CHAPTER 10. Human Growth and Development
Donna M. Defazio Quinn
OBJECTIVES
At the conclusion of this chapter, the reader should be able to:
1. Define growth and development.
2. Identify the stages of growth and development.
3. Compare Freud’s theory of psychosocial development with Erikson’s psychosocial stages.
4. List Piaget’s four stages of cognitive development.
5. Explain the five stages of language development.
6. Describe the effects of positive influence on the development of self-esteem.
7. Identify eight factors that could influence growth and development.
I. OVERVIEW OF GROWTH AND DEVELOPMENT
A. Definition
1. Growth and development
a. Often used interchangeably
b. Each has distinct definition
2. Growth
a. Implies a change in quantity (quantitative change)
(1) An increase in physical size of a whole or any of its parts
(2) Can be measured in:
(a) Inches, centimeters (height)
(b) Kilograms, pounds (increased organ mass, weight)
(c) Numbers (increased vocabulary, increased number of relationships with others, increased number of physical skills that can be performed)
b. Increase in number and size of cells
(1) Reflected in an increase in the size and weight of the whole or any of its parts
3. Development
a. A complex concept not easily measured or studied
b. Gradual growth and expansion; viewed as a qualitative change
(1) Increased function (skill) and complexity (capacity)
(2) Occurs through growth, maturation, and learning
c. Move from lower case to a more advanced stage of complexity
(1) Continuous, orderly series of conditions
(2) Leads to activities, new motives for activities, and eventual patterns of behavior
(3) Expansion of capabilities to provide greater facility in functioning
d. Developmental process
(1) Continuous, complex, and irreversible
(2) Involves aging
(a) Most rapid during fetal stage
(b) Is a lifelong process
e. Progression of development
(1) Simple to complex
(a) Infant’s vocalizations before speech refinement
(2) Sequence of changes leading to particular attainments
(3) General to specific
(a) Infant’s palmar grasp before acquiring finer control of pincer grasp
(4) From head to toe (cephalocaudally)
(a) Infant gains head and neck control before gaining control of trunk and limbs.
(5) From inner to outer (proximodistally)
(a) Control of near structures before control of structures farther away from the body center
(b) Infant coordinates arms to reach before gaining hand and finger coordination.
f. Predictability of development
(1) Sequence of development is invariable.
(2) Precise age will vary.
(3) Wide normal range allows for individual variances.
g. Uniqueness of development
(1) Each child has own genetic potential for growth and development.
(2) May be deterred or modified at any stage
II. FACTORS INFLUENCING GROWTH AND DEVELOPMENT
A. Genetics (heredity)
1. Inherent characteristics influence development.
a. Sex of child directs pattern of growth and behavior of others toward child.
b. Physical characteristics are inherited.
(1) Can influence how child grows and interacts with environment
B. Gender
1. Sex differences that influence behaviors in childhood
a. Boys
(1) More aggressive physically
(2) Engage in rough and tumble play
(3) Aggressive fantasies
(4) Competitive behavior more common
(5) Difficulty sitting still
(6) Engage in more exploratory behavior
(7) High activity level in presence of other boys
(8) Greater impulsiveness
(9) Subject to distraction
(10) More extensive sphere of relationships
(11) Highly oriented toward peer groups
(12) Congregate in large groups
(13) View themselves as more powerful and with more control over events
(14) Respond to a challenge, especially when it appeals to their ego or competitive feelings
b. Girls
(1) More aggressive verbally
(2) More likely to associate in pairs or small groups
(3) Involved in more intense relationships with a few close friends
(4) More concerned with the welfare of the group
(5) More apt to compromise in situations involving conflict
(6) May be superior regarding motivation to achieve
(7) More likely to comply to adult commands
(8) More nurturing or helping behavior
C. Environment
1. Before birth
a. Prenatal factors
(1) Maternal disease (diabetes)
(2) Alcohol intake
(a) Exhibit prenatal and postnatal growth deficiencies in height and weight
(b) May produce significant central nervous system alterations that may not be evident until the child is older
(3) Fetal exposure to drugs such as marijuana, cocaine, and heroin
(a) Associated with intrauterine growth retardation and prematurity
(4) Smoking may produce smaller infant.
b. Socioeconomic status
D. Culture
1. Includes habits, beliefs, language, values, ethnicity, demographic setting, socioeconomic class, parental occupation, and family structure
a. Attitude and expectations differ with respect to the sex of the child.
