NCM 107a-GROWTH AND DEVELOPMENT
DEFINITION OF TERMS:
Growth – refers to increase in the physical size.
Development – an increase in capability or function.
Maturation – development of traits carried through the genes
FACTORS INFLUENCING GROWTH AND DEVELOPMENT
1. Heredity/Genetic
a. gender
b. health
c. Intelligence
d. Temperament
a) Activity level
b) Rhythmicity
c) Approach
d) Adaptability
e) Intensity of reaction
f) Distractibility
g) Attention span and persistence
h) Threshold of response
i) Mood quality
Categories of Temperament
1. Easy Child
2. Difficult child
3. Slow-to-warm-up child
2. Environment
a. Nutrition
b. Socio-Economic Status
c. Race
d. Culture
e. Family
f. Prenatal Influences
PRINCIPLES OF GROWTH AND DEVELOPMENT
1. Growth and development are continuous, orderly, sequential process
● cephalocaudal proximodistal
● gross to refined
● general to specific
2. Each child grows at his own rate passing through predictable stages and different body parts
have asynchronous growth
3. Each development stage has its own characteristics and it is continuous throughout life.
4. There is an optimum time for initiation of learning and new skills tends to predominate.
➢ Readiness
➢ “Catch-up” growth
5. Learning can either help or hinder maturational process, depending on what is learned.
6. There are critical periods of G&D
7. Children resemble one another but each child is unique
8. The many factors influencing growth and development are interrelated. They act upon and
react with one another extensively and inseparably
DIFFERENT ASPECT OF DEVELOPMENT
1. Physical Growth – includes changes in body size
2. Mental Development – test of intelligence, problem solving, general understanding of
what to do in a given situation
● Intelligence quotient
3. Emotional Development
● Emotional Intelligence
How do Emotions Affect Children’s Personal and Social Adjustments?
1. Emotions add pleasure to everyday experiences
2. Emotional tension disrupts motor skill
3. Emotions serve as form of communication
4. Emotions interfere with mental activities
5. Emotions affect social interaction 6. Emotions affect psychological climate and in turn
affect them
How to Nurture Child’s Emotional Intelligence
1. We must be aware of the developmental milestones in our children’s social and emotional
development
2. Parenting and teaching styles make a difference
3. Make sure that our children’s time is used well in terms of balancing studies, household
responsibilities and leisure time.
4. Help children nurture and sustain friendships
5. Spend at least 15 minutes a day of focused time at play or in conversation to enhance
self-image and self-confidence
6. Give children the opportunity to solve own problems
7. Motivate children to study, to experience new things and learn to activities 8. Provide
children with positive models
4. Social Development
MEASUREMENT TOOLS FOR GROWTH AND DEVELOPMENT 1. Chronological
Age
2. Assessment of Cognitive Development – Mental Age
3. Denver Developmental Screening Test (DDST)/Metro Manila Development Screening Test
(MMDST)
4. Growth Parameters
THEORIES OF GROWTH AND DEVELOPMENT
Developmental Task – skill or learning process that an individual must accomplish at a
particular time in his life
I. SIGMUND FREUD’S THEORY OF PSYCHOSEXUAL DEVELOPMENT
➢ Believes that early childhood experiences form the unconscious motivation for actions in
later life
➢ Personality develops in five (5) overlapping stages from birth to adulthood; sexual energy is
centered in specific parts of the body at certain stage.
➢ unresolved conflict and unmet needs at a certain stage to a *fixation
Three Structures of Personality
1. ID –pleasure principle, primitive drives
2. EGO –reality principle, balances the ID and SUPER-EGO
3. SUPER-EGO – conscience and ego ideal
Freud’s Five Stages of Psychosexual Development
Stage
Age
Center of Pleasure
Oral Phase
0-1 yr (infant)
Mouth
Anal Phase
1-3
(toddlerhood)
Phallic
3-6 yrs (preschool)
Genitalia
Latency
6-12
age)
Sexual impulse is
repressed
Genital
12
and
after
(adolescence)
Nursing Implications:
yrs
yrs
(school
Nursing
Implication
1. The nurse must be aware of meeting the needs of each stage in order to move successfully
into future developmental stages.
2. The nurse should strive to meet an ill child needs.
a. The importance of sucking in infancy should alert the nurse to provide a pacifier when
needed.
b. The preschool’s concern for sexuality should guide the nurse to provide privacy and clear
expectations during any procedure involving the genital area.
c. It may be necessary to teach parents that masturbation by the young child is normal and to
help them deal with it.
d. The nurse should/may question about significant friends during history taking with an
adolescent.
II. Erik Erikson’s theory of PSYCHOSOCIAL DEVELOPMENT
➢ Establishes eight (8) psychosocial stages in an individual’s life span
➢ Each stage signals a task that must be achieved; the greater the achievement, the healthier
the personality of the individual
➢ Developmental tasks are viewed as a series of crises; Successful resolution is supportive to
the ego, while failure to resolve the task is damaging to the ego
➢ Failure to achieve a task influences the individual’s ability to achieve the next task
Erik Erickson’s Eight Stages of Psychosocial Development
Stage/Develop
mental Task
Age
Of
positive
Resolution
Of
Negative
Resolution
Trust
Mistrust
vs.
0-1 yr. Infancy
•
trusting
others
• views the
world as safe
place
and
people
as
helpful
and
dependable
•
mistrust,
withdrawal,
estrangement
•
fearful,
suspicious
Autonmy
Shame
doubt
vs.
and
1-3 yrs. Toddler
hood
• self control
without loss of
self esteem
• ability to
cooperate and
express self (let
them decide)
• compulsive
self-restraint or
compliance
•
Willfulness
and defiance
Initiative
vs.
3-6 yrs Prescho
•
Anal region
Full sexual maturity
beginning
•
lacks
Nursing
Implications
guilt
Industry
inferiority
vs.
6-12
Schoolage
yrs
ability
to
evaluate own
behavior
• learning how
to do things
and
child
initiates
new
activities
• consider new
ideas
selfconfidence
• pessimistic •
over
control
and
over
restriction of
own activity
• beginning to
create, develop
and manipulate
• sense of
competence
and
perseverance •
develops new
interest
and
involvement in
activities
• loss of hope
• sense of
mediocre
•
withdrawal
from
school
and peers
Integrity
Despair
Identity
vs.
