Review of Growth and Development
Theories of Growth and Development
Growth refers to an increase in size; development refers to acquisition of skills. Growth
and development occur simultaneously and interdependently. Maturation is the total
process that involves the unfolding of the child’s potential, regardless of practice. The
two major influences on growth and development are heredity and environment.
Hereditary characteristics are those that are transmitted by genes. All other factors that
affect the unborn child are environmental.
There are five universally recognized basic assumptions about growth and development.
Growth and development:
1. Progress in an orderly manner from simple to complex
2. Are continuous processes
3. Occur at highly individualized rates
4. Affect all body systems and stages
5. Together form a total process
Each individual has a unique behavior known as personality. Different theories of
personality development help the nurse promote individuals’ health and provide health
care. These personality theories describe stages of development. These stages are
generally progressive; that is, it is necessary to complete an earlier stage before moving
on to the next. However, at times, the individual may temporarily regress to an earlier
stage.
Freud described five stages of psychosexual development: oral, anal, phallic, latency, and
genital stages.
Erikson developed a theory of psychosocial development that covers the entire life span.
Certain tasks need to be accomplished in each of the eight stages: trust versus mistrust,
autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority,
identity versus role confusion, intimacy versus isolation, generativity versus stagnation,
and ego integrity versus despair.
Piaget’s theory focuses on cognitive development, which proceeds through four stages:
sensorimotor, preoperational, concrete operational, and formal operational. Maslow
believed that human behavior was motivated by human needs placed on a hierarchy from
the most basic to the most complex. These needs begin with the physiological and
progress to safety, belonging, self-esteem, and self-actualization.
Kohlberg’s theory of moral reasoning identified three levels of moral development:
preconventional, conventional, and postconventional. Moral development progresses
within an orderly sequence. However, one does not attain the highest level of moral
reasoning.
Important Things to Know:
Describe the five common characteristics of growth and development.
Growth and development occur in an orderly pattern from simple to complex; one task
must be accomplished before the next one is attempted. For example, infants must learn
head control before they can learn to sit. Growth and development are continuous
process.
Compare Freud’s psychoanalytic and Erikson’s psychosocial theories of development.
Freud described five stages of psychosexual development: oral, anal, phallic, latency, and
genital stages.
Erikson developed a theory of psychosocial development that covers the entire life span.
Certain tasks need to be accomplished in each of the eight stages: trust versus mistrust,
autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority,
identity versus role confusion, intimacy versus isolation, generativity versus stagnation,
and ego integrity versus despair.
Describe Jean Piaget’s theory of cognitive development.
Piaget’s theory focuses on cognitive development, which proceeds through four stages:
sensorimotor, preoperational, concrete operational, and formal operational.
Describe Kolberg’s theory of moral development.
Kohlberg’s theory of moral reasoning identified three levels of moral development:
preconventional, conventional, and postconventional. Moral development progresses
along an orderly sequence. However, one does not attain the highest level of moral
reasoning.
Describe Maslow’s theory of human needs.
Maslow believed that human behavior was motivated by human needs placed on a
hierarchy from the most basic to the most complex. These needs begin with the
physiological and progress to safety, belonging, self-esteem, and self-actualization,
characterized by spurts of growth and periods of slow steady growth. For example,
infancy is a period of very rapid growth; after infancy, the rate of growth slows down
until adolescence. Growth and development progress at highly individualized rates that
vary from child to child. Individuals have their own growth timetable, and one child’s
pattern of growth should not be compared to another’s. Growth and development affect
all body systems but at different time periods for specific structures. Although many
organs mature and develop throughout childhood, the reproductive organs mature at
puberty. Growth and development form a total process that affects the person physically,
mentally, and socially.
Name the two major influences on an individual’s growth and development.
Genetics and environment are the two major influences on growth and development.
