This document discusses child growth and development. It covers topics like growth and development definitions, theories of development, developmental milestones, factors affecting growth, nutritional needs of children, and feeding recommendations. It provides details on growth measurements, developmental stages, psychoanalytic and psychosocial theories of development, and principles of growth and development. The document aims to help nursing students understand child growth and development.

1. CHILD GROWTH AND DEVELOPMENT
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 Sileshi M. (BSC, MSC)
ANDINET HEALTH SCIENCE COLLEGE
DEPARTMENT OF NURSING

2. Outline
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Growth and development
Theories of child development
Developmental milestones
Factors affecting growth and development
Nutritional requirements of children
Feeding recommendations

3. Session objectives
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 At the end of this session the students will be able to:
 Define growth and development
Explain principles of growth & development
 Explain common theories of development
 Mention developmental milestones
 Discuss factors affecting growth and development
 Describe nutritional requirements of children
 State the feeding recommendation of children based on their age

4. Introduction
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 The goal of pediatric care is to maximize child's potential.
 Pediatrics nurse need to understand normal growth,
development, and behavior in order to monitor children's
progress, to identify delays or abnormalities in development and
to counsel parents.
 In addition to clinical experience and personal knowledge,
effective practice requires familiarity with major theoretical
perspectives and evidence-based strategies for optimizing growth
and development

5. Growth and development
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A. GROWTH
• Growth refers to an increase in physical size of the whole
body or any of its parts.
• It is simply a quantitative change in the child’s body.

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Growth

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 At birth 2cm less than head circumference
 At 1 year=head circumference, then it grows relatively
faster than the head
Chest circumference

11. Dentition
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Deciduous teeth Eruption (in months) Shedding (in years)
Central incisor 6-7 6-7
Lateral incisor 7-8 7-8
First molar 10-16 10-12
Canine 16-20 9-11
Second molar 20-30 12-13

12. Dentition ...
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Permanent teeth Eruption (in years)
Central incisor 6-7
First molar 6-7
Lateral incisor 7-8
Canine 9-11
First premolar 10-12
Second premolar 11-13
Second molar 12-13
Third molar 17-22

13. Growth and development
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B. DEVELOPMENT
• Development refers to a progressive increase in skill and
capacity of function.
• It is a qualitative change in the child’s functioning.

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Development:
Factors promoting development:

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22. Nutritional needs of children and feeding of infants
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 Early feeding and nutrition play important roles in the origin of
adult diseases such as type 2 diabetes, hypertension, obesity, and the
metabolic syndrome
 Therefore, appropriate feeding practices should be established in
the neonatal period and carried out as a continuum from childhood
and adolescence to adulthood.

23. Nutritional needs of children…..
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 Optimal neonatal feeding practices require a multidisciplinary
approach among health care providers, including physicians, nursing
staff, nutritionists, and lactation consultants.
 Whether by breast or by bottle, successful infant feeding requires
education and a supportive environment conducive to successful
transition from fetal to neonatal life

24. Breast-feeding
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 Feedings should be initiated soon after birth unless medical conditions preclude them.
 The American Academy of Pediatrics (AAP) and World Health Organization (WHO)
strongly advocate breast-feeding as the preferred feeding for all infants.
 The success of breast-feeding initiation and continuation depends on multiple factors,
such as education about breast-feeding, hospital breast-feeding practices and policies,
routine and timely follow-up care, and family and societal support.
 The AAP recommends exclusive breast-feeding for a minimum of 4 months and
preferably for 6 mo.
 The advantages of breast-feeding are well documented and contraindications are rare.

25. STEPS TO ENCOURAGE BREAST-FEEDING IN THE HOSPITAL
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HOSPITAL INITIATIVES
 Provide all pregnant women with information and counseling
 Document the desire to breast-feed in the medical record
 Document the method of feeding in the infant's record
 Place the newborn and mother skin-to-skin, and initiate breast-feeding
within 1 hr. of birth
 Continue skin-to-skin contact at other times and encourage rooming in
 Assess breast-feeding and continue encouragement and teaching on
each shift

26. Steps to encourage breast-feeding…..
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MOTHERSTO LEARN
 Proper position and latch on
 Nutritive sucking and swallowing
 Milk production and release
 Frequency and feeding cues
 Expression of milk if needed
 Assessment of the infant's nutritional status
 When to contact the clinician