Role Confusion
12-18
yrs
Adolescent
•
coherent
sense of self
• Feelings of
confusion,
indecisiveness,
and
possible
antisocial
behavior
Intimacy
Isolation
18-25
Young
adulthood
•
intimate
relationship
with
other
person
•Commitment
to work and
relationship
• Impersonal
relationships •
Avoidance of
relationship
career
or
lifestyle
commitment
•
Extends
concern
to
community,
becomes
•Self-absorbed
• Unable to
cope
with
change
vs.
Generativity vs.
Stagnation
yrs
25-60
yrs.
Middle
adulthood
politically active
• Self confident
•
Able
to
assume various
roles
vs.
60
years
onwards Old
adulthood
• Feels good
about his/her
life choices
• Wishes life
could turn out
differently
Nursing Implications:
1. Nurse should be aware of indicators of positive and negative resolution of each stage.
2. Nurse can assists the family in providing *opportunities and encouragement to the
child/person for enhancement of a positive resolution. 3. Nurse should help the person
develop coping skills relative to the crisis experienced at a specific level of development.
4. The nurse should be aware that the environment is highly influential in personality
development
III. Jean Piaget’s Theory of COGNITIVE DEVELOPMENT
➢ Swiss psychologist
➢ the way children learn to think, reason, and use language
➢ believes that cognitive development is a sequential, orderly process in which a variety of
new stimuli must exist before intellectual abilities can develop
➢ defined four (4) phases of development and each phase consists of sub-units with their own
characteristics
➢ as child advances from one phase to the next, thinking process is recognized until become
closer to adult thinking
Three (3) Primary Abilities:
1. ASSIMILATION - the process of changing a situation or one’s perception of it to fit one’s
thoughts/ideas
2. ACCOMODATION - the process of change whereby cognitive processes mature
sufficiently to allow the person to solve those that are unsolvable before
3. ADAPTATION - the ability to handle the demands made by the environment
Piaget’s Four (4) Phases of Cognitive Development
1. sensorimotor (0-2 years)
2. preconceptual/preoperational (2-7)
3. concrete operational (7-11)
4. formal operational (11-adulthood)
• Good game : throw and
retrieve
Piaget’s Stages of Cognitive Development
Stage
Age
SENSORIMOTOR
Substages:
a. Neonatal Reflexes
b. Primary Circular Reaction
• Good toy - Rattle or
parents taped voice
c.
Secondary
Circular
Reaction
• Good toy–mirror; peek-a
– boo
d.
Coordination
of
Secondary Schemes
• Good toy: nesting toys;
colored boxes
e.
Tertiary
Reactions
Circular
Child Activity/ Behavior
➢ 0-1 mo.
➢ entirely reflexive
➢ 1-4 mos.
▪ beginning intention of
behavior is present
▪ Pleasure is gained through
repetition of the behavior.
➢ 4-8 mos.
➢ 8-12 mos
➢ 12-18 mos.
to learn results
▪
*capable of space
perception, time perception,
and permanence
▪ Begins to be aware of the
environment as the infant
begins to connect cause and
effect.
▪ Learns from unintentional
behavior.
▪ memory traces are present
and anticipates familiar
events
▪ can plan activities to attain
specific goals
▪ Objects Permanence – the
knowledge that something
continues to exist even
when out of sight, begins
when the infant remembers
where a hidden object is
likely to be found; it is no
longer “out of sight, out of
mind.” - recognizes shapes
and sizes, imitates others. increased
sense
of
separateness
▪ *experimentation and
exploration predominate as
the toddler tries out actions
▪ object permanence now
FULLY DEVELOPED ▪
Language provides a new
tool for the toddler to use in
understanding the world.
▪
uses memory and
*imitation to act
▪ Initiates when model is
out of sight.
▪ can solve basic *problems
f. Mental Combination
• Good game : blocks,
colored plastic rugs
➢ 18-24 mos.
II. PRECONCEPTUAL
▪ 2-4 yrs.
▪
vocabulary
and
comprehension
increase
greatly
but
child
is
egocentric
thinking
is
basically concrete and literal
▪ static thinking
▪
no
awareness
of
reversibility
▪ concept of time is now,
concept of distance is as far
as he / she can see
II.1
INTUITIVE
THOUGHT
➢ 4-7 yrs
▪
child
relies
on
transducivereasoning
▪ thinks of one idea at a
time (
▪ words express thought
▪ lacks conservation
III.
CONCRETE
OPERATIONAL
➢ 7-11 yrs
▪ concept of “conservation”
is learned
▪ child can reason quite well
if concrete objects are used
in
teaching
or
experimentation
▪ aware of reversibility and
decentering
▪begins
to
relationships
IV.
FORMAL
OPERATIONAL
➢ 11 yrs- adulthood
understand
▪adult like thinking
▪fully mature intellectual
thought is attained
▪uses rational thinking
▪reasoning is *deductive and
futuristic
Nursing Implication:
▪ It is essential to the pediatric nurse that she must understand a child’s thought to design
stimulating activities and meaningful, appropriate teaching plans.
IV. Lawrence Kohlberg’s Theory of MORAL DEVELOPMENT
➢ focuses on the way children gain knowledge of right and wrong
➢ moral development progresses through three levels and six stages
Level
Stage
Age
I.PRECONVENT
IONAL
➢
externally
established
rules
determine right or
wrong actions
➢ Egocentric focus
1.
Punishment
and
Obedience
Orientation – fear
of punishment is
reason
for
conformity
/
behavior
2-3 yrs
2.
Instrumental
Relativist
Orientation
–
conformity is based
on egocentric and
narcissistic needs –
instrumental
purpose
and
exchange
II.
CONVENTIONA
L – concerns with
3. Interpersonal
Concordance
Orientation
–
4-7 yrs
Nursing Implication
maintaining
expectations
and
rules of family,
group, or society –
societal focus
behavior is based
on concerns about
other’s reactions –
follows
rules
because of the need
to be “good”
4. Law-and-Order
Orientation-–
maintenance
of
social order, fixed
rules and authority
III.
POSTCONVENT
IONAL – lives
autonomously and
defines moral values
and principles that
are distinct from
personal
identification with
group values
– universal focus
5. Social Contract
Logistic
Orientation
–
believes a higher
moral
principle
applies and not only
social rules
10-12 yrs
Older than 12
6.
