
• Noticing a child’s temperamental
characteristics when they are admitted to a
hospital will help nurses anticipate a child’s
probable reactions to procedures.
• MATERNAL MALNUTRITION
– Dietary insufficiency and anemia lead to
intra-uterine growth retardation.
- LBW and preterm babies have poor growth
• MATERNAL INFECTIONS
–HIV, HBV, STORCH etc. may transmit to the
fetus via placenta and affect fetal growth.
–Congenital anomalies and congenital
infections may occur.
• MATERNAL SUBSTANCE ABUSE
–Intake of teratogenic drugs, tobacco intake
and alcohol abuse (Thalidomide, phenytoin
etc.) by the pregnant woman in the first
trimester affects the organogenesis and
lead to congenital malformations or fetal
• MATERNAL ILLNESS
–Pregnancy Induced Hypertension, anemia,
heart disease, hypothyroidism, DM, CRF
etc. have adverse effect on fetal growth.
Iodine deficiency may lead to mental
retardation of the baby in later life.
leading to large
size fetus with
weight due to
• GROWTH POTENTIAL
–Indicated by the child’s size at birth
–Smaller the child at birth, the smaller
she/he likely to be in subsequent years.
–A major focus in health promotion
and disease prevention.
–A Child’s nutrition during the growing
years has a major influence on his or
her health and stature (Dudek, 2005)
• Nutrition also plays a vital role in the body’s
susceptibility to disease because poor
nutrition limits the body’s ability to resist
e.g. Lack of Calcium could leave a child prone to
• Poor nutrition also plays a major role in the
development of chronic illness.
– 10 leading causes of death in adults, most have
been linked to dietary excess:
• Diseases of the heart
• Diseases of the vascular system
• Diabetes Mellitus
• Malignant Neoplasms
• Eat a variety of foods.
– Choices from all food groups: dairy, meat and
poultry, fruits and vegetables, cereals and grains.
• Balance the food you eat with physical
activity to maintain and improve your
– Urge parents to be certain their children receive
all the nutrients they need for substantial growth
and a balanced lifestyle of physical activity.
• Choose a diet with plenty of grain products,
vegetables and fruits.
– Foods with starch and fiber are more beneficial
for the GI function.
– Intake of Fiber has been linked to lowered
incidence of constipation and colon cancer in
• Choose a diet low in fat, saturated fat and
– Fat intake does not have to be restricted for the
first 2 years of life.
! OLESTRA (synthetic fat in some foods) – do not
recommend to parents until further study is
completed. There is a danger of fat-soluble
vitamins being excreted and lost with the
• Choose a diet moderate in sugars.
– Can contribute to dental caries and obesity.
– Refined sugar “empty calories”
• Choose a diet moderate in salt and sodium
– Taste for salt is acquired. If infants are fed
unsalted or lightly salted foods they do not
develop a desire for heavily salted foods.
• If you drink alcoholic beverages do so in
– Adolescents are at increased risk for establishing
unhealthy patterns for alcohol use.
PROTIEN – major component of bones, skin,
hair and muscle and is responsible for a wide
variety of essential functions in the body.
e.g. beans, pasta, fish
CARBOHYDRATE – main and preferred fuel of
the body to supply energy. Essential to
functioning of most body systems, the
neurologic system in particular.
• Sugar- short-term Starch- sustained!
FAT – Also a source of energy. It can be an
immediate energy source or can be stored if
not used, then released when energy is
• In infants, fat deposits also serve as
insulating material for subcutaneous tissues.
Fat also ensures myelination of nerve fibers.
VITAMINS – Organic compounds that are
essential for specific metabolic actions in
cells. Does not produce energy but are
needed by cells to do so.
• VIT A,C,D,K and E – supplied by fortified dairy
products, fortified cereals, plant oils and fish
MINERALS – necessary to build new cells and
regulate body processes.
• E.g. Fluid and electrolyte balance, nerve
transmission and muscle contraction.
• > 100 mg – Macronutrient
• < 100mg – Micronutrient
• PHYSICAL ENVIRONMENT
–Housing, Living conditions, safety
measures, environmental sanitation
• PSYCHOLOGICAL ENVIRONMENT
– Family members, neighbors, friends,
peers, and teachers are important
factors for promoting emotional,
social, and intellectual development.
• CULTURAL INFLUENCES
–The childrearing practices, food habit,
traditional beliefs, social taboos,
standard of living etc.
• SOCIO-ECONOMIC STATUS
–Children born into families of low
socioeconomic means may not receive
adequate health supervision or good
• PLAY AND EXERCISE
–Play and exercise promote
physiological activity and stimulate
• ORDINAL POSITION IN
–Position of a child in the
family and size of the
e.g. Oldest child or only child
generally excels in language
conversations are mainly with
• Maternal and Child Nursing 5th Edition by
• Pediatric Nursing: Caring for Children and
Their Families by Potts and Mandleco
• Essentials of Pediatric Nursing 7th Edition by
• Pediatric Nursing 2nd Edition by Datta