Growth and Development Review

This reviewer is prepared to give you a brief knowledge of growth and

development, including the different theories, physiologic changes, hospital
reactions by age, and the different developmental milestones.

Theories of Growth and Development

The following are some of the theories involving child development that have
been proposed by these well-known theorists:

Erikson’s Theory of Psychosocial Development

 According to Erickson, a human being must go through a series of

psychosocial developmental stages that must be balanced throughout the
lifespan.
 Each stage is characterized by a psychosocial conflict that must reach a
resolution to allow the individual to go on the next phase of development.
Erik Erikson’s 8 Stages of Psychosocial Development

 Trust vs Mistrust: Infancy (birth to 18 months)

 Task: attachment to the mother/caregiver
 Successful outcome: feeling of trust
 Unsuccessful outcome: mistrust, suspicion, uncertainty of the future
 Autonomy vs Shame and Doubt: Early childhood (18 months to 3
years)
 Task: develop a sense of personal control over physical skills and sense
of independence
 Successful outcome: feeling of self-control, self sufficiency
 Unsuccessful outcome: lack of independence, feelings of self-doubt
 Initiative vs Guilt: Late childhood (3 to 6 years)
 Task: become purposeful and directive
 Successful outcome: sense of purpose
 Unsuccessful outcome: sense of guilt, self-doubt, and lack of initiative
 Industry vs Inferiority School age (6 to 12 years)
 Task: develop physical, social, and learning skills
  Successful outcome: self-confidence, competence
 Unsuccessful outcome: feelings of inferiority, poor self concept
 Identity vs Role Confusion: Adolescence (12-20 years)
 Task: develop sense of self and personal identity
 Successful outcome: sense of strong identity
 Unsuccessful outcome: self-confusion
 Intimacy vs Isolation: Early adulthood (20-35 years)
 Task: form intimate, loving relationship with other people
 Successful outcome: strong relationship
 Unsuccessful outcome: loneliness, isolation
 Generativity vs Stagnation: Middle adulthood (35 to 65 years)
 Task: achieve life goals and creating positive change for the benefit of
others
 Successful outcome: feelings of accomplishment
 Unsuccessful outcome: inability to grow as a person
 Integrity vs Despair: Late adulthood (65 years to death)
 Task: reflection on life
 Successful outcome: sense of fulfillment and integrity
 Unsuccessful outcome: regret, bitterness,dissatisfaction with life
Jean Piaget’s Theory of Cognitive Development

 The theory focuses on concepts of language, scientific reasoning, memory,

and moral development.
 According to Piaget, to progress from one stage to the next, the child
reorganizes his or her thinking process to bring them close to reality.
4 Stages of Cognitive Development

 Sensorimotor stage (birth to 2 years)

 Present at birth, the infant/child uses reflexes like sucking, grasping,
looking, and listening to gain an understanding about the environment.
 Object permanence (objects continue to exist even though it can no
longer be seen or heard) and separation anxiety develops in this stage.
 Preoperational stage (2 to 7 years)
 The child begins to use language and think symbolically.
 Egocentrism (inability to see a situation from another person’s point of
view) is evident in this stage.
 Comprehends simple abstract but thinking is usually concrete and literal
  Concrete operational stage (7 to 11 years)
 The child can think logically but can only apply it to physical objects.
 The child starts to use concepts of number, time, space, and volume.
 Formal operational stage (11 years to adulthood)
 Individuals demonstrate the ability to think abstractly, reason logically,
and draw conclusions.
 Can engage in hypothetical thinking and scientific reasoning.
Sigmund Freud’s Psychosexual Development

 According to Freud, the child’s development goes through a series of

psychosexual stages in which the child’s desires become focused on a
particular body part.
 Each stage is presented with a conflict that will help build or suppress
growth depending on how they are resolved.
Stages of Psychosocial Development

 Oral stage (birth to 1 year)