Birth to One Year
Inherited characteristics are determined at the time of conception. Any substance that can
adversely affect the developing child is called a teratogen. The period from fertilization
to birth is called the prenatal period. Immediately following fertilization, the new
structure is called a zygote. It is termed a blastocyst at the time of implantation. The
developing structure is referred to as an embryo for the first few weeks and a fetus
thereafter. Labor begins about 280 days after conception. There are three distinct stages
of labor: dilation; expulsion, or the birth of the baby; and delivery of the placenta. The
length of each of these stages varies with the individual. Immediately after the delivery
of the infant, the umbilical cord is clamped. This action ends fetal circulation and marks
the infant’s first breath. The Apgar score is the first assessment of the newborn done at 1
and 5 minutes after birth. The Apgar score indicates the general neurological status of the
newborn and assesses infant color, reflex irritability, heart rate, respiratory rate, and
muscle tone. The head is large in comparison to the rest of the body. The skull bones are
soft to permit passage of the head through the birth canal. The anterior fontanel should
close by 12 to 18 months, whereas the posterior fontanel closes by the 4th month.
Average birth weight is 7.5 lb. The average length for the newborn is 20 in. Boys tend to
be slightly larger than girls. The newborn’s skin is thin and delicate and varies in
pigmentation. Common characteristics and skin conditions include the following: vernix
caseosa, milia, lanugo, Mongolian spots, and physiological jaundice. The newborn has
the ability to swallow, digest, metabolize, and absorb nutrients. The first stool is passed
within 10 hours after birth and is called meconium.
Primitive reflexes that are evident in the normal newborn include protective reflexes such
as swallowing, gagging, sneezing, blinking, rooting, Moro, grasp, Babinski, and tonic
neck. The normal ranges for neonate vital signs are as follows: axillary temperature,
97.7° to 99.5° F (36.5° to 37.5° C); pulse, 120 to 140 beats per minute; blood pressure,
65/40 mm Hg (Dinamap); and respirations, 30 to 60 beats per minute. Gross motor skills
involve the large muscles of the extremities.
Growth and development follow an orderly pattern progressing downward from the head
to the feet. This pattern is known as cephalocaudal.
Fine motor control refers to the use of the hands and fingers. This follows the
proximodistal directional pattern where shoulder movements are mastered before hand
and finger movements.
Erik Erikson believed that at the time of birth the infant must master the critical task of
trust to foster psychosocial development. Cognitive development is evidenced by the
cause-and-effect method the infant uses to respond to its new environment. Infants begin
to communicate with their caregivers soon after birth by smiling and babbling. By
mimicking words, infants begin to build a vocabulary. By the time babies are 1 year old,
their vocabularies should consist of four to six words.
The newborn’s nutritional needs can be met by either breast milk or formula. Generally,
solids are not offered before the first 5 months to prevent food allergies or food
intolerance. In adding new foods to an infant’s diet, it is best to add one new food at a
time over the course of several days. The typical newborn sleep pattern includes periods
of light sleep marked by stirring movements and noises. Newborns typically sleep 20 out
of 24 hours. SIDS, or crib death, has been associated with infant sleep patterns. This
condition occurs most frequently in the first 5 months of life. To decrease the risk of
SIDS, it is recommended that healthy infants be put to sleep on their backs and sides, not
on their stomachs.
Play activities help infants explore and learn about their environments. Play during
infancy is solitary. Infants need brightly colored toys, free of small parts that could be
accidentally ingested or aspirated. Most injuries and deaths at this stage of development
occur from preventable accidents. Supervision can help to decrease accidents and ensure
safety.
Health promotion is aimed at helping infants achieve optimal growth and development.
This can be accomplished through good health practices and regular medical checkups.
Important Things to Know:
List three factors that promote a healthy pregnancy.
Quality of the women’s diet, a balance of rest and exercise, and good health practices and
proper health supervision all help to promote a healthy pregnancy.
Name four factors that may have an adverse affect on pregnancy.
Tobacco, alcohol, many drugs, and viruses are a few of the teratogens that adversely
affect the unborn.
