NURSING ROLE IN

HEALTH PROMOTION OF
CHILD BEARING FAMILY

PRINCIPLES OF GROWTH
AND DEVELOPMENT

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)
Assessment
- plot and measure the weight and height on a
standard growth chart
-.Take health history from parents and child and
observe what specific task the child can
accomplish to assess the developmental
milestone
-.Develop a 24 hour recall history of nutritional
intake, sleep and visual and hearing should be
scheduled on standard time
I.

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND
DEVELOPMENT)
II. Nursing Diagnosis
-risk for delayed growth and development related
to lack of age appropriate toys and activities
- Delayed growth and development related to
prolonged illness
- Readiness for enhanced family coping related to
parents seeking information about a childs
growth and development
- Health seeking behavior related to appropriate
stimulation for infants

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND
DEVELOPMENT)

II. Nursing Diagnosis

- Imbalanced nutrition, les than the body
requirements, related to parental knowledge
deficit regarding childs protein needs
- Deficient knowledge related to potential long term
effects of obesity in school age child

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)

III. Outcome identification and Planning

- To be able to provide holistic care , consider all

aspects of childs health; physical, emotional,

cultural, cognitive, spiritual, nutritional, and social
- Remember that each child developmental
progress is unique.
- Children must not be forced to achieve milestone
faster then their own time table. However,
anticipatory guidance can be encouraged to
reach maximum developmental potentia

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)

III. Outcome identification and Planning

- Suggest expected outcomes and guidance to

both the child and the family on ways to

encourage child development and preparing
children for a new experience
- Children should not be rushed to new experience
like toilet training or beginning school
- Varied ways of postering growth and
development; discipline , food

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)

Following questions can be asked for you to

isolate and better understand cultural differences

that will help you in planning care that is specific
child
Parents with a child with developmental delay will
use denial. So planning should be centered on
accepting what is happening

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)

IV. Implementation
- To foster growth and development encourage age
appropriate self-care in child and age appropriate
toys or activities to parents
- for children with delayed growth and
development motivate a child to reach anticipated
upper limits.
- Modelling is more effective in problem solving
then acting out.

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)

V. Outcome Evaluation
- Evaluation must be ongoing, because children do
not test well on any given day.
- On going evaluation provides opportunity for
early detection of various problems
Examples of expected outcomes
1. child, 5 years of age, express less negativism
at next clinic visit
2. At 9th month check- up parents describe how
they have made a space in their home

NURSING PROCESS OVERVIEW

(FOR PROMOTION OF NORMAL GROWTH AND DEVELOPMENT)

for their infants to crawl and not confined to a

playpen.
3. Parents list household tasks they believe
appropriate for 6 year old child by next visit
4. Parents state the pattern they use to phase out
high carbohydrate, non nutritive snacks for their
preschooler..

The Role of the nurse in growth and development

1. health promotion and illness prevention
- Be it known to the parent that parenting style are

major influence on the behavior and mental

health of children.
-know the varied changes that they observed that
is part of normal G and D
Anticipatory guidance should be offered at
appropriate time
- Nurse should recognize the predictable stages of
G and D

The Role of the nurse in growth and development

2. Health restoration and maintenance
- Keep developmental stage in mind when teaching
a parent or orientating a child about certain
procedure that will done to him
- Physical growth and development differences;
fracture is a 12 year old is more serious than an 8
year old. There are 2 major needs in a 8 year old;
healing the fracture and maintaining healthy bone
cells. while a 12 year old has 3 needs; calcium for
healing , maintaining health bone. Additional
amount for period of rapid growth

Principles of Growth and Development

Growth and development is a complex

phenomenon because of many interrelated facets

Maturing involved not only increase in height and
weight but the ability to perform skills, to think, to
relate to people, and to trust or have self
confidence
Growth and development are different but used
interchangeably

Growth
Generally denote an increase in physical size or

quantitative change
Growth in weight is measured in pounds or
kilograms
Growth in height is measured in inches or
centimeters

Development
Used to indicate an increase in skills, or ability to

function (qualitative change).

Development can be measured by observing
specific task like picks up small objects, by
recording parents description of a childs
progress or by the use of standardized test.
Maturation is synonymous with development

Psychosexual Development
This a specific type of development that refers to

developing instincts or sensual pleasure.

(Freudian Theory)

Psychosocial Development
Refers to Ericksons stages of personality

development

Moral Development
The ability to know what is right from wrong

and to apply this in real life situation.

This is the theory of Kohlberg

Cognitive development
The ability to learn or understand from

experiences, to acquire and retain knowledge,

and to respond to a new situation and solve.
Piagets theory
This is measured by intelligent test and observing
the child s ability function effectively in their
environment.