 Mouth is the center of gratification through sucking, chewing,
swallowing, breastfeeding, and biting.
 Improper resolution in this stage, may lead to oral fixation habits such
as nail-biting, thumb sucking, smoking, and excessive drinking.
 Anal stage (1 to 3 years)
 Child finds pleasure and sense of control through retention and
defecation of feces
 Toilet training is present that provides the child a sense of self-control.
 Parents that are too lenient during toilet training will result in an anal-
expulsive personality which includes being messy, disorganized,
rebellious, and careless.
 Parents that are too strict or start toilet training too early will result to
anal-retentive personality which includes being overly obsessive, and
rigid.
 Phallic stage (3 to 6 years)
 Interest in the genital area and masturbation are sources of pleasure in
this stage.
 Awareness of sexual difference can result in Oedipus complex (Electra
complex in women), an unconscious desire for the parent of the
opposite sex while developing a conflict for the parent of the same-sex.
  Latent stage (6 to 12 years)
 Sexual urges diminish and children start to channel their sexual energies
in honing their values and developing their new skills to form
relationships with other people.
 Fixation in this stage can lead to immaturity and a failure to form
relationships as an adult.
 Genital stage (12 years to adulthood)
 Starts with the onset of puberty when physical maturity prepares the
body for reproduction.
 Individuals starts to develop sexual and emotional interest towards the
opposite sex.
Lawrence Kohlberg’s Theory of Moral Development

 Kohlberg believed that a person can acquire knowledge of moral values

through active thinking and reasoning.
Stages of Moral Development

Here are three levels of moral development, with each level consisting of
different stages:

Level 1: Preconventional Morality

 Stage 0 (birth to 2 years). Egocentric Judgement: no concept of right or

wrong
 Stage 1 (2 to 3 years). Obedience and Punishment: behavior driven by
avoiding punishment.
 Stage 2 (4 to 7 years). Individualism and Exchange: behavior is driven by
rewards or have favors returned.
 Level 2: Conventional Morality
 Stage 3 (7 to 10 years). Good Boy- Nice Girl Orientation: behavior is
determined by social approval.
 Stage 4 (10-12 years). Law and Order Orientation: social rules and laws
determine behavior.
 Level 3: Postconventional Morality
 Stage 5: Social Contract and Legalistic Orientation: rules and laws exist
for the greater good of all.
 Stage 6: Universal Ethical Principles Orientation: development of own
moral principles even if they conflict with the law of the society.
Physiologic growth and development

 Weight. Most babies doubled their weight at the rate of 5 to 7 ounce

weekly for 6 months and tripled at 12 months.
 Length. A growth of 1.5 to 2.5 cm is seen monthly from birth to age 6
months while a growth of 1 cm per month is expected from ages 6 to 12
months.
 Fontanel. Anterior fontanel closes by 12 to 18 months of age; Posterior
fontanel closes by the end of the second month.
 Head circumference. The average head circumference of a newborn is
about 33 to 35 cm, 2 to 3 cm more than chest circumference.
 Teeth. Lower front teeth normally appear by the age of 5 to 9 months
while upper front teeth begin to appear by 8 to 12 months. All deciduous
teeth (20 in total) will erupt by the 2 ½ years of age.
Developmental Milestones

Here are the important milestones that an infant goes through:

2 to 3 months

 Begin to smile
 Coos, makes gurgling noises
 Turn head toward sounds
 Follow objects with eyes
 Hold head and chest up when prone
4 to 5 months

 Smile spontaneously
 Cooing and babbling when spoken to
 Grasp objects
 Rolls over by self
 Hold head steady, unsupported
6 to 7 months

 Recognize familiar faces and begins to show fear of strangers

  May say vowel sounds when babbling (oh oh) and imitate sounds
 Responds when own name is heard
 Sit with support
 Rolls back and forth and vice versa
 Show feelings of joys and annoyance
8 to 9 months

 Say first words such as (ma-ma-ma, ba-ba-ba)

 Uses index finger and thumb to pick up objects
 Can sit securely unsupported
 Crawls
 Stands, holding on
 Begin to stand without help
10 to 11 months

 Use simple gestures such as waving “bye-bye”