Describe the steps in prenatal development from fertilization to implantation.
Following fertilization, the zygote undergoes a series of cellular divisions and forms a
cell mass known as a morula. The morula continues to divide and change as it travels
down the fallopian tube to the uterus, where it implants itself in the uterine wall. At the
point of implantation, the entity is called a blastocyst. The total process, from fertilization
to implantation, takes about 7 days. After implantation, the multi-celled structure, which
is referred to as an embryo, continues to develop. By the end of the 8th week of
development, all essential structures are formed, and the embryo is now termed a fetus.
Describe physical development for infants from 1 to 2 months.
The head is large in comparison to the rest of the body. The skull bones are soft to permit
passage of the head through the birth canal. The anterior fontanel should close by 12 to
18 months, whereas the posterior fontanel closes by the 4th month. Average birth weight
is 7.5 lb. The average length for the newborn is 20 in. Boys tend to be slightly larger than
girls. The newborn’s skin is thin and delicate and varies in pigmentation.
Describe skin manifestations such as vernix caseosa, lanugo, Mongolian spots, milia,
and acrocyanosis.
Vernix caseosa is a white cheese-like covering that protects the infant’s skin. Lanugo
refers to fine hair covering the body. Mongolian spots are flat, irregular, pigmented areas
sometimes found in the lumbosacral region. Milia refers to small clusters of pearly white
spots found mostly on the infant’s nose, chin, and forehead. Acrocyanosis refers to a blue
color of the newborn’s hands and feet.
List five reflexes present at birth.
The presence of certain reflexes indicates a normal neurological system and also helps
approximate gestational age. Several reflexes are protective. These include
blinking, sneezing, swallowing, and gagging. Other reflexes present include Moro or
startle, rooting, grasp, Babinski, and tonic neck. Rooting and sucking help the infant
secure food.
Name the normal ranges for vital signs for the newborn.
The normal ranges for neonate vital signs are as follows: axillary temperature, 97.7° to
99.5° F (36.5° to 37.5° C); pulse 120 to 140 beats per minute; blood pressure, 65/40 mm
Hg (Dinamap); and respirations, 30 to 60 beats per minute
Compare the patterns of fine and gross motor acquisition.
Gross motor skills involve the large muscles of the extremities. Growth and development
follow an orderly pattern progressing downward from the head to the feet. This pattern is
known as cephalocaudal. Fine motor control refers to the use of the hands and fingers.
This follows the proximodistal directional pattern, in which shoulder movements are
mastered before hand and finger movements.
Give an example of cognitive development for this stage.
Cognitive development is evidenced by the cause-and-effect method the infant uses to
respond to its new environment.
State the process of language acquisition during infancy.
Infants begin to communicate with their caregivers soon after birth by smiling and
babbling. By mimicking words, infants begin to build a vocabulary. By the time babies
are 1 year old, their vocabularies should consist of four to six words.
Describe the nutritional needs of developing infants.
The newborn’s nutritional needs can be met by either breast milk or formula. Generally,
solids are not offered before the first 5 months to prevent food allergies or food
intolerance. In adding new foods to an infant’s diet, it is best to add one new food at a
time over the course of several days.
Describe the advantages and disadvantages of breast-feeding and bottle-feeding.
The advantages of breast-feeding are that immune factors are transferred from the mother
to the baby, it promotes infant mother bonding, it hastens uterine involution, it is lower in
saturated fat and easier to digest, and it decreases the incidence of allergies. It is also less
expensive and requires less time in preparation.
Bottle-feeding requires more preparation, it is more costly, it is higher in saturated fat,
and it is not as easily digested. Bottle-feeding, however, does free up a mother’s time,
allows a father to feed and bond, and means that the mother’s diet will not affect the
baby’s diet.
Distinguish between the stools of breast-fed and formula-fed infants.
Breast-fed infants have stools that resemble light, seeded mustard. Stools of formula-fed
infants are commonly semisolid and tan or yellow in color.