Patterns
Respiratory , digestive, musculoskeletal, and

circulatory proceeds fairly smoothly during

childhood
Neurologic (spinal cord and brain)mature rapidly
then others for the first two years
Maturity of the brain occurs at 2 5 years old
Lymphoid tissue(spleen, thymus, lymph nodes,
and tonsillar tissue) grow rapidly during infancy
and childhood so children are protected against
infection

Factors Influencing Growth and Development

I. Genetic
Gender- girls are born lighter
Health- inherited illness
intelligence children with high intelligence
generally do not grow faster, they fall behind
physical skills

Temperament as influence in G and D

Temperament is the usual reaction pattern of an

individual
s characteristics manner of thinking, behaving or
reacting to stimuli in the environment
This is an inborn characteristics set at birth,.
It is essential to understand childrens
differences, to care for each child constructively

Temperament as influence in G and D

1. Reaction pattern; 9 separate characteristics

that define temperament of children

a. Activity level
-.Differs widely- some or active, some are not.
Display extreme motor activity
b. rhythmicity- in sleeping, eating, and bowel
movement. On the contrary there are those
children with different or inconsistent pattern. In
this case parents should adopt to the childs
rhythm

Temperament as influence in G and D

c. Approach refers to the childs response on

initial contact with a new stimulus.

d. Adaptability the ability to change ones
reaction to stimuli over time
e. Intensity reaction- some react to situation with
their whole being like when their diapers are wet,
hungry or when their parents leave
f. distractibility- easily distracted to a new
situation. Other children find it difficult to focus on
new attention and resist changes,

Temperament as influence in G and D

Attention Span and persistence- attention span is

the ability to remain interested in a project or

activity, that varies among children.
The degree of persistence also varies
Threshold response- t he intensity level of
stimulation that is necessary to evoke a reaction.
Mood quality- a child who is always happy and
laughing has positive mood quality

Categories of temperament
1. The easy child- is they have a predictable

rhythmicity, approach and adapt to new

situation readily, have a mild to moderate
intensity of reaction, and have an overall
positive mood quality. Most children are rated
by their parents as being in this category
2. The difficult child- if they are irregular in habits,
have negative mood quality, and withdraw
rather than approach new situation. Only about
10 % of children fall into this catogery.

Categories of temperament
Slow- to warm up child

They fall in this category if they are overall fairly

inactive, respond only mildly and adapt slowly to
new situations and have a general negative mood.
About 15 % of children display this pattern. When
discussing the temperament with parents try to
use positive terms such as ways to find a healthy
fir for your child rather than stressing ways the
child is hard to manage.

Nursing implications regarding temperament

It is useful to talk to parents about their childs

reactivity patterns because this patterns tend to

persist; the way the child react in the future
depends a great deal on the way the child react
today.
The way a child react on a toy will have the
same reaction on toilet training.
Parents should learn that shying away is the
childs way coping.
They should accept individualism that is
essential for successful child rearing

Nursing implications regarding temperament

Effects of environment to G and D- Inadequate nutrition because of socio- economic

condition
- Parents do not give much attention in developing
childrens skills
- Chronic illness
- Alcoholic parents provide inconsistency in care
and could affect the3 mental health

Environmental influences that most like to affect G

and D
1. Socio economic level
2. Parent child relationship- the role of the primary

care giver in nurturing the emotional aspect of

the child
3. Ordinal position in the family
4. Health environmental condition, and illness
5. Nutrition

Servings of the Five Pyramid Food Groups for

Children
Recommended Daily Amounts
Group

Foods

Children 2-6

Older children Major

nutrients
provided

Bread,
Whole grain
cereals, pasta and enriched

6 servings

6-11 servings

Thiamine,
niacin,
riboflovin,,
iron,
incomplete
protein,
carbohydrates

vegetables

3 servings

3-5 servings

Vit. A, iron,
calcium,
carbohydrates
,

Vegetables,
yellow and
green

Servings of the Five Pyramid Food Groups for

Children
Recommended Daily Amounts
Group

Foods

Children 2-6

Older children Major

nutrients
provided

Fruit

Fruits

2 servings

2-4 servings

Vit. C,
carbohydrates

Milk, yogurt,
cheese

Whole milk,
other milk
product
except butter

2 servings

23 servings

Calcium,
phosphorus,
complete
protein,
riboflaavin,
niacin, Vit. D

Servings of the Five Pyramid Food Groups for

Children
Recommended Daily Amounts
Group

Foods

Children 2-6

Older children Major

nutrients
provided

Meat, poultry,
fish

Muscles
meat, dry
beans, eggs,
fish, poultry

2 servings

2-3 servings

Complete
protein, iron
thiamine,
riboflavin,
niacin, vit. B
12, fats

Fats, oils,
sweets

Candy, cake,
fried foods

Use sparingly

Use sparingly

Essential fatty
acids, CHO

Servings of the Five Pyramid Food Groups for

Children
Eat variety of foods
Balance the food you eat
Choose diet with plenty of grains
Choose diet low in fat, saturated fat and cholesterol
Choose a diet moderate in sugar
Drink alcohol in moderation

Components of healthy diet

Protein
Carbohydrates
Fat
Vitamin minerals

Promoting adequate nutritional intake in veggeta

Economic- less expensive than animal based food
Ecologic- if every one are lower on food chain, world

hunger could be reduced

Medical and health related- avoiding animal foods stop
ingestion of hormones and chemicals used in meat and
poultry production and lowers serum cholesterol,
thereby reducing the frequency of atherosclerosis and
obesity; avoiding red meat may reduce the likelihood of
developing colon cancer. Because of association
between saturated fats and bowel cancer and
atherosclerosis, avoiding red meat will increase in the
future

Promoting adequate nutritional intake in vegetarian

diet
Philosophical: a belief that killing animal for food

is unnecessary.
Religious: Hindus and seventh day Adventist
promote vegetarian lifestyle.