27. Steps to encourage breast-feeding…..
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ADDITIONAL INSTRUCTIONS
 Refer to lactation consultation if any concerns arise
 Infants should go to the breast at least 8-12 times/24 hr day and night
 Avoid time limits on the breasts; offer both breasts at each feeding
 Do not give sterile water, glucose, or formula unless indicated
 If supplements are given, use cup feeding, a Haber man feeder, fingers, or
syringe feedings
 Avoid pacifiers in the newborn nursery except during painful procedures
 Avoid anti lactation drugs

28. Human milk has been suggested to have a protective
effect
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Acute disorders
 Diarrhea
 Otitis media
 Urinary tract infection
 Necrotizing enterocolitis
 Septicemia
 Infant botulism

29. Con't………
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Chronic disorders
 Insulin-dependent diabetes mellitus
 Childhood cancer (Lymphoma and Leukemia)
 Recurrent otitis media
 Allergy
 Obesity and overweight
 Hospitalizations
 Infant mortality

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34. Complementary Feeding
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 The timely introduction of complementary foods (all solid foods and liquid
foods other than breast milk or formula, also called weaning foods or
beikost) during infancy is necessary to enable transition from milk feedings
to other foods and is important for nutritional and developmental reasons .
 The dilemmas of the weaning period are different in different societies.
 The ability of exclusive breast-feeding to meet macronutrient and
micronutrient requirements becomes limiting with increasing age of the
infant.

35. Principles of weaning:
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 Start with one food at one feed time, offering a small quantity only
 Introduce new foods one at a time at 3-4 day intervals
 Introduce second meal after 3-4 weeks.
 Include iron containing foods, e.g. liver, green vegetables
 As solid foods increased and milk volumes reduced, remember to
offer dilute fruit juice or water from a cup to infant at least twice a
day particularly during hot weather.

36. Assessment of Nutritional Status
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Growth Monitoring:
 The first step in appraising the growth of a child is by
comparing the child with others of the same age and sex.
 A child, generally, is healthy if she/he grows well and gains
weight.
 When a child is not growing well, he is probably not healthy
 The causes for this ill health could be infection or inadequate
food intake.

37. Con't….
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 Because of these, the growth of a child will slow down or stop
months before clear signs of protein energy malnutrition (PEM).
 Thus, measuring the growth of a child helps to understand if the
child is healthy or not.
 Growth monitoring is particularly important for follow-ups for
children under 3 years of age. You are advised to refer growth-
monitoring chart.

38. How to interpret the growth chart:
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 The first sign of protein energy malnutrition (PEM) is
growth failure.
 Weighing a child regularly on a growth chart and
understanding the direction of the growth line are the
most important steps in detection of early malnutrition.

39. IMPORTANCE OF GROWTH AND DEVELOPMENT
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• Knowing what to expect of a particular child at any given age.
• Gaining better understanding of the reasons behind illnesses.
• Helping in formulating the plan of care.
• Helping in parents’ education in order to achieve optimal
growth & development at each stage.

40. PRINCIPLES OF GROWTH & DEVELOPMENT
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• The developmental principle, that is, the concept of ongoing change
and maturation, is integral to the daily practice of pediatrics.
• Predictable Sequence
• Don’t progress at the same rate (↑ periods of GR in early childhood
and adolescents & ↓ periods of GR in middle childhood)
• Not all body parts grow in the same rate at the same time.
• Each child grows in his/her own unique feature.
• Each stage of Growth &Development is affected by the preceding
types of development.

41. Principles of Growth & Development
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Growth & Development proceed in regular patterns related in
directions :
- Cephalo-caudal (head down to toes)
- Proximodistal (center of the body to the peripheral)
- General to specific

42. Growth Pattern
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43. Types of growth and development
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Types of growth:
- Physical growth (Ht,Wt, head & chest circumference)
- Physiological growth (vital signs …)
Types of development:
- Motor development
- Cognitive development
- Emotional development
- Social development

44. STAGES OF GROWTH AND DEVELOPMENT
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• Prenatal
- Embryonic (conception- 8 w)
- Fetal stage (8-40 or 42 w)
• Infancy
Neonate : Birth to end of 1 month
Infancy: 1 month to end of 1 year
• Early Childhood
- Toddler: 1-3 years
- Preschool: 3-6 years
• Middle Childhood
- School age
- 6 to 12 years
• Late Childhood
- Adolescent
- 13 years to approximately 18 years