State the normal sleep patterns for the neonate.
The typical newborn sleep pattern includes periods of light sleep marked by stirring
movements and noises. Newborns typically sleep 20 out of 24 hours.
List three interventions used to promote infant safety.
Supervision can help to decrease accidents and ensure safety. Proper use of car seats and
safety restraints helps prevent injuries.
Name the immunization schedule for the newborn.
Within 2 months of birth, hepatitis B; diphtheria, tetanus, pertussis; influenzae type B;
inactivated polio; and pneumonococcal vaccines are given.
List two concerns for health promotion during the infancy period.
Health promotion can be accomplished through good health practices and regular medical
checkups.
Toddlers
Toddlerhood refers to the period of development from 12 months to 3 years of age.
Growth rates slow down compared to the rate of growth during infancy. Growth during
this period results in the body appearing more proportionate, with a taller, more slender
look. Bone development continues with a gradual hardening, or ossification. By 2-1/2
years of age, toddlers usually have a complete set of deciduous teeth (20). Children at this
age must visit the dentist for dental examinations and treatments to help ensure healthy
teeth later in life.
Gradually, visual acuity will improve and can be enhanced with use of large objects held
at close range. Hearing is fully developed and should be tested during periodic
examinations. Heart rate, respiratory rate, and blood pressure readings will slow down
during the toddler period. Gross and fine motor skills are developing further. By the end
of toddlerhood, the child will gain skills related to walking, eating, toileting, dressing,
and communicating independently.
Development of gross motor skills depends on growth and maturation of muscles, bones,
and nerves. Teaching new skills is of little value until a state of readiness is reached.
Fine motor skills achieved during this stage relate to self feeding, dressing, and playing.
By end of this stage, children should be actively participating in dressing, washing, and
brushing teeth. Toilet training can be successful once the child has achieved a degree of
maturity in sphincter muscles, nerves, and language development. Autonomy
(independence) is a primary psychosocial task of toddlers. It encourages toddlers to
make decisions, especially in their activities of daily living.
Two-year-olds need guidance and discipline. Caregivers should be consistent and
repeatedly reinforce limitations. Limit setting should not deny children freedom but give
them greater opportunity to explore. Piaget suggested that toddlers interpret new
experiences based on memories of previous happenings. This is referred to as
preoperational thought.
Moral development occurs as children imitate their parent’s moral behavior and
teachings.
Language acquisition develops along with memory and cognition. Young toddlers use
one-word sentences. Three-year olds have a vocabulary of approximately 3000 words and
use multiple words is a sentence.
Toddlers need a well balanced diet and good eating habits to support muscle and bone
growth. Portion sizes vary greatly depending on individual toddlers’ activity levels. Likes
and dislikes are influenced by other family members’ dietary habits. Most frequently
accepted foods are those that the child can eat as he or she moves about.
Sleep needs decrease during this stage of development. However, short naps are still
needed by most children at this stage. Bedtime rituals are common and help reduce
anxiety and give the child a sense of security. Nightmares should be handled in a
consistent, comforting manner.
Play is the major means by which the child continues to explore and understand his or her
world. Toddlers usually prefer parallel play. Imaginary play or playmates are common
and normal at this stage. Natural curiosity and the child’s lack of the ability to recognize
danger make accident prevention of utmost importance at this stage. For this reason,
toddlers require continuous supervision in all of their activities. Regular physical
examinations should be scheduled for toddlers. These visits should be at 18, 24, and 36
months. Dental exams are scheduled when the children have their complete set of
deciduous teeth.
Important Things to Know:
Describe the main physical characteristics common to toddlers.
The toddler’s body appearance is more proportionate than it was at earlier stages. At 21/2 years of age, toddlers can be expected to have their complete set of deciduous teeth.
Bone development continues with hardening of the bones.
Name three developmental skills that the toddler can master independently.
Toddlers master fine motor skills relating to playing, walking, toileting, and dressing.