Universal
Ethical Principle
Orientation
–
decision
and
behaviors are based
on internalized rules
and on self-chosen
ethical and abstract
principles that are
universal,
consistent,
and
comprehensive
Nursing Implications:
1. Emphasize the importance of helping children determine what are right actions.
2. Allow child to help in simple activities and praise for the desired behavior
7-10 yrs
V. Robert Havighurst’s Theory of DEVELOPMENTAL TASK
– Theorizes that LEARNING is essential to life and that human being continues to LEARN
throughout life.
AGE PERIOD
TASKS
1. Infancy & Early Childhood
▪ learn to walk, to take solid food, control
elimination of body wastes, sex difference,
sexual modesty, relate emotionally to
parents, siblings & others, to distinguish
right from wrong (develop conscience);
achieve physiological stability, from physical
& social concepts of reality.
2. Middle Childhood
▪ Learn physical skills necessary for
ordinary games, to get along with age mates’
appropriate masculine and feminine social
role; develop wholesome attitude toward
self, skills in reading, writing, calculating,
concepts necessary for everyday living,
morality, values, personal independence.
3. Adolescence
▪ Achieve mature relationship with peers of
both sexes, masculine/feminine social role,
acceptance of one’s body image, emotional
independence of parents and others adults
economic independence, selection and
preparation for marriage and family life,
intellectual skills and concepts necessary for
civic competence, socially responsible
behavior, set of values and an ethical
system.
4. Early Adulthood
▪ Select a mate; learn to live with significant
others; start family; rear children; manage a
home; begin occupation; assume civic
responsibility; identify with a social group.
5. Middle Age
▪ Achieve adult civic & social responsibility;
establish & maintain an economic standard
of living; assist children to become
responsible; happy adults; develop leisure
activities; relate to spouse on a more intense
basis; accept & adjust to physiological
changes of middle age; adjust to accept own
aging parents.
6. Later Maturity
▪ Accept and adjust to decrease physical
strength and health; adjust to retirement;
lower income; aging and inevitable death of
self and spouse; establish affiliation with age
group; meet social and civic obligations; live
in satisfactory physical environment.
THE INFANT
Weight
– Gains 1-2 lb/month during the first 6 months
– Gains ¾ - 1 lb/month during the 2nd half of infancy (2nd 6 mos.)
– Birth weight doubles at 6 months (4-6 mos.)
– Birth weight triples at 12 months (I year)
Length
– With 50% increase by one yearor grows from the average birth length of 20-30 inches
Head Circumference
– Head is greater than chest at birth
– Head is equal with the chest at one year
Teething (baby teeth/deciduous/temporary)
– 6-7 months lower incisor
– at 12 months, an average of 8 teeth have erupted
Play
– Solitary
Toys
– Musical mobiles (1 month)
– Small rattles (2 months)
– Small blocks (3 months)
– playpen or a sheet spread on the floor (4 months)
– Rubber/plastic ducks
– squeeze toys, plastic keys/rings, blocks(5 months)
– teething rings(6 months)
– musical boxes
– soft, cuddly toys (8 months)
– large wooden beads (9 months)
– activity box for crib or playpen
– Nesting toys (9 months)
– Pull toys
Greatest Fear
– Stranger Anxiety(7-8 months) - Eight Month Anxiety
Other specific behavior: Fine and Gross Motor
– Lifts head intermittently when on prone (1 mo.)
– Social smile, head lag, sheds tears, can raise head but cannot raise chest (2 mos.)
– Raise head bobbles and cues can lift head and shoulders (3 mos.)
– raise both head and chest, grasps objects and brings to mouth, no head lag laughs aloud,
extrusion reflex fades, neck-righting reflex which tends to turn front to back (4mo.)
– Rolls over and turn from side to side, raking grasp (5 mo.)
– Sits with support, eruption of first tooth (6 mo.),vertebral curves develop, capable of
Hitching
– Plays with feet, says dada or mama, thumb-finger grasp, sits alone when held or placed
forward for balance(7 mo.)
– Sits alone steadily), independently drinks from a cup (8 mo.)
– Good hand-mouth coordination, crawls, neat pincer grasp, understands simple gestures and
requests (9 m0.)
– Pulls self to stand by holding on to sides of playpen but can’t let self to down again,
responds to name (10 m0.)
– Stands with assistance, attempts to walkby holding on to objects (cruising) (11 mo.) – Walks
with help, drinks from cup, says 2 words (12 mo.)
Neurologic Reflexes that appear during Infancy
▪ Labyrinth Righting
▪ Neck righting
▪ Body righting
▪ Otolith righting
▪ Landau
▪ Parachute
Health Maintenance
– caloric requirement = 1,200 calories/day
– introduction of solid foods = 4-6 months
Requirements to readiness for solid foods
– extrusion and sucking reflexes are fading
– can sit with support
– salivary glands, intestinal enzymes are developed and present
– there is a nutritional need to be met
Rules to Follow when Introducing Supplementary Foods
– one food at a time
– Small amount each feeding (1 tsp.)
– have an interval of 4-7 days between new foods
– Do not place in bottles with formula
– Introduce the food before formula or breastfeeding when the infant is hungry
– do not force, bribe, plead or threaten the child
Sequence of Introducing Solids
1. Cereals as first solids
2. Vegetables
3. Fruits
4. Meats
5. Egg yolk
6. fish
7. whole egg
Weaning -he process of giving up one method of feeding for another
- 6 months from breast to bottle
- 12 months from bottle to cup
- There should be no weaning during periods of illness or stress
Food Allergies
– Signs of hypersensitivity:
1. Vomiting
2. Diarrhea
3. Urticaria
4. Abdominal pain
5. Respiratory difficulty
Immunizations
– At birth = BCG intradermal
– 2 months = DPT, OPV, Hepa B (3 doses at one month interval)
– 9 months = anti measles
Contraindications:
– fever
– allergies
– immunosuppression
– malignancy
– skin rash
– blood transfusion within 6-8 weeks prior to vaccination
Common Concerns Related to Infancy
1. Teething
➢ High fever, seizure, vomiting, diarrhea or earache are not normal signs of teething 2.
