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Objectives

Growth & Development

At the end of this session students will be able to:

Define the terms growth, development, maturation and
personality.
2. Discuss the factors influencing growth and development.
3. Explain the patterns of growth and development.
1.

Prepared by: M. Cole

August, 2013
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Objectives

Growth and development

contd

4. Explain physical and physiological changes in the major body

systems that take place during the process of growth and
development.

Growth and development begin with birth.

As infants and children grow and mature, they pass

through predictable stages of development.

5. Describe the basic divisions of childhood.

Growth

Growth and development

The term growth and development both refer to a dynamic

process.

Is physical change and increase in size.

Can be measured quantitatively.

Often used interchangeably, these terms have

different meanings.

Indicators of growth includes height, weight, bone size, and

dentition.

Growth and development are interdependent interrelated

processes.

Growth rates vary during different stages of growth and

development.

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Growth contd

Development

The growth rate is rapid during the prenatal, neonatal, infancy

and adolescent stages and slows during childhood.

Is an increase in the complexity of function and skill

progression.

Physical growth is minimal during adulthood.

Is the capacity and skill of a person to adapt to the

environment.

Development is the behavioural aspect of growth.

Maturation

Personality

Is a physiologically determined pattern for growth and

development.

Relates to increase in competence and adaptability to

function at a higher level.

Sum of all an individuals traits

(Murphy, 1932 as cited in John, Robins and Pervin, 2008, p. 7)

The sum/total of the physical, mental, emotional, and social

characteristics of an individual
(Dictionary.com, 2010)

Personality

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Factors influencing growth and

development

contd

The unique self

The organized system of attitudes and behavioral disposition

by which an individual feels, thinks, acts, impresses and
establish relationship with others.

Nature and nurture are important in determining individual

patterns of development.
Genetics
Gender
Health

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Nutrition
Socio-cultural
Interpersonal
relationship

Environment

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Genetics

Has to do with the how normal and abnormal traits/genes are

transmitted from one generation to the next.

Biological traits including some behavioural traits, gender, race,

eye colour, height potential, certain diseases or illness are
directly linked to genetic inheritance

Gender

Inheritance determines learning styles & temperament

A child gender is established when sex chromosomes join

Girls tend to be born lighter (by an ounce or two) and

shorter than boys (by an inch or two).

Girls tend to surge ahead of boys as they begin puberty

earlier (6 months to 1 year).

Boys tend to be taller and heavier than girls.

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Gender

Influences physical characteristic, male/female genitalia

development, body development, hair distribution, some
diseases or illness are gender related (e.g. scoliosis more
common in females)

An early influence of gender in children involve survival

rate; premature girls have higher survival rate than
premature boys

Gender

Social effects on gender gender identity (speaks to how

the interaction with family, activities and societal values
affect how children perceive themselves as a specific
gender)

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Environment

Health

A child who inherits a genetically transmitted disease will not

grow as rapidly as a healthy child depending on the type of
illness & therapy/care.

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The physical condition of the newborn is influenced by the

prenatal environment.

The health of the mother at the time of conception & the

amount, quality and type of diet during pregnancy are
important for foetal development

Infections and diseases can result in foetal malformation

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Environment

Environment

A clean stable environment with adequate nutrition and

health care allows a child to focus energy on healthy growth.

Socioeconomic level
Ordinal position in family
Health
The profile of the family characteristics affects the
development of children
Teratogens

A tense environment in which a child feels unloved, or an

insecure environment where there is limited nutrition
interferes with the growth and development process.

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Nutrition

Balance amounts of essential nutrients have a great

significant role in growth & development

Poor nutrition of the mother during pregnancy may limit the

childs growth and development from the moment the child is
born.

Socio-cultural

Health care and nutrition attract a cost; children born to

families of low economical status may not receive adequate
nutrition or health supervision.

Cultural norms determine how the child expected to achieve

particular milestones

Lack of the essential dietary nutrients result in inadequate

physical growth, energy and stamina.
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Nature/Heredity

Socio-cultural

Childbearing practices, food habit, traditional beliefs, social

taboos, attitudes towards health, standards of living,
educational levels etc. influences a child growth and
development

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Heredity has to do with the innate qualities/factors that have

been inherited such as appearance, temperaments and
abilities.

Determines the limits of each individual childs capacity to

achieve optimal structural & functional maturity.