E. Lifestyle
1. Different family structures
a. Two parents
b. One parent
c. Extended family
d. Other variations
2. Family relationships a major determinant of how children grow and progress
F. Nutrition
1. Single most important influence on growth
2. Satisfactory nutrition closely related to good health throughout lifetime
3. Malnutrition
a. Defined as undernutrition, primarily resulting from insufficient calorie intake
b. Need a continuous supply of nutrients
c. Poor nutrition may have negative influence on development from time of implantation of ovum until birth
d. Severe maternal malnutrition associated with permanent reduction in total number of fetal brain cells
(1) Has critical effect on child’s intellectual functioning
e. Malnutrition may result from:
(1) Inadequate dietary intake
(a) Quality
(b) Quantity
(2) Disease that interferes with:
(a) Appetite
(b) Digestion
(c) Absorption
(3) Excessive physical activity
(4) Inadequate rest
(5) Disturbed interpersonal relationships
(6) Other environmental or psychological factors
G. Health status
1. Diseases that affect growth and development
a. Skeletal (dwarfism)
b. Chromosome anomalies (Turner syndrome)
c. Disorders of metabolism
(1) Vitamin D–resistant rickets
(2) Mucopolysaccharidoses
(3) Endocrine disorders
d. Klinefelter syndrome and Marfan syndrome
e. Chronic illness
f. Congenital cardiac anomalies
g. Respiratory disorders
(1) Cystic fibrosis
h. Digestive malabsorptive syndromes
i. Defects in digestive enzyme systems
j. Metabolic diseases
H. Neuroendocrine
1. Possible relationship exists between hypothalamus and endocrine system that influences growth.
2. Peripheral nervous system may influence growth.
a. Muscles deprived of nerve supply degenerate.
3. All hormones affect growth in some manner.
a. Growth hormone, thyroid hormone, and androgens given to a person deficient in these hormones
(1) Stimulates protein anabolism
(2) Produces retention of elements essential for building protoplasm and bony tissue
I. Play
1. Activity with meaning and purpose
2. May be directly related to expanding:
a. Social development
b. Intellectual development
c. Motor development
d. Language development
3. Play used to accomplish developmental tasks and master the environment
J. School
1. Contributes to development in the form of:
a. Skill training
b. Cultural transmission
c. Self-actualization
K. Neighborhood
1. Offers child opportunity to experience world outside the home
a. Accepting
b. Supportive of child’s physical and psychosocial needs
c. Reinforcing of child’s self-confidence and safety
L. Season, climate, and oxygen concentration
1. Some evidence that:
a. Growth in height faster in spring and summer months
b. Growth in weight more rapid in autumn and winter
2. Effects of hypoxia on growth
a. Children with disorders that produce chronic hypoxia characteristically smaller than same children of chronological age
b. Children native to high altitudes smaller than children of lower altitudes
M. Stress
1. Abnormal conditions that tend to disrupt normal functions of the body or mind
2. Imbalance between environmental demands and coping resources
3. Some children more vulnerable than others
a. Affected by age, temperament, life situation, and state of health
b. Response can be behavioral, physiological, or psychological
4. Methods of coping
a. Respond by trying to change the circumstance (primary control coping)
(1) Tantrums
(2) Aggressive behavior
b. Trying to adjust to circumstances (secondary control coping)
(1) Withdrawal
(2) Submission
5. Fear
a. Emotional reaction to a specific real or unreal threat or danger
(1) Child perceives threat
(a) Person
(b) Animal
(c) Situation
(2) Perceives threat to be stronger than himself or herself and capable of harm
b. Alleviate fear by:
(1) Presence of adult who will offer protection
(2) Becoming familiar with source of threat (animal)
N. Media
1. Television
a. Pervasive force
b. Primary source of socialization in children
c. Major source of information
(1) Unhealthy messages regarding sex and violence
(2) Alcohol consumption synonymous with having a good time
(3) Food products promoting unhealthy nutritional practices
2. Internet
a. Instantaneous access to unlimited material; informative and detrimental
b. Potential exposure to illegal activities
(1) Parental controls need to be in place to limit Internet access to age-appropriate sites.