Thumb sucking
➢ Sucking reflex peaks at 6-8 months; thumb sucking peaks at about 18 months
3. Use of pacifier
➢ Infants should be weaned any time from 3 months and certain during the time that sucking
reflex is fading at 6-9 months
4. Head banging
➢ Normal
• Uses this method to relax and fall asleep
5. Sleep problems
➢ Develop in early infancy due to colic or because an otherwise healthy infant takes longer
than usual to adjust to sleeping through the night
➢ Breast fed babies tend to wake more often than those who are formula fed
6. Constipation
➢ It may occur for formula fed infants
7. Loose stools
➢ Formula-fed – formula not diluted properly ➢ Mother takes laxatives while breastfeeding
➢ Introduction of solid foods- fruits
➢ Malabsorption syndrome (celiac disease) or inability to digest fats
8. Colic – paroxysmal abdominal pain that generally occurs in infant’s under 3 mos.
THE TODDLER
Weight
– Gains 5-10 lb/2-3 kg. during the period
– decreases due to physiologic anorexia
– decreased BMR and loss of subcutaneous fats
Length
– doubles by age 2
– boys slightly taller than girls, gains more in proportion to weight
Head Circumference
– Equal to chest by 6 months to 1 year.
Fontanelles
– Anterior – closes at 12-18 mos.
Teething
– 8 new teeth (the canines and the first molars) erupt during the 2nd year.
– Completion of 20 primary or deciduous teeth by 2 ½ - 3 yr.
MAJOR CONCERNS IN TODDLERS:
1. Toddlerhood is the critical period for toilet training.
Pre-requisites:
a. physical readiness
✓ rectal and urethral sphincter control
✓ Gross motor ability to stand and walk to bathroom
✓ Fine motor skill to remove clothing
b. Mental readiness
✓ Recognize the urge to defecate or urinate
✓ understands the act of elimination
✓ ability to use words or gestures regarding toileting needs
c. Psychologic Readiness
✓ Expressing willingness to please parent
✓ Ability to sit on toilet for 5-8 minutes without fussing or getting off
✓ Curiosity about adult’s or older sibling’s toilet habits
✓ Impatience with soiled or wet diapers, desire to be changed immediately
d. Parental Readiness
✓ Recognition of child’s level of readiness
✓ Willingness to invest the time require for toilet training
✓ Absence of family stress or change, such a s divorce, moving, new sibling
Schedules of Toilet Training
15-18 mos. - start of training
18-24 mos. - bowel control
2-3 yr. - Daytime bladder control
3-4 yr. - Nighttime bladder control
4. Loss of privileges for older children
Effects of Good Punishment
1. security
2. self-control
3. socially appropriate and acceptable behavior
5. Separation Anxiety
➢ most acute at 2 – 2 ½ years old
2. Toddlers are headstrong and negativistic, naturally active, mobile and curious.
➢ “NO” is a favorite word, with negativistic behavior
3. Toddlers are rigid, repetitive, ritualistic and stereotyped in behavior. When things
are rearranged, are strange, or when places and persons are unfamiliar, they go into
temper tantrums.
Temper Tantrums - characterized by the child’s kicking, screaming, stamping of feet and
shouting “NO!”, child lies on the floor, hails his arms and legs, hold his breath until he
becomes cyanotic and slumps to the floor.
4. Discipline and Setting Limits – setting of rules and external control whenever necessary
to the child so that he knows what is expected of him.
Punishment – consequence that results from a breakdown of discipline; from the child’s
breaking the rules he has learned.
Principles of Good Discipline:
1. Immediately after a wrong doing
2. consistent and firm
3. disapproves of behavior and not of the child
4. positive approach
5. allow the child to explain your reason of disciplining
6. observe safety
7. provide physical care after so that DOUBT is erased and AUTONOMY reinforced
Forms of Disciplining
1. Ignoring
2. Redirect the child’s attention
3. Corporal punishment
6. Health Maintenance
a. Nutrition
▪ Caloric requirement – 1,300 calories/day
▪ Physiological anorexia – voracious appetite on one day then nothing the next day
Effects:
a. prone to iron deficiency anemia
b. refusal to eat
Management:
• do not force the child to eat
• let the child feed himself
• allow the child to join others at the table
• let the child decide for the order of food
• recognize ritualistic behavior
• give small portions
• do not give bottle as a substitute for solids, give solids before or with milk
• do not use food as reward (contributes to obesity)
b. Dentition
➢ 8 new teeth added by 2nd year (canines and first molars)
➢ completion of primary teeth at 2 ½ - 3 years (20 deciduous teeth)
➢ brush and floss 2x daily with parent’s help
➢ FIRST DENTAL VISIT as soon as all primary teeth are out
➢ Limit concentrated sweets
➢ prone to “BOTTLE MOUTH CARIES”
c. Accident Prevention
1. Falls
➢ leading cause of death
▪ use stair guards and bed rails
▪windows and doors screened
▪ supervise play
▪ floors must not be slippery
2. Poisoning
▪ keep cabinets locked
▪ do not place medicines on places where children can reach
▪ give medicines as drugs NOT as candies
3. Burns
▪ cover electrical outlets
▪ keep electrical wires out of reach
▪ teach child what “HOT’ means
▪ check bath water temperature
4. Cuts and stabs
▪ place knives and sharps on safe areas
5. Drowning
▪ do not leave the child unattended
THE PRE-SCHOOLER
Weight – gains 5 lb/year
Height – 2-2 ½ inches/year
Teething – have all 20 deciduous teeth by 3 years old
Physical Development of a preschooler
Three
- walks backward
- pedals strike
- uses scissors
- climbs stairs
Four
- climbs and jumps well
- brushes teeth
- throws ball overhead
Five
- jumps rope
- Ties shoelace with ribbon
- skips and balances on 1 foot 8 sec
Nutrition
➢ 90 kcal/kg for an average daily intake of 1800 calories
➢ Fluid requirements - 100ml/kg/day – but depends on activity level, climatic conditions and
state of health
Play
➢ Associative or cooperative
\]
Fears
➢ Castration complex
➢ Fear of mutilation
➢ Fear of abandonment
➢ Fear of the dark
Behavior Traits of a Preschooler
1. Imitate adult behaviors
2. Favorite word: Why
3. Love to tell lies and enjoy offensive language
4. Age of sibling rivalry
5. Oedipal/electra complex
6. Masturbation may be seen in some
7. Still egocentric
THE SCHOOL AGE CHILD
Weight – Doubles
Height – grows 2 inches/year
Teething
– age of dental caries
– 5-7 years old – loss of deciduous teeth, average is at 6 years old
– 12 years old
– all permanent teeth (1st and 2nd molars) erupts – 28 permanent teeth (upper and central
incisor – first to disappear) – 3 rd molar – 17-21 years
Nutrition
– calories needed – 2,100 – 2,400 calories/day
– More likely to eat junk foods and carbonated beverages
– Display good table manners
Play
– Competitive, Cooperative (team and rules governed)
– Number of play activities decreases while amount of time spent on a particular activity
increases
– beginning of school year (6-7 years)
– boys and girls together but gradually separates into sex oriented type of activities
– Team play – rules and rituals dominates play; evades/eliminates individuals not tolerated by
peers.