45. Measurements of physical growth
(anthropometric measurements)
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1. Weight
 Normal birth weight: 2.5-4.0 kg,
 loss of 5-10% in the 1st week
 Regained at the age of 10th and 14th day
 Increases 25gm/day in the 1st 3 months and 15 gm/day in
the reminder of the 1st year
 Doubles at 5-6 months, triples at 1 year and quadriples at 2
years of age

46. ... anthropometric measurements
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2. Height/length
 At birth=50cm
 At 6 months=65cm
 At 1 year=75cm
 At 2 years=85cm
 At 4 years=100cm, then increases about 5-6cm/year

47. ... anthropometric measurements
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3. Head circumference
 At birth=35cm
 At 1 year=45cm
 At 2 years=48cm
 At 5 years=50cm

48. ... anthropometric measurements
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4. Chest circumference
 At birth 2cm less than head circumference
 At 1 year=head circumference, then it grows relatively faster
than the head

49. Common theories of child development
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Freud theory
(Psycho-sexual development).
Erikson theory
(psychosocial development).
Piaget theory
(cognitive development ).

50. Psychoanalytic theories
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 Freud’s psychosexual theory
 Personality has three structures: the id, the ego, and the
superego
Id consists of instincts-an individual’s reservoir of psychic
energy
 The primary source of psychic energy is sexual
 id is totally unconscious; it has no contact with reality

51. Freud’s ...
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Ego-deals with the demands of reality
It is the executive branch of personality because it uses
reasoning to make decisions
 Id and ego have no morality
Superego– the moral branch of personality

52. Topographical Model
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53. Freud’s ...
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 5 stages of development
1. Oral stage (birth to 1 ½ years)
2. Anal stage (1 ½ to 3 years)
3. Phallic stage (3 to 6 years)
4. Latency stage (6 years to puberty)
5. Genital stage (puberty onward)

54. Erikson’s psychosocial theory
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 Erikson said we develop in psychosocial stages, rather than in
psychosexual stages
 For Freud, the primary motivation for human behaviour was
sexual in nature, for Erikson it was social and reflected a
desire to affiliate with other people
 Erikson emphasized developmental change throughout the
human life span, whereas Freud argued that our basic
personality is shaped in the first five years of life.

55. Erikson’s ...
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 Eight stages of development
 Each stage consists of a unique developmental task that
confronts individuals with a crisis that must be resolved
 The crisis is not a catastrophe but a turning point of increased
vulnerability and enhanced potential
 The more successfully an individual resolves the crisis, the
healthier development will be

56. Erikson...
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The Eight stages of development
1. TrustVs mistrust (infancy)
 A sense of trust requires a feeling of physical comfort and a
minimal amount of fear about the future
 Trust in infancy sets the stage for a lifelong expectation that the
world will be a good and pleasant place to live

57. Erikson...
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2.AutonomyVs shame and doubt (1 to 3 years)
 After gaining trust in their care givers, infants begin to
discover that their behaviour is their own
 They start to assert their sense of independence, or
autonomy
 They realize their will
 If infants are restrained too much or punished harshly, they
are likely to develop a sense of shame and doubt

58. Erikson...
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3. InitiativeVs guilt (3 to 5 years)
 As preschool children encounter a widening social world, they
are challenged more than when they were infants
 Active, purposeful behaviour is needed to cope with these
challenges
 Children are asked to assume responsibility for their bodies,
their behaviour, their toys, and their pets
 Uncomfortable guilt feelings may arise, though, if the child is
irresponsible and is made to feel too anxious
 Most guilt is quickly compensated for by a sense of
accomplishment

59. Erikson...
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4. IndustryVs inferiority (6 years to puberty, elementary
school years)
 Children’s initiative brings them in contact with a wealth of new
experiences
 They direct their energy toward mastering knowledge and intellectual
skills
 The danger in the elementary school years is that the child can develop
a sense of inferiority –feeling incompetent and unproductive
 Teachers have a special responsibility –mildly but firmly coerce
into the adventure of finding out that one can learn to accomplish
things which one would never have thought by oneself

60. Erikson...
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5. IdentityVs identity confusion (10 to 20 years)
 Individuals are faced with finding out who they are, what they are
about, and where they are going in life
 Adolescents are confronted with many new roles and adult
statuses – vocational and romantic, for example
 Parents need to allow adolescents to explore many different roles
and different paths within a particular role
 If an identity is pushed on the adolescent by the parent, if the
adolescent does not adequately explore many roles, and if a
positive future path is not defined, then identity confusion reigns

