1.
Pediatric Nursing
(Seminar - 3)
Growth & Development
Tagreed Awad Khalid
KU – Nursing Collage - PhD (4) 2016

2.
Objectives
At the end of this presentation, the objectives should be
achieved are:
1. Define growth
2. Define development
3. Define maturation
4. Identify principles of growth and development .
5. Identify factors that affect growth and development.
6. Enumerate stages of growth and development in pediatric
7. Discuss theories of development .

3.
Introduction
O All children pass through predictable stages of growth and
development as they mature.
O Parents often ask what to expect from their children regarding
their developmental progress at health care visits.
O Growth and development are interrelated, ongoing processes in
infancy and childhood
O Growth and development is essential in the establishment of
complete and effective nursing care plans for children

4.
Outlines:
1. Definition of growth, development and maturation
2. Principles of growth and development.
3. Factors that influence child's growth and
development
4. Stages of growth and development in pediatrics.
5. Theories of development

5.
Fundamental Concepts of Growth
and Development
O Growth refers to the quantitative changes in physical size of the
body and its parts.
O Development refers to behavioral changes and increasing
competency in functional abilities and skills.
O Maturation describes the increasing complexity of a person’s
capabilities.
O Maturation involves biological growth, functional changes, and
learning that come with age.

6.
17-6
Principles of Growth and Development
1. Occurs in a cephalocaudal direction and
proximodistal manner
2. Occurs from simple to complex and from
the general to the specific
3. All individuals go through the same
developmental processes.

7.
17-7
4. Growth and development do not proceed at a consistent rate.
5. The pattern of growth and development is continuous, orderly,
and predictable.
6. Every person proceeds through stages of growth and
development at an individual rate.
7. Every stage of development has specific characteristics.
8. Each stage of development has certain tasks to be achieved or
acquired during that specific time
Principles of Growth and Development

8.
Principles of Growth and Development
9. Some stages of growth and development are more critical
than others.
10. A critical period can be a time of the most rapid growth or
development in a particular stage of the life cycle.
11. Growth and development may temporarily be regress
during critical periods.

9.
Factors Influencing Growth and
Development
1. Heredity
O The genetic composition of an individual determines
physical characteristics.
O Determines to a great extent the rate of physical and
mental development.
2. Gender
O On average, girls are born lighter (by an ounce or two)
and shorter (by an inch or two) than boys.

10.
Factors Influencing Growth and
Development
3. Health Status :
O Illness or disability can interfere with the achievement of
developmental milestones.
4. Life Experiences
O A child’s experiences can influence the rate of growth and
development.
5. Cultural Expectations
O The age at which an individual masters a particular task is
determined in part by culture.

11.
6. Environment
Environment can interfere with the achievement of
developmental milestones (pollution – acquired
environmental disease)
7. Nutrition
nutrition has become a major focus of health promotion
and disease prevention the quality of a child’s nutrition
during the growing years has a major influence o health
and stature

12.
Developmental Milestones
O For each period of growth and development in a child, there are
four major parameters within which developmental milestones
(significant points in the growth process) occur:
O Physical Development
O Intellectual-Cognitive Development
O Psycho-Emotional Development
O Social Development

13.
Physical Development
O Refers to the actual bodily changes observed in a client during
a particular period of growth
O Sometimes these changes are measurable
O Example: height and weight are measurable physical attributes
Intellectual-Cognitive Development
O Refers to the thinking skills a client develops during a
particular period of growth and development

14.
Psycho-Emotional Development
O Refers to the changes in feelings a client may be likely to
experience during a particular period
Social Development
O Refers to the way in which a child interact with those around
him, such as Family ,Friends, Business associates
O It is important to note that the way one child interacts with
another depends upon the child with whom he is interacting
O Example: a teen may speak differently with a parent than he
would with a friend or peer

15.
PERIOD OF DEVELOPMENT
O Time frame in life characterized by certain
features, usually involving an 8-period
sequence

16.
8 – PERIOD SEQUENCE
1. Prenatal period: conception to birth.
2. Infancy – Birth to 1 year
3. Early childhood – 1-6 years
4. Late childhood – 6-12 years
5. Adolescence – 12-18 years
6. Early adulthood – 19-40 years
7. Middle adulthood – 40-65 years
8. Late adulthood – 65 years and older

17.
Pediatric Stages
1) Prenatal period
O Conception to birth:
O From single cell to complete organism with complex brain
and nervous system capable to variety of behaviors

18.
2) Infancy:
O Birth to 12 months;
O Extreme dependency on adults and other older
individuals.
O Psychological activity begins
3) Early Childhood:
• Age 2 to 5 or 6
• Preschool years
• become more self-sufficient
• learn school readiness skills such as following instructions
and recognizing letters and colors

19.
4) Middle and Late Childhood:
O From 6 to 11 or 12
O Elementary school years;
O Master basic skills of reading, writing and
arithmetic;
O Achievement is central theme;
O Person shows increasing self-control;

20.
5) Adolescence:
O Transition from childhood to early adulthood;
O From 10-12 to age 18-22
O Begins with rapid physical changes
characteristic of puberty
O Major goals becoming independent and
developing an individual identity
O Thinking more logical and abstract

21.
THEORIES OF
DEVELOPMENT

22.
THEORY
O A theory is a systematic statement of principles that
provides a framework for explaining some phenomenon.
O Developmental theories provide road maps for explaining
human development.