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Nature

Nurture/Environment

contd

Others include:
eye colour
height
cognitive ability to learn
(do math or a language)
patience or temper

genetics
gender
family history of
chronic/non-communicable
diseases & mental illness.

Has to do with the personal

experiences determining or causing individual
differences in physical and behavioral traits.

This excludes genetics.

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Nurture contd

Patterns of growth and development

Focuses on the environment that the child is raised in, including:

parenting
early schooling
the home
eating habits
interactions with people
family values & norms

Directional
Cephalocaudal
Proximodistal
Sequential
Differentiation
Developmental pace

cultural beliefs & practices

nutritional & consumption practices
in general
socio-cultural factors
interpersonal relationships
environmental influences

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Cephalocaudal

Proximodistal

This development proceeds from head throughout the body

and towards the feet.

This development proceeds from the centre of body outward to

the extremities from general to specific.

Brain/head development: head is larger relative to the rest of

the body

Brain/spinal cord and organs in the trunk develop before arms

and legs; motor control of trunk occurs before arms and legs

E.g. infant must be able to raise his head before he can sit up.

E.g. An infant close his hand and grasp before he has finger
pinch.

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Growth Pattern
Cephalocaudal

Sequential

Proximodistal

Growth in height occurs in sequence from small to large,

development occurs in a predictable order

Progression occasionally occurs in a different order but most

children will follow a predictable sequence of growth and
development

E.g. majority of children sit before creeping, creep before

standing

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Retrieved from http://www.authorstream.com/Presentation/samarsen-326986-growth-development-introduction-science-technology-ppt-powerpoint/

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Developmental pace

Differentiation

This is the process by which behaviours and physical

structures become more specialized

Physical reactions become less global and more specific.

A stage in mental, neuromuscular or social maturation of an

infant or young child, generally marked by the attainment of a
capacity or skill.

E.g. 2-4 months, holds rattle in hand, looks at and plays with
own fingers and readily brings object to hand and mouth.

E.g. An infant gets burnt on the finger will flash the finger, cry show sign of
distress in response to pain whereas a toddler may cry and show signs of
distress but does not thrash around (Ranthus, n.d)

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Principles

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Principles contd

contd

1.

Growth is an orderly process, occurring in systematic fashion

2.

Rates and patterns of growth are specific to certain parts of

the body

3.

Wide individual differences exist in growth rates

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4.

Growth and development are influenced by multiple factors

5.

Development proceeds from the simple to the complex and

from the general to the specific

6.

Development occurs in a cephalocaudal and a

proximodistal progression

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Principles

Basic development of
childhood

contd

7.

There are critical periods for growth and

development

8.

Rates in development vary

9.

Development continues throughout the

individual's life span

Stage

Characteristics
Neonate
birth to 28 days

Requires high level of care in

daily activity.

Infant
29 days to 1 year

Requires high level of care in

daily activity.

Toddler
1-3 years

Increase motor ability and

independent behaviour.

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Basic development of childhood contd

Stage

What are the changes

that occur during Growth
and
Development ?

Characteristics
Preschool child
3-5 years

Has refined gross motor, fine

motor ability, and language ability.

School child
5-12 years

Has growing intellectual skills,

physical ability and independence.

Adolescent
12-18 years

Has cognitive thoughts that are

mature, identity formation and
peer influence.
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Neonate

Neonate

Weight

Height

Head/chest
circumference

6-8 lbs
(2750-3629 g); gains
5-7 oz (142-198 g)
weekly for first six
months.

20 inches (50 cm)

grows 1 (2.5 cm) inch
monthly for first six
months

33-35.5 cm (13-14 inches),

head circumference slightly
larger than chest increases
by inch (1.25 cm) for
first six months.

contd

Prefers visual stimuli of mobiles, faces, black and white

patterns, mirrors (sight not fully developed).

Hearing well developed at birth. Use of auditory stimuli

such as music boxes, soft voices is encouraged.

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Neonate

Infant

contd

Moves legs and arms

contd

Weight

Height

Head/chest
circumference
Both are equal. Brain about
2/3 adult size.

Can lift head slightly off bed when in

prone position

Doubles birth weight by 6

months and triple by 1
year.

Increases in height in the 1st year

by 50% (from birth height of 20
inches to 30 inches [50.8 76.2]).

