1. THEORIES & FACTORS
AFFECTING GROWTH AND
DEVELOPMENT
(KOHLBERG’S AND FOWLER’S THEORY)
Submitted to :
Mrs. B. Padmavathi madam
Dept. of Pediatrics M.sc(N)
CON-NIMS

2. 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.

3. 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

4.  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

5. 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-

6. 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.

7. C
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C GROWTH & DEVELOPMENT
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8. CHARACTERISTICS OF GROWTH
AND 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

9. PRINCIPLES
OF
GROWTH &
DEVELOPMENT

10. PRINCIPAL OF GROWTH AND
DEVELOPMENT:
 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

11.  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.

12.  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.

13. STAGES OF GROWTH &
DEVELOPMENT

14. STAGES OF GROWTH AND
DEVELOPMENT:-
 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.

15. FACTORS
AFFECTING
GROWTH &
DEVELOPMENT

16. Factors affecting growth and
development are
1. Hereditary
2. Sex
3. Race
4. Nationality
5. Environment

17. FACTORS INFLUENCING GROWTH
AND 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.

18.  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.

19. 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.

20.  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

21. ENVIRONMENT
PRE NATAL
ENVIRONMENT
• INTELLIGENCE
INTERNAL • HARMONAL INFLUENCE
• EMOTIONS
POSTNATAL
ENVIRONMENT • CULTURE
• SOCIO-ECONOMY
• NUTRITION
• CLIMATE & SEASON
EXTERNAL • ORDINAL POSITION
• EXERCISE
• DEVIATIONS FROM
+VE HEALTH

22. 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.

23.  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.

24.  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.

25. 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.

26. EXTERNAL ENVIRONMENT
SOCIO 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

27. EXTERNAL ENVIRONMENT
NUTRITION:
 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

28. 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.

29. 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.

30.  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.

31. 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.

32. EXTERNAL ENVIRONMENT
EXERCISES:
 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

33. EXTERNAL ENVIRONMENT
ORDINAL 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.

34. INTERNAL ENVIRONMENT
INTELLIGENCE:
 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.

35. INTERNAL ENVIRONMENT
HARMONAL 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.

36.  HARMONAL INFLUENCE:
 An excess of growth harmone causes gigantism & lack
results in dwarfism.

37.  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.

38. 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.

39.  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.

40. 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.

41. PHYSICAL GROWTH &
DEVELOPMENT

42. PHYSICAL GROWTH&
DEVELOPMENT
 Physical growth & development can be
divided into 3 areas
 Biological growth
 Motor development
 Sensory development

43. 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

44. BIOLOGICAL GROWTH
Length 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.

45. 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.

46. 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.

47. BIOLOGICAL GROWTH
Thoracic 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.

48. 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.

49. MOTOR DEVELOPMENT
Motor 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

50. MOTOR DEVELOPMENT
Gross 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.

51. SENSORY DEVELOPMENT
The 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.

52. 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.

53. CATEGORIES
Categories 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

54. 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.

55.  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.

56.  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”.

57.  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

58.  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.

59.  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.

60.  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.

61.  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.

62. FOWLER’S THEORY (SPIRITUAL
DEVELOPMENT)
 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.

63. 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.

64.  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.

65.  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.

66. 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.

67. 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.

68. 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.

69.  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.

70.  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.

71. SUMMARY

73. THANK YOU