Describe the psychosocial task of the toddler as outlined by Erikson.
According to Erikson, autonomy, or independence, is the primary psychosocial task to be
accomplished by the toddler.
List one method of discipline useful in resolving conflicts during this stage.
Consistency and limit setting are important disciplinary approaches.
Describe the stage of cognitive development for the toddler as presented by Piaget.
Piaget suggested that toddlers interpret new experiences based on memories of previous
happenings. This is referred to as preoperational thought.
List two factors that help toddlers develop language skills.
Encouraging speech and reading to toddlers help them build language skills.
List three feeding recommendations for parents of toddlers.
Give food choices, ignore refusals, and remember that toddlers like consistency.
Describe the type of play typical of toddlers.
Toddler play style is called parallel play. This means that toddlers enjoy having other
toddlers nearby while playing by themselves. However, they do not interact or share.
Name five common safety hazards for this period of development.
Car safety, playing near roads, poisonings, burns, choking and suffocation are common
safety hazards.
Preschool
The rate of growth for the preschool period is best described as slow and steady. Children
grow 2-1/2 inches per year. The average weight gain is 5 to 7 lb a year. The trunk and
body lengthen, giving the child a taller appearance and more erect posture. Care of teeth
during the preschool stage is important to promote healthy teeth in future stages. Visual
acuity improves, and hearing will mature during this stage. Structural makeup of the
child’s ear continues to account for the increased incidence of middle ear infections seen
in this age group as compared to older children. Normal pulse rate is between 90 and 100
per minute and blood pressure is about 100/60 mm Hg. The normal respiratory rate is 22
to 25 per minute at rest. The focus during preschool is on improving motor skills and
vocabulary, and increasing knowledge about the environment. Four-year-olds are capable
of walking and running on their tiptoes, hopping, and balancing on one foot. Preschoolers
can pedal a tricycle and like to climb and jump. By age 5 they can skip, walk on a
balance beam, and catch a ball. Improved fine motor development permits 4-yearold
children to perform self-care.
Preschoolers find pleasure in examining and exploring their bodies. They are now very
curious about the differences between male and female bodies. Masturbation is a
common activity for both sexes during this stage. Parents should respond in a matter-offact manner so as not to instill guilty feelings in their child.
The psychosocial task of the preschool period is the development of initiative. Preschool
children need discipline to learn impulse control. A preschool should be selected based
on the school’s philosophy, location, and cost. Jealousy is a normal pattern of behavior
seen at various stages of development.
Divorce is one of the common stresses that affect children. Preschool children often
blame themselves and have a strong wish to reunite their parents.
Cognitive development is at the preoperational stage. At this stage, the child continues to
develop language and memory. The thinking style of the preschool stage is often
described as magical, giving the child the feeling that he or she is all powerful. Preschool
children are developing their consciences and have the beginning capacity for moral
reasoning. Children learn moral reasoning by imitating parents and other adults. It is,
therefore, important that adult role models use appropriate words and set good examples
for children to follow. Communication is more sophisticated during this period
of development. Children at this stage are very talkative, and they can be taught their full
names and addresses and how to respond to emergencies.
The average caloric need for this age is 1800 calories divided over the course of the day.
By age 5, many children have developed food habits similar to those of their peers. The
diet for this age group should include food sources containing proteins, carbohydrates,
vitamins, minerals, and limited fats.
Children at this stage are very active and require an average of 10 to 12 hours of sleep
each night. All preschool children need consistency in their night rituals. Nightmares and
night terrors are common occurrences during this stage of development. Preschool play
style is known as cooperative, or associative, play. Children at this stage are able to share,
take turns, and follow simple rules. Toys should be selected to help stimulate fine and
gross motor development. Just as growth patterns vary with each child, so do motor
skills. Innate abilities vary among children, making some children more coordinated than
others. Safety continues to be a major concern for preschool children. They still need
constant reminders about potential environmental hazards and adult supervision.
