INTRODUCTION TO GROWTH

AND DEVELOPMENT -
THEORIES & CONCEPTS

PCCN/ PNT 2024

OBJECTIVES
By the end of this session the student
will be able to :
s

-Demonstrate knowledge of human development from

conception to birth.
-Apply the knowledge of growth and development
through different stages on order to anticipate health
needs of a child
-Utilize the relevant theories of growth and development
to develop and design appropriate care for a child who is
admitted.
 Growth
• Growth refers to the increase in mass and size of
a body or organs.
• It typically occurs through the multiplication of
cells and an increase in intracellular substance.
• It is quantitative.

3
 Development
• It is progressive increase in skill and capacity
to function.
• It is related to maturation and myelination of
the nervous system.
• It includes psychological, emotional and
social changes.
• It is qualitative.

4
 Principles
of
Growth
and
Development

5
 Gesell's theory

• Cephalocaudal direction

• Proximodistal direction

• General to Specific
 Cephalocaudal direction
• The process of
cephalocaudal
direction is from
head down to toes
• This means that
improvement in
structure and
function come first
in the head region,
then in the trunk,
and last in the leg
region. 7
 Proximodistal direction
• The process in
proximodistal is from
center or midline to
periphery
direction.
• Development
proceeds from near to
far
• Outward from central
axis of the body
toward the 8
 General to Specific
• Children at first are able hold the big things
by using both arms
• In the next part are able to hold things in a
single hand, then only able to pick small
objects like peas, cereals etc.
• Children when able to hold pencil, first starts
draw circles then squares then only letters
after that then words.

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General to Specific
• Development proceeds from general to
specific responses
G & D AGE PERIODS

• Infancy • Middle Childhood

–Neonate – School age
• Below 28 days
– 6 to 12 years
–Infancy
• Below 1 year
• Late Childhood
• Early Childhood
–Toddler • Adolescent
• 1-3 years – 13 years to
–Preschool approximately 18
• 3-6 years years
 Growt
h and
Development
Monitoring
12
 Assessment of growth
• Assessment of physical growth can be done
by anthropometric measurement
• Measurement of different growth parameters
is an important nursing responsibility in child
care.

13
 Weight
• Weight is one of the best criteria for assessment of growth
and a good indicator of health and nutritional status of
child.
• Among children, weight of the full terms neonate at
birth is approximately 2.5 kg to 3.5kg.
• The infants double weight gain their birth weight by
5month of age, tripled by one year, four times by two
years, five times by three year, six times by five year,
seven times by seven year and ten times by ten year.
• Then weight increases rapidly during puberty
followed by weight increase to adult size.
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 Length/ Height
• Increase in length/ height indicates skeletal growth. Yearly
increments in length/ height gradually diminished from
birth to maturity.
• At birth average length of a healthy newborn
baby is 50 cm.
• It increases to 60 cm at 3 months, 70 cm at 9
months and 75 cm at one year of age.
• The child doubles the birth by 4 to 4.5 years of
age
• Afterwards there is about 5 cm increase in every
year until onset of puberty
15
16
 Head circumference
• It is related to brain growth and development of
intracranial volume. Average head circumference
measured about 35 cms at birth.

• At 3 months it is about 40 cms, at 6 month 43 cms, at

one year 45cms, at 2 years 48 cms, at 7 year 50 cms and
at 12 years of age it is about 52 cms, almost same adults.

• Head circumference is measured by tape, placing it over

the occipital protuberance at the back, above the ear on
the side and just over the supraorbital ridges in front
measuring the point of height circumference.
18
 Fontanelles
• At birth, an infant has six fontanels
• Posterior fontanelle closes early (6-8week of age).

• The anterior fontanelle normally closes by 12- 18

months of age.

• Anterior fontanelle largest and clinically significant.