Startle and rooting reflex are

predominant

During 1st 6 months

average weight gain of 2
lbs/month, during 2cd 6
months about 1 lb per
month.

During the early months growth

more apparent in the trunk and in
the 2cd half more apparent in the
extremities.

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Developmental characteristics: Infant

Physical

PHYSICAL

Anterior fontanel (soft and flat in a normal infant) closes at

12 to 18 months

Posterior fontanel (soft and flat in a normal infant) closes by

2 to 3 months

contd

Appetite (physiological anorexia); 20 teeth

Naps; daytime bowel/bladder control at 3 years and night

control by 35 years

Taste preferences; walks by 14 months; runs by 18 months

Mastery of gross and fine motor movements

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Infant

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Infant

contd

2-4 months

Holds rattle in hand, looks at and plays with own fingers and
readily brings object to hand and mouth

Needs assistance to sit up

Moro reflex fading in strength

contd

2-4 months contd

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Can turn from side to side and return

Decrease in head lag when pulled to sit position, head midline

with some bobbing

Follows objects, turns head to look towards voices and faces

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Infant

Infant contd
4-6 months

contd

4-6 months contd

Grasp rattle and other objects at will, drops and picks

up others
Mouth objects
Hold bottle
Grasp with whole hand and manipulates objects
Can sit alone in the tripod position

Head held steady during sitting

No further lagging of head when pulled to sitting position
Turns from abdomen to back (4 months) and back to
abdomen (6 months)

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Infant

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Head control

contd

4-6 months contd

Supports much of weight when held standing

Watches objects as they fall and responds to sound

Newborn
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Infant
6-8 months
Bangs objects held in hand

Move objects from one hand to the other

Begins pincer grasp

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Infant

contd

Age 6 months

(Growth and Development, n.d.)

contd

6-8 months contd

Inborn reflexes diminished

Sits alone steady without support

Bounces on leg when placed in the standing position

Recognizes name and respond by looking and smiling

Enjoys playing with small and complex objects

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Sitting Up

Infant contd
8-10 months

Age 2 months

Picks up small objects and grasp well using pincer

Crawls/put whole body along floor
Creeps using hand and knees to keep trunk off floor
Pulls self to standing and sitting

Age 8 months

(Growth and Development, n.d.)

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Infant contd

Fine motor development

8-10 months contd

Understand words such as no

Able to say mama and dada plus an additional word

Recognizes sounds without difficulty

6-month-old
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Infant

12-month-old
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(Growth and Development, n.d.)

Ambulation

contd

10-12 months

May hold crayon/pencil and mark on paper

Able to place objects in container through holes

Stands alone, walks while holding on to furniture and sits

down from standing
Nine to 12-months
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(Growth and Development, n.d.)

13 month old
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Toddler

Eruption of primary teeth

Weight:
Gains 5-6 (2.5 kg) lbs/year
Height:
Gains 5 inches/year
Losses subcutaneous fat changes from plumb baby to lean
child with more muscle
Head/chest circumference:
Chest has grown greater than head

From Wong, D. (1999). Whaley and Wongs nursing care of infants and children, ed 6, St Louis: Mosby. Data from McDonald RE, Avery
DR: Dentistry for the child and adolescent, ed. 6, St. Louis, 1994, Mosby.

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Toddler

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Toddler

contd

By the end of two years

contd

By the end of three years

Builds tower of four blocks, scribbles on paper, undress self

and throws ball

Draws circle and other basic forms, learns to pour and

learning to dress self

Able to run, walk up and down stairs

Able to jump, kick ball and throws ball overhead

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Speech milestones

1-2 months: coos

2-6 months: laughs and squeals

8-9 months babbles: mama/dada as sounds

10-12 months: mama/dada specific

Speech milestones contd

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18-20 months: 20 to 30 words 50% understood by

strangers

22-24 months: able to construct two word sentences, knows

>50 words, 75% understood by strangers

30-36 months: almost all speech understood by strangers

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Bowel and bladder control: toddler

Bowel and bladder control: toddler

Signs that a toddler is ready for toilet-training include:

contd

muscle coordination with walking,

communicating with parents,
awareness of a wet or soiled diaper,
holding urine for 2 hours,
and interest in pleasing parents

By age 3, the toddler achieves fairly good bowel and bladder

control

The toddler may stay dry during the day but may need a
diaper at night until about age 4

Bowel control develops before bladder control

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Preschool child

Preschool child contd

Weight:
Gains about 4.5 lbs (2 kg) a year
Height:
Minimal, 2-3.5 inches (6-8 cm) a year.