During the preschool stage, children need to be given booster vaccinations for DTP and
TOPV to help ensure immunity and protection against these diseases. Children at this
stage need yearly preventative health-care visits and screening to supervise their physical,
emotional, and social development. Thumb sucking is thought to be a primitive and
instinctive behavior. If this becomes a prolonged habit, it may cause malalignment of the
child’s teeth. Bedwetting, also known as enuresis, is a problem seen more often in boys
than in girls. Stress and illness in the child seem to make it worse.
Important Things to Know:
Describe the physical changes that commonly occur during the preschool years.
The rate of growth for the preschool period is best described as slow and steady. Children
grow 2-1/2 inches per year. The average weight gain is 5 to 7 lb a year. The trunk and
body lengthen, giving the child a taller appearance and more erect posture.
List two gross motor skills characteristic of preschoolers.
Four-year-olds are capable of walking and running on their tiptoes, hopping, and
balancing on one foot. Preschoolers can pedal a tricycle and like to climb and jump. By
age 5 they can skip, walk on a balance beam, and catch a ball.
Describe the psychosocial task of the preschooler as outlined by Erikson.
The psychosocial task of the preschooler is the development of initiative.
List the important guidelines useful in assessing a nursery school program.
Parents should select a preschool for their child after considering the school’s philosophy,
location, cost, and attention to safety of children.
Describe the stage of cognitive development for the preschool child as presented by
Piaget.
Cognitive development is at the preoperational stage. At this stage, the child continues to
develop language and memory. The thinking style of the preschool stage is often
described as magical, giving the child the feeling that he or she is all-powerful.
List three appropriate snack foods for preschool children.
Foods appropriate for snacking are those that can be eaten on the move. Foods to avoid
are those that are more likely to cause choking and aspiration such as popcorn, peanuts,
and hard candies. Caregivers should select foods for snacks that are good sources of
protein, minerals, and vitamins, including raisins, cheese bites, and cut-up vegetables.
Describe the type of play characteristic of the preschool years.
Preschool play style is known as cooperative or associative play. Children at this stage
are able to share, take turns, and follow simple rules.
List the safety concerns important to the preschool stage of development.
All of the earlier safety concerns still exist for the preschooler. Play activities must be
supervised at home and on the playground. Toys must be safe and age appropriate. Water
safety programs are important for this age group.
Name two common behavioral concerns affecting preschoolers.
Thumb sucking and bedwetting are two behaviors that affect children at this stage of
development.
School Age
The period of development known as school-age, middle years, or late childhood is
characterized by slow, consistent growth. This stage begins with the entrance into formal
school and ends with the onset of puberty.
Five important accomplishments occur during this stage including:
1. Growth becomes slow and steady.
2. Children move away from the family towards peer relationships.
3. Children become less self-centered and more goal directed.
4. Deciduous teeth are replaced by permanent teeth.
5. Sexual tranquility replaces sexual curiosity and preoccupation.
An important hallmark of this stage is the loss of deciduous teeth and the appearance of
the permanent teeth. The appearance of permanent teeth follows the same pattern as the
eruption of deciduous teeth. Initially school-age children experience an increased number
of respiratory infections related to their increased exposure to other children. Once the
immune system matures, this will become a relatively healthy period of development.
Heart rate and respiratory rate slows, whereas blood pressure readings increase. Changes
in the nervous system permit expanded cognitive processes. There will be marked
improvement in existing gross and fine motor skills, permitting children more
independence. This stage is sometimes called latency because sexual energies are
dormant. Because their peer relationships are mainly of the same sex, this stage is thought
of as a period of normal homosexuality.
According to Erikson the task for this stage of development is industry. Children are now
capable of focusing on reality, and they gain satisfaction from their accomplishments.
Friendships are very important and are the cornerstone of the school-age child’s social
world. During this stage, children are able to develop reciprocal relationships with their
peers. It is common for them to establish intimacy with their friends and share their
feelings and possessions.