3. Reading materials
a. Books, newspapers, magazines
(1) Provide enjoyment
(2) Increase child’s knowledge
4. Movies
a. Not closely associated with reality
b. Usually provide opportunity for desirable social learning
c. Child may be unable to distinguish between reality and fantasy.
(1) Results in fears
5. Cell phone
a. Continuous contact with others
(1) Parents
(2) Friends
O. Responsible adults
1. Can influence positive choices (life decisions, media, social, etc.)
2. Interact with child to identify right from wrong
III. STAGES OF GROWTH AND DEVELOPMENT (Box 10-1)
A. Prenatal
1. Period of life from conception to birth
a. Crucial period in developmental process
b. Health and well-being of the infant directly related to adequate prenatal care
c. Direct relationship between maternal health and certain manifestations in the newborn
B. Newborn or neonatal
1. From birth through the first month of life
2. Major physical adjustment to extrauterine existence
C. Infancy
1. Begins at end of first month of life and ends at 1 year of age
2. Period of rapid motor, cognitive, and social development
3. Establishes basic trust
a. Foundation for future relationships
D. Early childhood (Box 10-2)
1. Toddler
a. From 1 to 3 years
2. Preschool
a. From 3 to 6 years
3. Characteristics of early childhood
a. Intense activity and discovery
b. Marked physical and personality development
c. Motor development advances steadily.
d. Acquire language skills.
e. Expand social relationships.
f. Learn role standards.
g. Gain self-control and mastery.
h. Develop increasing awareness of dependence and independence.
i. Begin to develop self-concept.
BOX 10-2
EMERGING PATTERNS OF BEHAVIOR FROM 1 TO 5 YEARS OF AGE*
15 Months
Motor: Walks alone; crawls up stairs
Adaptive: Makes a tower of three cubes; makes a line with crayon; inserts raisin in bottle
Language: Jargon; follows simple commands; may name a familiar object (e.g., ball)
Social: Indicates some desire or needs by pointing; hugs parents
18 Months
Motor: Runs stiffly; sits on small chair; walks up stairs with one hand held; explores drawers and wastebaskets
Adaptive: Makes a tower of four cubes; imitates scribbling; imitates vertical stroke; dumps raisin from bottle
Language: Ten words (average); names pictures; identifies one or more parts of body
Social: Feeds self, seeks help when in trouble; may complain when wet or soiled; kisses parents with pucker
24 Months
Motor: Runs well; walks up and down stairs, one step at a time; opens doors; climbs on furniture; jumps
Adaptive: Tower of seven cubes (6 at 21 months); scribbles in circular pattern; imitates horizontal stroke; folds paper once imitatively
Language: Puts three words together (subject, verb, object)
Social: Handles spoon well; often tells immediate experiences; helps to undress; listens to stories when shown pictures
30 Months
Motor: Goes up stairs alternating feet
Adaptive: Tower of nine cubes; makes vertical and horizontal strokes, but generally will not join them to make a cross; imitates circular stroke, forming closed figure
Language: Refers to self by pronoun “I”; knows full name
Social: Helps put things away; pretends in play
36 Months
Motor: Rides tricycle; stands momentarily on one foot
Adaptive: Tower of ten cubes; imitates construction of “bridge” of three cubes; copies circle; imitates cross
Language: Knows age and sex; counts three objects correctly; repeats three numbers or a sentence of six syllables
Social: Plays simple games (in “parallel” with other children); helps in dressing (unbuttons clothing and puts on shoes); washes hands
48 Months
Motor: Hops on one foot; throws ball overhand; uses scissors to cut out pictures; climbs well
Adaptive: Copies bridge from model; imitates construction of “gate” of five cubes; copies cross and square; draws man with two to four parts besides head; identifies longer of two lines
Language: Counts four pennies accurately; tells a story
Social: Plays with several children with beginning of social interaction and role-playing; goes to toilet alone
60 Months
Motor: Skips
Adaptive: Draws triangle from copy; names heavier of two weights
Language: Names four colors; repeats sentence of ten syllables; counts ten pennies correctly
Social: Dresses and undresses; asks questions about meaning of words; engages in domestic role-playing
From Kliegman RM, Behrman RE, Jenson HB, et al: Nelson textbook of pediatrics, ed 18, Philadelphia, 2007, Saunders.