 Walk with support while holding onto objects
 Stand alone
12 months

 Say simple words like “mama” or “dada”

 Get to a sitting position with no help
 Can drink from a cup and hold spoon to feed self
15 to 18 months

 Say several single words

 Understand and follow simple instructions
 Can point to one body part
 Walks alone
 Walk up and down stairs while holding on
 Can help undress oneself
Hospitalized Reaction by age

A summary of the normal developments expected in a child during

hospitalization at different age stages:
 Infant and toddler. Characterized by separation anxiety, loss of control
(shown in behaviors related to toileting, feeding, bedtime), and fears of
bodily pain and injury
 3 phases of separation anxiety:
 Protest- hours and several days of screaming, crying, and is
inconsolable.
 Despair- child becomes withdrawn, hopeless, and apathetic.
 Detachment- occurs after prolonged separation of parent; child
appears to have adjusted to the loss; becomes more interested in
the environment; appears to be happy and content with caregivers
and other children.
 Interventions:
 Encourage parents to stay with and participate in the care as often as
possible.
 Continue and maintain the same routine to what the infant/toddler is
accustomed to.
 Provide comfort measures such as their favorite toy, pacifier for oral
and sucking stimulation, and blanket.
 Provide a safe environment especially during temper tantrums such
as side rails up, keeping equipment out of reach.
 Allow toddler with opportunities to make choices to gain some
control.
 Provide age appropriate distraction and pain reducing techniques.
 Preschooler. separation anxiety decreases, fears loss of family routine and
schedules, and fear of bodily injury from invasive procedures; believes that
hospitalization is a punishment for bad actions.
 Interventions:
 Encourage parents to stay with and participate in the care as often as
possible.
 Acknowledge and allow expression of fears and anger
 Explain procedures in simple terms
 Encourage interaction and play with other children of the same age
 Encourage the preschooler to be independent
 Bring a familiar items with the child
 Continue to set normal limits and provide structure
 School age. Fears of getting behind in school, fear of disability and death,
loss of control and independence, separation from family and friends, child
 may ask many actions and relate his or her actions with the cause of
condition.
 Interventions:
 Explain illness, and treatment to child and patent (use body
diagrams, models or videotapes)
 Encourage independence and provide choices as much as possible
 Allow participation in discussion and expression of feelings and fears
 Continue doing school work/assignments if possible
 Provide privacy
 Set limits, and establish routines
 Adolescence. Experience fear of being different, concerns with
appearance, fears of separation from friends, loss of privacy and
independence, may exhibit withdrawal and noncompliance with the
treatment regimen.
 Interventions:
 Encourage questions and open discussion regarding the effect of
illness or treatment in their appearance and relationship
 Provide clear information about the condition and treatment (may
use body diagrams) and involve them in decision making as much as
possible
 Maintain privacy such as wearing pajama instead of gown
 Allow visitation from peers if possible
 Encourage interaction with friends and others in the same age group
Car Seats

 One of the leading causes of physical injury and death among children is
motor vehicle accidents. An effective measure to prevent these injuries is
the use of protective equipment such as car seats. Choosing the right car
seat will depend on the age, weight, and developmental needs of the child.
Types of Car Seats

 Rear-facing car seats (birth until the age of 2-4 yrs). Infants and
toddlers should be placed in a rear-facing car seat until they reach the
maximum weight or height permitted by their car safety seat manufacturer.
 Forward-facing car seat (until at least age 5). When the children start to
outgrow their rear-facing seat, they should be restrained in a forward-
 facing car seat until they reach the maximum weight or height restriction of
their car seat.
 Booster seat. Once the children outgrow their forward-facing seat, they
should be buckled in a booster seat until seat belts fit properly. This usually
occurs when the children are 4 feet and 9 inches tall and age between 8-
12.
 Seat belt. A shift to a seat belt is allowed when the child can sit with his or
her back straight against the vehicle seat back cushion and the knees are
bent over the edge with the absence of slouching. Children under age 13
should be properly buckled in the back seat.