61. Erikson...
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6. IntimacyVs isolation (20s, 30s, early adulthood)
 Individuals face the developmental task of forming intimate
relationships with others
 Erikson describes intimacy as finding oneself yet losing
oneself in another
 If the young adult forms healthy friendship with another
individual, intimacy will be achieved; if not, isolation will
result

62. Erikson...
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7. GenerativityVs stagnation (40s, 50s, middle adulthood)
 A chief concern is to assist the younger generation in developing
and leading useful lives – generativity.
 The feeling of having done nothing to help the next generation is
stagnation.

63. Erikson...
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8. IntegrityVs despair (60s onward, late adulthood)
 A person reflects on the past and either pieces together a
positive review or concludes that life has not been spent well
 Through many routes, the older person may have developed
a positive outlook in most or all of the previous stages of
development. If so, the person will fill a sense of satisfaction
– integrity.
 If the older adult resolved many of the earlier stages
negatively – despair

64. Cognitive DevelopmentTheory
(PiagetTheory)
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• Children "construct" their understanding of the
world through their active involvement and
interactions
• Two processes are essential for development:
 Assimilation
Learning to understand events or objects, based on existing
structure.
 Accommodation
Expanding understanding, based on new information
Assimilation + accommodation lead to equilibrium

65. Piaget
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Children pass through specific stages as they develop their Cognitive Development skills:
•Sensorimotor – birth - 2 years – infants develop their intellect
•Preoperational – 2-7 years – children begin to think symbolically and
imaginatively
•Concrete operational – 7-12 years – children learn to think logically
•Formal operational – 12 years – adulthood – adults develop critical thinking
skills

66. Factors affecting growth and development
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 Group discussion

67. Factors ...
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1. Genetic factors
 The maximum possible growth and development potential
is genetically determined
2. Environmental factors
 For full realization of genetic potential, a favourable
environment is of paramount importance

68. Environmental factors
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1. Intrauterine or prenatal factors
 Maternal nutrition
 Infections
 Drugs
 Radiation
 Other illnesses during pregnancy

69. Environmental ...
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2. Birth and natal factors
 Brain injury (physical or anoxia), for example
3. Postnatal factors
a. Adequate nutrition
b. Education and learning opportunity
c. Social and psychological or emotional factors

70. Factors contributing to development
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 Love
 Security
 Recognition of achievement
 Independence
 Playing
 Language training

71. Discussion question
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 Which one is the most influential factor on
growth and development – nature or nurture?

72. Nutritional requirements of children
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LIFE
STAGE
GROUP
TOTAL
WATER[†]
(L/day)
CARBOHY
DRATE
(g/day)
TOTAL
FIBER
(g/day) FAT (g/day)
PROTEIN
(g/day)
INFANTS
0–6 mo 0.7[*] 60[*] ND 31[*] 9.1[*]
7–12 mo 0.8[*] 95[*] ND 30[*] 11.0
CHILDREN
1–3 yr 1.3 130 19[*] ND 13
4–8 yr 1.7[*] 130 25[*] ND 19
MALES
9–13 yr 2.4[*] 130 31[*] ND 34
14–18 yr 3.3[*] 130 38[*] ND 52
19–30 yr 3.7[*] 130 38[*] ND 56

73. Nutritional requirements ...
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LIFE
STAGE
GROUP
TOTAL
WATER
(L/day)
CARBOHY
DRATE
(g/day)
TOTAL
FIBER
(g/day) FAT (g/day)
PROTEIN
(g/day)
FEMALES
9–13 yr 2.1[*] 130 26[*] ND 34
14–18 yr 2.3[*] 130 26[*] ND[*] 46
19–30 yr 2.7[*] 130 25[*] ND 46
PREGNANCY
14–18 yr 3.0[*] 175 28[*] ND 71
19–30 yr 3.0[*] 175 28[*] ND 71
LACTATION
14–18 yr 3.8[*] 210 29[*] ND 71
19–30 yr 3.8[*] 210 29[*] ND 71

74. Nutritional requirements ...
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Child’s weight Caloric need
<10kg 100kcal/kg/day
10-20kg 50kcal/kg/day
>20kg 20kcal/kg/day

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