– types of play/games:
▪ quiet games – painting, collections, reading, viewing television, listening on the radio
▪ athletic activities – swimming, hiking, cycling
6-9 yrs/old – housekeeping toys, dolls, accessories, needle works, collection hobbies
9-12 yrs/old – handicrafts, science toys, chess, scrabble, model kits, video games, radio/record,
books, comic books, joke books
Safety
– motor vehicle accidents
– Supervise during sports activity
– Teach respect for fire and its danger
▪ Latch Key Children– school children without adult supervision and who are left to care for
themselves before or after school
Fears
➢ fear of displacement or replacement in school
➢ fear of body injury
➢ fear of death
➢ Anxiety r/t beginning school
Morality – develops before age 9
– with STRICT superego
– rule dominance
– AUTONOMOUS MORALITY develops after 9 yr – recognizes differing points of view
LANGUAGE DEVELOPMENT
1. rapid expanding vocabulary
2. Rapidly develop metalinguistic awareness – an ability to think about language and to
comment on its properties
3. likes name calling, word games
4. with passwords and secret languages
5. with sense of humor; giggles and laughs a lot
6. enjoys dirty jokes
PSYCHOLOGICAL SKILLS
1. school occupies half of his waking hours
▪ friends and classmates are more important than family
▪ teacher becomes parent-substitute
▪ school phobia may result to psychosomatic disorders and complaints
2. increasing social activities
3. more cooperative and with improved manners
4. capable of a good deal of responsibilities
5. modest and enjoys privacy (starts at 10 yr. Old)
6. with hero worshipping
COGNITIVE SKILLS
• Concrete Operational
1. period of industry – likes to explore, produce, accomplish to have adventure
2. develops confidence
3. decentering
4. conservation
5. reversibility
6. with logical thinking
7. acquires use of reason and understanding of rules; allows greater use of language
8. names months and years, right and left and can tell time
9. knows that the quantity remain the same even though appearance differs
10. Capable of simple problem solving
THE ADOLESCENT
Adolescence
▪ it is the period of social and behavioral maturation from the beginning of pubescence to
beyond the time of reproductive maturity
▪ behavioral indicators:
a. rapid bodily changes
b. wants to be exactly like peers
c. much interest in opposite sex
d. formation of personality
e. concerned with lie after school
f. moves from dependency of childhood to independence of adulthood g. transition period: no
longer a child, not quite an adult
Puberty
➢ Period of full reproductive maturity
GIRLS – begins with menarche; most young girls are not fertile for about 1-2yr. after
menarche
BOYS – at or near first ejaculation
Physical Growth
Weight
▪ with pubertal spurt
Height
Female: 10-14 y/o
-20.5 cm gain; 95% of the mature height is achieved by the onset of the first menarche(within
3 years from menarche, may reach adult height)
Male: 12-16 y/o
- 27.5 cm gain; 95% of mature height is achieved at 15.
– rapid increase in weight and height, alteration in body shape:
GIRLS - forms becomes smoother because of the fat deposition
- Pelvis broadens
▪ breast development is the first overt sign of beginning of reproductive maturation BOYS increase in the size of the testes and scrotum and later the penis
- Leaner chest and shoulders broadens
Teething
– 12-13 y/o – 2 nd molars
14-15 y/o – 3 rd molars or wisdom teeth; can extend up to 18-21 yrs.
Nutrition
–calories: 2200 in girls, 2700 in boys
– appetite increases with rapid growth
– increase in CHON, Ca, Fe & Zinc needs for sexual maturation
– increase in nutritional requirement because of sports activities
– eating habits – influences by peer group, usually with feeding problems
Play
–recreational and leisure activities:
Girls:
- social functions
- Romantic TV shows
- Telephone use for a long time
- Cooking and sewing
- Outings and movies
- Art and poetry
- daydreaming
Boys
- group activities
- Sports activities are important
- Part-time employment
- Mechanical and electrical devices
Safety and Accidents:
1. Leading cause of death, with motor accidents and sports injuries
2. Drugs and alcohol are serious problems
3. Suicide
4. Drowning is also common
Fears
– fear related to body image
– body injury
– death
Psychosocial Patterns
1. Early Adolescence (12-14)
a. physical and body changes can result to altered self concept leading to fear of rejection
b. early and late developers may also have anxiety regarding fear of rejection
c. may have mood swings
d. with fantasy and daydreaming e. needs consistent discipline, limits and behavior
f. Middle Adolescence (F: 13-16; M: 13-17)
g. emancipated from parents h. identifies own values
i. finds increasing interest in heterosexual relationships; may find a mate or form ‘love’
relationships
j. with peer group
- One of the strongest motivating forces of behavior
- finds importance to be part of the group and be like everyone else, conforms to values and
fads of the group
- Clique formation- may be determined by race, social class and special interest
k. sex education is complete at this period
2. Late Adolescence (F: 18-21: M: 17-21)
a. physically and financially independent from parents
b. finds a mate
c. finds identity
d. develops morality
e. Increasing social and moral interest; participate in society.
f. completes physical and emotional maturity
• That relationship is not solely based or learn on physical appearance but on inner qualities
Independence
a. by 15-16 years, adolescents feel they should be treated as adults
b. AMBIVALENCE – wants freedom but is not happy with the corresponding
responsibilities that come with it.
c. PARENTAL AMBIVALENCE – parents give the adolescent freedom but continue to
offer constructive guidance and offer discipline.