Able to use scissors, button clothing, brush teeth etc

Throws ball, climbs well and ride bicycle

Able to use spoon and fork

Head/chest circumference:
Not routinely measured on physical examination beyond 2
years

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School child

Bowel and bladder control: Preschooler

By age 4, the preschooler has daytime control of bowel and

bladder but may experience bed-wetting accidents at night

By age 5, the preschooler achieves both bowel and bladder

control, although accidents may occur in stressful situations

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Weight:
Gains 3-5 lbs (1.3-2.2 kg) annually
Height:
Gains 1-2 inches (2.5-5 cm) annually

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Eruption of secondary teeth

School child contd

Plays ball games, cards and board games

Can skate, ride bicycle

Enjoys craft projects

Jump rope

Can read
Able to concentrate for longer period on activities by
filtering out sounds
From Wong, D. (1999). Whaley and Wongs nursing care of infants and children, ed 6, St Louis: Mosby. Courtesy of Bruce Carter, DDS,
Texas Childrens Hospital, Houston, TX

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Adolescent

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Adolescent - Physical

Weight:
Boy - 15-65 lbs (7-30 kg)
Girl 15-55 lbs (7-25 kg)

Male puberty:
1216 years; enlargement of scrotum,
testes and penis
pubic, axillary, facial and body hair
nocturnal emissions and mature spermatozoa
voice deepens
95% of height by 15 years

Height:
Boy - 4-12 inches (10-30 cm)
Girl - 2-8 inches (5-20 cm)

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Adolescent

Adolescent Physical contd

contd

Well developed skills

Attempts new sport activities
Muscle development continues
Increase in communication and time spent with peers
Apply abstract thoughts and analysis in conversation

Female puberty:
1014 year; breasts develop
pubic and axillary hair
first menstruation (menarche); ovulation about 12 months
after menarche
95% of height by menarche

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References

Reading assignment:

Atherton, J.S., (2010). Learning and teaching; Piaget's developmental theory. Retrieved from
http://www.learningandteaching.info/learning /piaget.htm

Physical changes that occur at each stage

Boeree, C. G., (2009). Retrieved from http://webspace.ship.edu/cgboer/genpsypiaget.html

1.
2.

chapter 28 and 29 Pilliteri text

chapter 40 - Lippincott manual

Child Development Institute. (2010). Retrieved from

http://www.childdevelopmentinfo.com/development/pl1.shtml

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References

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References
Hatfield, N. T. (2008). Broadribb's Introductory Pediatric Nursing (7th ed.). China:
Wolters Kluwer Health, Lippincott Williams and Wilkins.

Growth and development (n.d.). Retrieved from http://nursingcrib.com/nursing-notesreviewer/human-growth-and-development-theories/

John, O.P., Robins, R.W., & Pervin, L.A. (2008). Handbook of personality: Theory and
research. New York: The Guilford Press.

Growth and Development (n.d.). Retrieved from

http://www.authorstream.com/Presentation/samarsen-326986-growthdevelopment-introduction-science-technology-ppt-powerpoint/

London, M.L., Wieland Ladewig, P.A., Ball, J.W., & Bindler, R.C. (2007). Maternal and
child nursing care (2cd ed.). New Jersey: Prentice Hall.

Growth and development. (2003). Saunders online resources. USA: Elsevier Science.
[Power Point Slides]. Retrieved from http://online.darton.edu/NCLEXRN/htmdocs/study_set.htm

Pillitteri, A. (2010). Maternal and child health nursing: Care of the childbearing and
childbearing family (6th ed.). Philadelphia: Wolters Kluwer Health, Lippincott
Williams and Wilkins.

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References
Personality. (2010). Dictionary.com. Retrieved from
http://dictionary.reference.com/browse/personality
Rathus, S.A. (2008). Childhood and adolescence: Voyages in development (3rd
ed.). Belmont: Thomson, Wadsworth.
Stein, A.M. (2005). NCLEX-RN Review (5th ed.). New York: Thompson Delmar
Learning.
Vitale, B.A. (2007). NCLEX RN notes: Core review and exam prep. United states
of America: F.A Davis Company.

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