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Fontanelles
21
 Chest
•
circumference
Chest circumference or thoracic diameter is an
importance parameter of assessment of growth and
nutrition status.
• At birth it is 2-3cm less than head circumference. At 6 to
12 months of age both become equal.
• After first year of age, chest circumference is greater than
head circumference by 2.5 cm and by the age of 5 years, it
is about 5 cm larger than head circumference.
• Chest circumference is measured by placing the tape
measure around the chest at the level of the nipple, in
between inspiration and expiration.
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23
MUAC

• MUAC stands for Mid Upper Arm

Circumference
• This measurement helps to assess the
nutritional status of younger children.
• The average MUAC at birth is 11 to 12 cm,
at one year of age it is 12 to 16 cm, at 1 to 5
years it is 16 to 17 cm, at 12 years it is 17 to
18 cm and at 15 years it is 20 to 21cm.
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 Assessment of Development
• Normal development is a complex process &
has a multitude of facets.
• However, it is convenient to understand &
assess development under the following
domains.
1. Gross motor development
2. Fine motor skill development
3. Personal & social development
4. Language
5. Vision & hearing
Gross motor development
• Motor development progress in an orderly
sequence to ultimate attainment of
locomotion & more complex motor
tasks thereafter.

• In an infant it is assessed & observed as

follows:-

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Key gross motor development milestones
Age Milestone
3m Neck holding
5m Rolls over
6m Sits with own support
8m Sitting without support
9m Standing holding on (with support)
12m Creep well, stand without support
15m Walks alone creeps upstairs
18m Runs
2 yr Walks up and down stairs
3 yr Rides tricycle,
4yr Hops on one foot, alternate feet going downstairs.
 Fine motor skill development
• Fine motor development occurs upon neural tract
maturation.
• Fine motor development promotes adaptive
actives with fine sensorimotor adjustments and
include eye coordination, hand eye
coordination, hand to mouth coordination,
hand skill as finger thumb apposition,
grasping, dressing etc.
53
 Key fine motor development milestone
Age Milestone
4m reaching out for the objects with both hands
6m Reaching out for the objects with one hand
9m Immature pincer grasp
12m Pincer grasp mature
15m Imitates scribbling, tower of 2 blocks
18m Scribbles, tower of 3 blocks
2yr Tower of 6 blocks, vertical and circular stroke
3 yr Tower of 9 blocks, copies circle
4yr Copies cross, bridge with blocks
5yr Copies triangle, gate with blocks
Personal & social development
• Personal and social development includes
personal reactions to his own social and
cultural situations with neuromotor maturity
and environment stimulation.

• It is related to interpersonal and social skill as

social smile, recognition of mother, use of
toys.

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Key social and adaptive milestones
Age Milestone
2m Social smile
3m Recognizes mother
6m Recognizes strangers, stranger anxiety
9m Waves “bye bye”
12m Comes when called, plays simple ball game
15m Jargon
18m Copies parents in tasks
2yr Asks for food, drink, toilet
3yr Shares toys, knows full name and gender
4yr Plays cooperatively in a group, goes to toilet alone.
5yr Helps in household tasks, dressing and undressing
 Language development
Age Milestone
1m Alerts to sound
3m Coos ( musical vowel sounds)
4m Laugh loud
6m Monosyllables (ba, da, pa) sound
9m Bisyllables ( mama, baba, dada) sound
12m 1-2 words with meaning
18 m 8 -10 words vocabulary
2yr 2-3 word sentences, uses pronouns “I”, “Me”, “you”
3 yr Ask question
4yr Says songs or poem, tell stories
5yr Asks meaning of words
THEORIES AND CONCEPTS OF
GROWTH AND DEVELOPMENT.
 PSYCHOSOCIAL –ERICK ERIKSON
 COGNITIVE –JEAN PIAGET
 MORAL DEVELOPMENT- LAWRENCE KOHLBERG
 PSYCHOSEXUAL –SIGMUD FREUD
Erik Erikson’s Psychosocial Theory
 PIAGET’S
THEORY OF
COGNITIVE
DEVELOPMENT
 KOHLBERG’S
THEORY OF
MORAL
DEVELOPMENT
QUESTIONS??
ASSIGNMENT
READ AND MAKE NOTES ON:

1. ATTACHMENT THEORY BY JOHN BOWLBLY

2. SPIRITUAL DEVELOPMENT THEORY BY JAMES W
FOWLER
3. GILLIGAN’S THEORY OF MORAL DEVELOPMENT
4. VYOTSKY’S SOCIOCULTURAL THEORY
5. GARDNER’S MULTIPLE INTELLIGENCES THEORY
 References

• Hockenberry, M.A and Wilson (2013).Wong’s

nursing care of infants and children (10th
ed.).Elsevier: Mosby, St Loius
• Jarvis, C (2020) Physical Examination and
Health Assessment (8th Ed.) Lippincott:
Elsevier
• Muscari, E.M (2016). Lippincotts review
series paediatric nursing (4th ed.)