NCM 107a-GROWTH AND DEVELOPMENT
CHAPTER 2. PROCREATIVE AND SEXUAL HEALTH
LESSON 1. CONCEPT OF UNITIVE AND PROCREATIVE HEALTH
study of sexual physiology based on more than 10,000 episodes of sexual
activity among more than 600 men and women (Masters, 1998). In this
study, they described the human sexual response as a cycle with four
discrete stages: excitement, plateau, orgasm, and resolution.
Marital Act – The marital meaning is only present when the natural sexual act occurs between
a man and a woman married to each other.
A family grows from the marriage and union of a male and female. The spouses’ union
achieves the twofold end of marriage:
1. The good of the spouses themselves
2. The transmission of life
Purpose of Marriage: a. Unitive b. Procreation
The unitive and procreative purpose of a conjugal act forms a new life. The new life gives new
role and responsibilities to the spouse, that is to become parents.
LESSON 2. HUMAN SEXUALITY
Human sexuality are the characteristics that make a man, a man, or a woman, a
woman. This includes the man’s or woman’s capability for sexual feelings and behavior. It also
includes his or her total personality. Now, let us determine what are major components of
human sexuality.
5 major components of Human Sexuality:
1. Biological Sex
2. Sexual Orientation
3. Sexual identity
4. Gender Identity
5. Values, attitudes, feelings and emotions
Sexual Response Cycle:
Did you know that the two of the earliest researchers of sexual response
were Masters and Johnson? In 1966, they published the results of a major
LESSON 3. RESPONSIBLE PARENTHOOD
Responsible Parenthood, is the will and ability of parents to respond to the needs and
aspirations of the family and children. It is a shared responsibility of the husband and the wife
to determine and achieve the desired number, spacing, and timing of their children according
to their own family life aspirations, taking into account psychological preparedness, health
status, socio-cultural, and economic concerns.
Duties and Responsibilities of Parents to their Children:
1. Provision of Physical Care and Love
2. Inculcating discipline
3. Developing social competence
4. Providing education
5. Citizenship training
6. Teaching the wise use of money
7. Financial aspect of responsibility
8. Spiritual formation
LESSON 4. PHYSIOLOGY OF MENSTRUAL CYCLE
Menstruation is a normal cyclic physiologic event signifying the reproductive years
in the human female. It is also defined as an episodic uterine bleeding in response to
cyclic hormonal changes or it is the shedding of the lining of the uterus which
include blood, some endometrial tissue, white blood cells and mucus. On the other
hand, menstrual cycle is the rhythmic preparation of the uterus to receive a
fertilized egg and the discharge of the uterine lining usually at monthly intervals
when no fertilized egg enters the uterus (prepares the uterus for pregnancy).
Purposes of Menstrual Cycle:
1. to bring an ovum to maturity
2. to renew uterine tissue bed that will be responsible to its growth should it be
fertilized
Phases of Menstrual Cycle
The hypothalamus, the pituitary gland, the ovaries, and uterus are four body
structures involved in the physiology of menstrual cycle. For a menstrual cycle to be
complete, all four structures must contribute their part; inactivity of any part results
in an incomplete or ineffective cycle (Pillitteri, 2014).
1. Menstrual Phase- approximately 4 days The shedding of the functional 2/3 of
the endometrium which is initiated by periodic vasoconstriction of the spiral
arterioles most marked in the upper layers of the endometrium.
2. Proliferative Phase – approximately 10 days
On the 3rd day of the menstrual cycle, decrease estrogen level in the blood
stimulates the hypothalamus to release Gonadotrophin Releasing Factors (GnRF),
FSHRF, LHRF, FSHRF stimulates the APG to produce FSH that act on a primodial
follicle in an ovary-producing estrogen. The primodial follicle termed now as
Graafian follicle. Estrogen in the Graafian follicle causes the cells of the uterus to
proliferate, thickens to almost eightfold.
3. Progestational Phase – approximately 11 days
The low level of progesterone in the blood which is on the 13th day of the cycle
stimulates the hypothalamus to release LHRF that further stimulates the APG to
produce LH, responsible for the production of progesterone. Increase amount of
ES and Pro pushes the new mature ovum to the surface of the ovary. Graafian
follicle ruptures and release the mature ovum thus ovulation occur. Graafian follicle
turns to corpus luteum that contains an increasing amount of progesterone and
giving it a yellowish appearance.
4. Regressive/premenstrual phase – approximately 3 days
On the 24th or 25th day of the cycle, if the mature ovum is not fertilized, the
amounts of hormone in the corpus luteum will start to decrease and turns to white
called corpus albicans. After 3-4 days, the thickened lining of the uterus start to
degenerate and slough off and capillaries ruptures thus menstruation.
Hormones play an important role in the menstrual cycle phase. Here is a table for
you specifying the effects of estrogen and progesterone to the cycle.
The Effects of Hormone to Menstrual Cycle
ESTROGEN
PROGESTERONE
1. inhibits the production of FSH
2. causes hypertrophy of the myometrium
3. stimulates growth of the ductile
structures of the breast
4. increases quantity and pH of cervical
mucus
5. stimulates growth of vagina and uterus,
thickening of the endometrium
6. increases sexual desire
7. assist in the maturation of ovarian follicle
1. inhibits the production of LH
2. facilitates transport of the fertilized ovum
through the fallopian tube
3. increase endometrial tortousity
4. inhibits uterine and gastrointestinal
motility
5. decreases muscle tone of urinary tract
6. increase musculo-skelatal motility
7. decreases renal threshold for lactose and
dextrose
8. increases fluid retention
9. increases basal fibrinogen levels
10. increases body temperature after
ovulation
The effect of estrogen and progesterone does not limit to the menstrual cycle, they
also act on different reproductive organs.