23.
DEVELOPMENTAL TASK
O A developmental task is a skill or a growth
responsibility arising at a particular time in an
individual’s life.
O The achievement of which will provide a
foundation for the accomplishment of future
tasks.

24.
Freud’s Psychoanalytic Theory
O Sigmund Freud (1856–1939)
O An Austrian neurologist and the founder of psychoanalysis,
offered the first real theory of personality development
O He described child development as being a series of psychosexual
stages in which a child’s sexual gratification becomes focused on a
particular body part.

25.
FREUD’S PSYCHOSEXUAL STAGE
O INFANT
1. “Oral Stage”:
O Child explores the world by using mouth,
especially the tongue
O Nursing Implication: provide oral stimulation
by giving pacifiers, do not discourage thumb-
sucking
O Breast feeding has more stimulation than
formula feeding

26.
FREUD’S PSYCHOSEXUAL STAGE
O TODDLER (1- 3 years)
2. “Anal Stage”:
O Child learns to control urination
and defecation
O Nursing Implication: help
children achieve bowel and bladder
control

27.
FREUD’S PSYCHOSEXUAL STAGE
O PRESCHOOLER
3. “Phallic Stage”
O Child learns sexual identity through awareness of genital area
O Nursing Implication: Accept children’s sexual interest, such
as fondling their own genitals, as a normal area of
exploration; help parents answer child’s questions about birth
and sexual differences
O Masturbation is common during this phase.

28.
FREUD’S PSYCHOSEXUAL STAGE
O SCHOOLAGE
4. “Latent Stage”:
O Child’s personality development
appears to be nonactive or dormant
O Nursing Implication: Help children
have positive experiences with
learning so their self-esteem continues
to grow.

29.
Freud’s Psychosexual Stages
O ADOLESCENT
5. “Genital Stage”
O Develops sexual maturity and learns to establish
satisfactory relationships with the opposite sex.
O Nursing Implication: Provide appropriate
opportunities for the child to relate with the
opposite sex; allow the child to verbalize feelings
about new relationships.

30.
Erikson’s Theory of Psychosocial
Development
O Erik Erikson (1902–1996)
O Was trained in psychoanalytic theory but later
developed his own theory of psychosocial
development
O A theory that stresses the importance of culture
and society in development of the personality

31.
Erikson’s Psychosocial
Developmental Stages
O INFANT
O Developmental Task “TRUST VS MISTRUST”
O Child learns to love and be loved
O Nursing Implication: Provide a primary caregiver; provide
experiences that add to security, such as soft sounds and touch;
provide visual stimulation for active child involvement

32.
Erikson’s Psychosocial Developmental
Stages
O TODDLER
O Developmental Task “AUTONOMY VS SHAME”
O Child learns to be independent and makes decisions
for self
O Nursing Implication: provide opportunities for
decision making; praise for ability to make
decisions rather than judging correctness of any one
decision

33.
Erikson’s Psychosocial Developmental
Stages
O PRESCHOOOLER
O Developmental Task “INITIATIVE VS GUILT”
O Child learns how to do things (basic problem solving) and that
doing things is desirable
O Nursing Implication: Provide opportunities for exploring
new places or activities; allow play to include activities
involving water, clay (for modeling), or finger paint

34.
Erikson’s Psychosocial Developmental
Stages
O SCHOOLAGE
O Developmental Task “INDUSTRY VS. INFERIORITY”
O Child learns how to do things well
O Nursing Implication: provide opportunities such as allowing
child to assemble and complete a short project so that child
feels rewarded for accomplishment

35.
Erikson’s Psychosocial
Developmental Stages
O ADOLESCENT
O Developmental Task “IDENTITY VS ROLE CONFUSION”
O Adolescents learn who they are and what kind of person they
will be; seeking emancipation from parents and choosing a
vocation
O Nursing Implication: Provide opportunities for an adolescent
to discuss feelings about events important to him or her; offer
support and praise for decision making.

36.
Piaget’s Theory of Cognitive
Development
O Jean Piaget (1896–1980)
O A Swiss psychologist, introduced concepts of cognitive
development or the way children learn and think
O Piaget defined four stages of cognitive development
O Each period is an advance over the previous one. To progress
from one period to the next, children reorganize their thinking
processes to bring them closer to adult thinking.

37.
Piaget’s Stages of Cognitive
Development
O SENSORYMOTOR STAGE
O Infant’s stage
O Babies relate to the world through
their senses, using only reflex
behavior.
O Concept of “permanence” is present.

38.
Sensorimotor
O Neonatal reflex: 1 month: Stimuli are assimilated into
beginning mental images. Behavior entirely reflexive.
O Primary circular reaction : 1- 4 months
- Hand- mouth and eye – ear coordination develop.
- Infant spending much time looking at objects and separating
self from them
- Infant brings thumb to mouth to suck it.
- Enjoyable activity for this period is a rattle or tape of parent's
voice.