Four types of vegetarian diets

Lacto-ovo-vegetarian includes dairy products

(lacto), eggs (ovo) and plants (vegetables, fruits

and grains)
Ovovegetarian diets includes eggs, but excludes
dairy products
Lactovegetarian diets includes dairy products but
exclude eggs
Vegan diets exclude animal product consist of
only vegetables, fruits and grains

THEORIES OF GROWTH
AND DEVELOPMENT

Theory
A systematic statement of principles hat

provides a framework for explaining some

phenomenon.
Developmental theories provide road maps
for explaining human develpment

Developmental Task
Is a skill or growth responsibility arising at a

particular time in an individuals life, the

achievement of which will provide a
foundation for the accomplishment of future
task. Chronological age does not define the
completion of developemental tasks

Sociocultural theory
Stress the importance of

environment on growth and

development

Learning Theory
Proposes that children are like blank pages

that can be shaped by learning.

Epigenetic Theory
Stress that genes are the true basis

for growth and development

Freuds stages of childhood

Psychosexual
stage

Nursing
implications

Infant
Oral stage; child
explore the world
by using mouth,
especially the
tongue

Provide oral
stimulation by
giving pacifiers, do
not discourage
thumb sucking.
Breast feeding
may provide more
stimulation than
formula feeding
because it require
the infant to
expend more
energy

Ericksons stages of childhood

Developmental
task

Nursing
implication

Infant
Developmental
task is to form a
sense of trust
versus mistrust.
Child learns to
love and be loved

Provide a primary
care giver. Provide
experiences that
add to security,
such as soft
sounds, and
touch. Provide
visual stimulation
for active child
involvement

Summary of Freuds and Ericksons theories on

personality development
Freuds stages of childhood

Ericksons stages of childhood

Psychosexual
stage

Nursing
implications

Developmental
task

Nursing
implications

Toddler; (1-3 )
Anal stage; child
learns to control
urination and
defecation

Help children
achieve bowel
and bladder
control without
undue emphasis
on its
importance. If at
all possible,
continue bowel
and bladder
training if
hospitalized

Toddler;
Developmental
task is to from
sense of
autonomy versus
shame and doubt.
Child learns to be
independent and
make decision for
self.

Provide
opportunities for
decision making,
such as offering
choices of clothes
to wear or toys to
play with. Praise
for ability to make
decisions rather
than judging the
correctness of any
one action

Summary of Freuds and Ericksons theories on

personality development
Freuds stages of childhood

Ericksons stages of childhood

Psychosexual
stage

Nursing
implications

Developmental
task

Nursing
implications

Preschooler ;
Phallic stage;
child learns
sexual identity
through
awareness of
genital area

Accept childrens
sexual interest,
such as fondling
their own genitals,
as a normal area
of exploration.
Help parents
answer childs
questions about
birth or sexual
differences

Preschooler;
Developmental
task is to form a
sense of initiative
versus guilt. Child
learns how to do
things (basic
problem solving)
and doing things is
desirable.

Provide
opportunities for
exploring new
places or
activities. Allow
play to include
activities involving
water, clay (for
modeling) or finger
paint.

Summary of Freuds and Ericksons theories on

personality development
Freuds stages of childhood

Ericksons stages of childhood

Psychosexual
stage

Nursing
implications

Developmental
task

Nursing
implications

School age child

Latent stage;
childs
personality
development
appears to be
non active or
dormant

Help child have

positive
experiences with
learning so their
self-esteem
continues to grow
and they can
prepare for the
conflicts of
adolescence

School age;
Developmental
task is to form a
sense of industry
versus inferiority.
Child learns how
to do things well

Provide
opportunities such
as allowing child to
assemble and
complete a short
project so that
child feels
rewarded for
accomplishment

Summary of Freuds and Ericksons theories on

personality development
Freuds stages of childhood
Psychosexual
stage
Adolescent ;
Genital stage;
Adolescent
develops sexual
maturity and
learns to
establish
satisfactory
relationships with
opposite sex

Nursing
implications
Provide
opportunities for
the child to
related with
opposite sex;
allow child to
verbalize feelings
about new
relationships

Ericksons stages of childhood

Developmental
task

Nursing
implications

Adolescent;
Developmental task
is to form a sense of
identity versus role
confusion.
Adolescent learn
who they are and
what kind of person
they will be by
adjusting to a new
body image, seeking
emancipation from
parents, choosing a
vacation and
determining value

Provide
opportunities for
adolescent to
discuss feelings
about events
important to him
or to her. Offer
support and praise
for decision
making.

system