Target Organ
Estrogen
Progesterone
Vagina
rowth of cells of vaginal
epithelium,
glycogen
appears in cells
maturation of cells of
epithelium ceases, surface
cells degenerate and are
shed- release of glycogen
Vulva
growth and health of vulval
tissues
Cervix
growth of cervical glands
abundant secretion of clear
thin mucus
changes secretion to scant
but thick mucus
Uterus
proliferation
of
endometrium
stimulates
growth of myometrium
enlargement of stromal cells
glands, mucus and glycogen
secretion,
increases
endometrial tortousity
Breast
growth of duct system
enlargement
and
pigmentation of nipple and
areola
growth of breast alveoli
Estimating Ovulation Time
Count back 14 days from the first day of menstruation e.g. May 15 (1st day of
menstruation) May 15 -14 = 1 Ovulation occur in May 1
Signs and Symptoms of Ovulation:
1. Presence of Mittleschmerz
2. Identification of fertile cervical mucus
a. clear, transparent
b. slippery, lubricative
c. stringy, stretchable
d. positive ferning test
3. Positive Spinnbarkeit test
- Spinnbarkeit is the property of cervical mucus to stretch a distance before
breaking.
4. Slight abrupt rise in basal body temperature (0.3- 0.5 C) which is preceded by
a slight drop
Premenstrual Syndrome
Factors Related to the Occurrence of PMS:
These are the factors that contribute to the presence of PMS.
1. estrogen- progesterone imbalance
2. excess aldosterone
3. vitamin deficiencies
4. psychologic
5. high caffeine intake
6. increasing age
7. tobacco use
8. family history – identical twins(high)
Symptoms of Premenstrual Syndrome:
1. Emotional - tension, depression, irritability, fatigue, lethargy, out of control
feelings, hostility, loneliness and mood swings
2. Behavioral - interpersonal conflict, sleep changes, clumsiness, bouts of substance
abuse (alcohol), social withdrawal, changes in sexual desire
3. Breast - tenderness, enlargement
4. Skin - pimples, recurrence of herpes and other skin disorders
5. Gastrointestinal - abdominal bloating, decrease or increase desire for food, food
craving
6. Others - headaches, backaches, edema, weight gain, enuresis (involuntary passage
of urine), cystitis (inflammation of the urinary bladder).
Pharmacologic Interventions for PMS:
1. vitamin and mineral supplements
2. diuretics
3. psychotrophic drugs
4. progesterone and progesterone derivatives
5. flouxetine (serotonin uptake inhibitor)
6. Anti-prostaglandins
Abnormalities of Menstruation/Abnormal Uterine Bleeding:
1. Dysmenorrhea - painful menstruation which may be due to physical or
emotional
2. Amenorrhea - absence of menstruation/ temporary cessation of menstruation
3. Menorrhagia/hypermenorrhea - excessive bleeding during menstruation
4. Metrorrhagia - bleeding between menstrual cycle
5. Polymenorrhea - frequent menstruation occurring at interval of less than 3
weeks/periods occur too often
6. Oligomenorrhea - markedly diminished menstrual flow/ bleeding more than 35
days apart with decreased amount of bleeding
7. Hypomenorrhea - very light flow spotting
GENERAL CONSIDERATIONS IN MENSTRUATION:
1. Ushered in menarche and ends with menopause
2. 300 – 400 thousand immature oocytes each developed in a primordial follicle are
present in each ovaries at the time of birth (these were formed by the process called
oogenesis during the first 5 months of intrauterine life)
3. Normal menstrual period lasts for 3-7 days.
4. Mittelschmerz– pain felt as mature ovum is released which is either RLQ or LLQ
5. In a 28 day cycle, ovulation takes place on the 14th day (subtract 14 days from the
cycle)
6. Menstruation can occur without ovulation (women taking oral contraceptives,
ovulation can also occur even without menstruation).
7. Anovulatory periods after menarche in some girls not unusual because of
immaturity of feedback mechanisms. (Anovulatory states occur also in pregnancy,
lactation and related disease conditions)
8. Body structures involved: hypothalamus, anterior pituitary gland, ovaries and
uterus.
9. Hormones which regulate cyclic activities: a. follicle-stimulating hormone b.
luteinizing hormone
LESSON 5. THE PROCESS OF CONCEPTION
1. FERTILIZATION/CONCEPTION/FECUNDATION/IMPREG
NATION
-The union/fusion of the sperm and the mature ovum in the outer third of the
fallopian tub
Factors Necessary for Fertilization to Occur
1. Maturation of both the ovum and the sperm
2. Ability of the sperm to reach the ovum
3. Ability of the sperm to penetrate the zona pellucida and cell membrane
General Considerations:
1. Amount of semen per ejaculation (3-5 cc/1 tsp.)
2. Number of sperms/cc (120-150 M)
3. Mature ovum is capable of being fertilized for 24-48 hours after ovulation.
Sperms are capable of fertilizing even for 3-4 days after ejaculation
4. Normal life span of sperm (7 days)
5. Sperms once deposited in the vagina will generally reach the cervix within 90
seconds after ejaculation
6. Only one sperm is required for actual fertilization but the presence of many
increases the chance for one to penetrate. Sperm undergo physiologic
change/capacitation and structural change or acrosome reaction
7. Only the sex chromosome of the male determines the sex of the child. Sperms
have 22 autosomes and 1 X or Y sex chromosomes. The ova contain 22 autosomes
and 1 X chromosome
Fertilization Changes
Fertilized ovum (zygote) stays in the fallopian tube for 3 days during which time
rapid cell division (Mitosis/Cleavage) is taking place. The developing cells are now
called BLASTOMERE and when there are already 16 BLASTOMERES, it is
termed as MORULA. It is in this morula form that it will start to travel (by ciliary
action and peristaltic contractions of the fallopian tube) to the uterus where it will
stay for another 3-4 days. When a cavity is formed in the morula, it is termed as
BLASTOCYST. Fingerlike projections called trophoblast form around the
blastocyst and this trophoblast are the one’s which implant high on the anterior or
posterior surface of the uterus thus implantation/nidation takes place about a week
after fertilization (6-8 days).
2. Ocassionally, a small amount of vaginal spotting appears with implantation
because capillaries are ruptured by the implanting trophoblast – this should not be
mistaken as the last menstrual period.
2. IMPLANTATION/NIDATION
After fertilization occurs, implantation happens. It is the contact between the
trophoblast and the uterine endothelium.