39.
OSecondary circular reaction: 4-8months.
- Infant learns to initiate, recognize and repeat a
pleasurable experiences from environment.
- Good toy is mirror, peek- a- boo.

40.
OCoordination with secondary reaction: 8-12 mo
- Infant can plan activity to attain specific goals.
- Can search for and retrieve toy that disappears
from view.
- Recognize shapes and sizes of familiar objects.
- Can experience separation anxiety.
- Good toy: nesting toys (colored boxes)

41.
O Tertiary circular reaction: 12- 18months.
- Child is able to experiment to discover new properties of
objects and events.
- Capable of space perception, time and permanence.
- Objects outside self are understood as cause off actions.
- Good game: throw and retrieve

42.
O Invention of new means through mental combinations: 18-
24 months:
- Use memory and imitation to act.
- Can solve basic problems.
- Good toys: those with several uses, such as blocks, colored
plastic rings.

43.
Piaget’s Stages of Cognitive
Development
O PRE-OPERATIONAL THOUGHT
O Toddler’s stage
O Preschooler stage (Intuitive Thought)
O Children relearn on a conceptual level some of the lessons
they mastered as infants at the sensorimotor level, before
having language.

44.
O Preoperational thought 2-7 years:
- children are able to use symbols to represent objects
OEgocentric (unable to see the viewpoint of another)
ODisplays static thinking (inability to remember what
they started talking about)
OConcept of time is now.
ONo awareness of reversibility (opposite action)
O unable to state cause effect relationships.
OGood toy is that required imagination such as:
modeling clay.

45.
Piaget’s Stages of
Cognitive Development
3.CONCRETE OPERATIONAL
THOUGHT
O School age Stage
O Can discover concrete solutions to
everyday problems and recognize
cause-and-effect relationships.

46.
O Concrete operation thought:
- Uses memory to learn broad concepts (fruit) and
subgroups of concepts (apples, oranges).
- Classifications involve sorting objects according to
attributes such as color; weight.
- Child is aware of reversibility
- Understands conservation
- Good activity for this period: collecting and classifying
natural objects such as native plants, sea shells

47.
Piaget’s Stages of Cognitive
Development
O FORMAL OPERATIONAL THOUGHT
O Adolescent stage
O Adolescents are capable of thinking in terms of
possibility—what could be (abstract thought)—rather than
being limited to thinking about what already is

48.
O Formal operational thought: 12 years
- Can solve hypothetical problems with scientific
reasoning.
- Understand causality and can deal with past, present
and future.
- Good activity is (talk time)

49.
Kohlberg’s Theory of Moral Development
O Lawrence Kohlberg (1927–1987)
O A psychologist, studied the reasoning
ability of boys and, based on Piaget’s
development stages.
O Developed a theory on the way children
gain knowledge of right and wrong or
moral reasoning.

50.
Kohlberg’s Theory of Moral Development
1. PRE-CONVENTIONAL
- The Infant
O Is a pre-religious stage. Infants learn moral concepts when
they do certain actions, parents give affection and approval; for
other actions, parents scold and label the behavior “bad.”
O The development of trust is important in moral development
O Infants who develop a sound sense of trust can better develop
a spiritual orientation in future years or be a moral conscience

51.
- The Toddler
O Toddlers begin to formulate a sense of right
and wrong, but their reason for doing right is
centered most strongly in “mother or father
says so” rather than in any spiritual or societal
motivation.
O Kohlberg referred to this as a “punishment
obedience orientation” (a child is good
because a parent says a child must be good,
not because it is “right” to be good).

52.
- The Preschooler
O They tend to do good out of self-interest rather than out of
true intent to do good or because of a strong spiritual
motivation.
O Children at this age also imitate what they see, so if they see
less-than-perfect role models, they may copy those wrong
actions, assuming those actions are correct.
O They have great difficulty knowing what rules apply to new
situations because they cannot judge whether a previously
learned principle of right or wrong can be applied to this
new situation

53.
Kohlberg’s Theory of Moral Development
2. Conventional development
O The School-Age Child
children enter a stage of moral development at a level at
which many adults continue to function.
O Young school-age children adhere to a phase of
development termed the “nice” or “fair” rather than
necessarily right.
O Later in the school-age period, as children learn about
community resources, they become aware that community
laws

54.
3. Post-conventional development
- The Adolescent
O They become capable of abstract thought, they
become capable of internalizing standards of right or
wrong
O As adults they continue at a school-age level, doing
right things only when obvious authority or set rules
are present
Kohlberg’s Theory of Moral Development

55.
References':
O Suzan S- R, Terri-K, Suzan C (Maternity and Pediatric Nursing ),
2nd eddition,2013.
O Adele Pillitteri (Maternal and Child Health Nursing- care of child
bearing and child bearing family) 5th eddition,2010
O Terri –K (essential for pediatric Nursing) 1st eddition 2008