E. Middle childhood or school-age years
1. From age 6 to 11 or 12 years
2. Child is directed away from family group and centered around peer relationships.
3. Steady advancement in physical, mental, and social development
4. Emphasis on developing skill competencies
5. Social cooperation and moral development take on importance.
a. Relevant for later life stages
6. Critical period in the development of self-concept
F. Later childhood or adolescence and young adulthood
1. From the beginning of the 12th year to the end of the 21st year
2. Period of rapid maturation and change
3. Considered to be a transition that begins with the onset of puberty and extends to the point of entry into the adult world
4. Biological and personality maturation accompanied by physical and emotional turmoil
5. Self-concept redefined
6. In late adolescence, the child begins to internalize all previously learned values and focus on an individual rather than a group identity.
BOX 10-1
DEVELOPMENTAL AGE PERIODS
Prenatal Period: Conception to Birth
Germinal: Conception to approximately 2 weeks
Embryonic: 2 to 8 weeks
Fetal: 8 to 40 weeks (birth)
A rapid growth rate and total dependency make this one of the most crucial periods in the developmental process. The relationship between maternal health and certain manifestations in the newborn emphasizes the importance of adequate prenatal care to the health and well-being of the infant.
Infancy Period: Birth to 12 Months
Neonatal: Birth to 27 to 28 days
Infancy: 1 to approximately 12 months
The infancy period is one of rapid motor, cognitive, and social development. Through mutuality with the caregiver (parent), the infant establishes a basic trust in the world and the foundation for future interpersonal relationships. The critical first month of life, although part of the infancy period, is often differentiated from the remainder because of the major physical adjustments to extrauterine existence and the psychological adjustment of the parent.
Early Childhood: 1 to 6 Years
Toddler: 1 to 3 years
Preschool: 3 to 6 years
This period, which extends from the time the children attain upright locomotion until they enter school, is characterized by intense activity and discovery. It is a time of marked physical and personality development. Motor development advances steadily. Children at this age acquire language and wider social relationships, learn role standards, gain self-control and mastery, develop increasing awareness of dependence and independence, and begin to develop a self-concept.
Middle Childhood: 6 to 11 or 12 Years
Frequently referred to as the “school age,” this period of development is one in which the child is directed away from the family group and centered around the wider world of peer relationships. There is steady advancement in physical, mental, and social development, with emphasis on developing skill competencies. Social cooperation and early moral development take on more importance with relevance for later life stages. This is a critical period in the development of the self-concept.
Later Childhood: 11 to 19 Years
Prepubertal: 10 to 13 years
Adolescence: 13 to approximately 18 years
The tumultuous period of rapid maturation and change known as adolescence is considered to be a transitional period that begins at the onset of puberty and extends to the point of entry into the adult world—usually high school graduation. Biological and personality maturation are accompanied by physical and emotional turmoil, and there is redefining of the self-concept. In the late adolescent period, the young person begins to internalize all previously learned values to focus on an individual, rather than a group, identity.
From Hockenberry MJ: Wong’s essentials of pediatric nursing, ed 8, St Louis, 2009, Mosby.
IV. ASSESSMENT OF GROWTH AND DEVELOPMENT
A. Assessment of growth
1. Obtain accurate assessments at regular intervals.
2. Record and plot data on growth charts.
a. Allows for comparison with statistical norms
3. Assessments include:
a. Height
b. Weight
c. Head circumference
d. Body mass index
B. Assessment of development
1. Complex process
2. Gather data from many sources.
a. Observations
(1) Activities of daily living (eating, playing, dressing)
(2) Communication patterns
(3) Interaction skills
(4) Emotional responses
b. Interviews
c. Physical exams
d. Interactions with child and parents
V. THEORIES OF DEVELOPMENT—OVERVIEW (Table 10-1)
A. Freudian
1. Psychosocial
2. Emphasis on development of personality
B. Erikson
1. Psychosocial development
C. Piaget
1. Cognitive development
D. Kohlberg
1. Moral development
E. Sullivan
1. Interpersonal development
F. Skinner, Watson
1. Learning theory; behaviorism.
2. Focus entirely on behavior.
3. Internalize processes such as thoughts and feelings.
G. Maslow
1. Humanistic
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