3 PROCESSES THAT OCCUR IN IMPLANTATION
1. Apposition
2. Adhesion
3. Invasion
General Considerations:
1. Once implantation has taken place, endometrium is called Decidua
Divisions of the Decidua:
a. deciduas basalis
b. deciduas capsularies
c. deciduas vera/parietalis
Trophoblast Differentiation: At about three weeks, the trophoblast cells
differentiate into two distinct layers:
1. Cytotrophoblast/Langhan’s Layer
-inner layer which is present as early as 12 days gestation and appears to be
functional early in pregnancy but then disappears between the 20th and 24th week.
2. Syncytiotrophoblast/Syncitial Layer -outer layer containing fingerlike
projections called chorionic villi which gives rise to fetal membranes that arise from
the zygote
a. chorion - outer membrane, together with deciduas basalis gives rise to placenta
which starts to form at 8th weeks gestational age
b. amnion - inner layer which gives rise to:
• umbilical cord/funis
o the lifeline that links the embryo/fetus and the placenta
o contains 2 umbilical arteries that returns deoxygenated blood to the placenta and 1
umbilical vein that carries oxygenated blood to the fetus
• amniotic fluid/bag of water (BOW)
o begins to form at 11-15th weeks gestation
o a pale, clear, straw colored albuminous fluid in which the baby floats
o specific gravity = 1.007 to 1.025
o pH is neutral to slightly alkaline =7.0 to 7.25
o near term, is clear, colorless containing little white, peaks of vernix caseosa and
other solid particles
o produced at a rate of 500 ml in 24 hours and fetus swallows it at an equally rapid
rate of 500 ml/24 hours
o by 4th lunar month, urine is added to the amount of amniotic fluid derive chiefly
from maternal serum and fetal urine
Purposes of BOW
1. Protective function
a. shields the fetus against blows or pressures on the mother’s abdomen
b. protects the fetus against sudden changes in temperature since liquid changes
temperature more slowly than air
c. protects the fetus against infections
2. Diagnostic Function
a. Amniocentesis – removal of amniotic fluid to diagnose chromosomal
abnormalities
b. Meconium – stained amniotic fluid in non-breech presentation is a sign of fetal
distress
3. Aids in the descent of the fetus during active labor
3. PLACENTATION -arises out of trophoblastic tissues
-chorion together with deciduas basalis gives rise to the placenta which starts to
form at 8th week gestational age
Placenta - develops into 15-20 lobes or cotyledons/each functioning unit and each
cotyledons are separated by fenestrated septa
Purpose of Placenta:
1. respiratory system (lungs) - exchange of oxygen and carbon dioxide takes place in
the placenta not in the fetal lungs
2. gastrointestinal system - nutrients pass to the fetus via the placenta by means of
diffusion through placental tissues
3. circulatory system - feto-placental circulation takes place by selective osmosis via
the umbilical arteries and umbilical vein
4. renal system - waste products are excreted through the placenta. It is the mother’s
liver that detoxifies the waste products of the fetus
5. endocrine system - produces the following hormones:
- HCG – orders the corpus luteum to keep on producing Estrogen and
Progesterone that is why there is amenorrhea during pregnancy. Basis for pregnancy
tests
- Human Placental Lactogen (HPL) human chorionic somatotrophin
– promotes growth of the mammary glands necessary for lactation
- Estrogen
- Progesterone
6. protective - inhibits the passage of bacteria and large molecules to the fetus
LESSON 6. FETAL CIRCULATION
The fetus derives oxygen and excretes carbon dioxide not from oxygen exchange in
the lungs but from the placenta. The blood enters the blood vessels of the lungs not
for oxygen exchange but to supply the cells of the lungs. There are specialized
structures present in the fetus which shunt blood flow:
a. ductus venosus
b. foramen ovale
c. ductus arteriosus
While the baby is still in the uterus, his or her lungs are not being used. The baby’s
liver is not fully developed. Circulating blood bypasses the lungs and liver by flowing
in different pathways and through special openings called shunts.
In the fetus, oxygenated blood comes through the (1) umbilical vein where it
enters the inferior vena cava via the (2) ductus venosus. The oxygenated blood
streams from the right atrium through the open (3) foramen ovale to the left
atrium and via the left ventricle into the aorta. Venous blood from the superior vena
cava crosses under the main blood stream into the right atrium and then, partly
mixed with oxygenated blood (purple), into the right ventricle and pulmonary artery.
The pulmonary vasculature has a high resistance and so little blood passes to the
lungs; most blood passes through the (4) ductus arteriosus to the descending
aorta. The aortic isthmus is a constriction in the aorta that lies in the aortic arch
before the junction with the ductus arteriosus and limits the flow of oxygen-rich
blood to the descending aorta. Then blood passes through the (5) umbilical artery
and back to placenta.
LESSON 7. MILESTONES FOR FETAL DEVELOPMENT
1. First lunar month
a. Steady increase in overall growth and organ system
b. Germ layers differentiate by the second week
c. Fetal membranes
d. nervous system
e. cardiovascular system
f. digestive system and respiratory tract exist as a single tube
2. Second lunar month
a. all vital organs are formed by the 8th week
b. Placenta developed
c. Sex organs (ovaries/testes) are formed by the 8th week
d. Brain is the largest organ of the body so head is disproportionately large
e. Meconium is formed in the intestines
3. Third lunar month
a. Kidneys are able to function
b. Buds of milk teeth
c. Beginning bone ossification
d. Fetus swallows
e. Feto-placental circulation is established by selective osmosis
4. Fourth lunar month
a. Lanugo appears
b. Buds of permanent teeth form
c. Heart beats maybe audible
5. Fifth lunar month
a. Vernix caseosa appears
b. Lanugo covers entire body
c. Quickening felt
d. Fetal heart beats very audible
6. Sixth lunar month
a. Skin markedly wrinkled
b. Attains proportion of full term baby
7. Seventh lunar month
a. Alveoli begins to form
b. May survive with excellent nursing care
8. Eight lunar month
a. Fetus is viable
b. Lanugo begins to disappear
c. Nails extends to ends of fingers
d. Subcutaneous fat deposition begins
e. Vigorous fetal movement
f. Stores minerals, iron,
9. Ninth lunar month
a. Lanugo and vernix caseosa disappear
b. Face and body have a loose wrinkled appearance
c. Amniotic fluid volume somewhat decreases
10. Tenth lunar month
a. All organs are functioning
b. Bones of skull are ossified
c. Has all the characteristics of a normal newborn