Discipline teaches children boundaries and helps to set limits on their behavior. Too
much discipline may lead to acting-out behaviors, whereas not enough discipline may
lead to insecurity and doubt. Television violence may adversely affect many school-age
children. Parents should therefore supervise their children’s choice of
programming. About one-fourth of school-age children spend time home alone while
their parents are at work. These “latchkey” children need special guidelines to follow
while they are alone.
Piaget describes the beginning of this stage as the preconventional level of cognitive
development. By the end of this phase, school-age children have acquired concrete
operational thought, permitting organized thinking and the ability to understand and
follow rules. School becomes a major focus of the child’s environment. Unlike the
experience in preschool where the focus was on protection, play, and nurturing, the
emphasis at this time is on education and learning.
According to Kohlberg, school-age children are at the preconventional level of maturity.
Reciprocity is the concern for others that school-age children develop. Trust and loyalty
is demanded from friends. The child’s moral code is based on the teachings and actions
of the parents.
Language improves, enabling them to communicate more effectively with others. School
places emphasis on the development of vocabulary, grammar, pronunciation, and
sentence structure.
The nutritional requirements during this stage are those nutrients necessary for growth of
the musculoskeletal system. Food preferences result from cultural, family, and
peer influences. Breakfast is the most important meal of the child’s day. It should not be
skipped and should supply one-fourth to one-third of the daily nutritional needs.
The average 6-year-old needs about 12 hours of sleep, whereas 11-year-olds need 10
hours of sleep each night. Inadequate sleep can produce irritability and interfere with the
child’s academic and social relationships. School-age children perform play and most
self-care activities independently. School-age children learn to write, draw, and dance,
and they develop many other creative hobbies. In the home children are able to take
responsibility for their possessions, and they like to earn money for small jobs.
The style of play for this stage of development is referred to as team play. It at this time
that children are able to learn to follow rules and regulations. Most of the play at this age
occurs in groups of children of the same sex and is competitive in nature.
The leading cause of accidental deaths continues to be motor vehicle accidents. Children
should be expected to use seat belts whenever they are passengers. Other causes of
increased injuries are related to the school-age child’s natural tendency to try new skills
without help, supervision, or training.
Children of this age need adequate exercise to help develop muscle strength and
endurance. School-age children should be screened for abnormal curvature of the spine
known as scoliosis. They will need to receive their booster vaccinations to maintain their
immunity. The school-age period is considered to be a relatively healthy period of
development. As their organs continue to mature, they are better able to resist infections,
and they tend to recover more rapidly.
Important Things to Know:
List four physical characteristics common to school-age children.
Generally there is an increase in muscle mass and strength. Marked improvement is seen
in both fine and gross motor skills. Permanent teeth begin to erupt, replacing the
deciduous set. Visual maturity continues along with better hand-eye coordination.
Describe three developmental milestones common to school age children.
School-age children move away from their families towards peer relationships. They
become less self-centered and more goal directed. Sexual tranquility replaces sexual
curiosity and preoccupation.
Describe the psychosocial task identified by Erikson for the school-age period.
According to Erikson, the task for this stage of development is known as industry.
Children are now capable of focusing on reality, and they gain satisfaction from their
accomplishments.
Describe the cognitive levels of functioning during the school-age period.
Piaget described the beginning of this stage as the preoperational level of cognitive
development. By the end of this phase, school-age children have acquired
concrete operational thought, permitting organized thinking and the ability to understand
and follow rules.
Describe moral development in school-age children.
According to Kohlberg, school-age children are at the preconventional level of maturity.
Reciprocity is the concern for others. They learn to trust and expect loyalty from their
friends.
List three factors that help contribute to the health of school age children.
Good nutrition, adequate sleep and rest, and proper health supervision all contribute to
the overall health of the school age child.
Puberty and adolescence
Puberty or preadolescence is a period of rapid growth ending with reproductive maturity.
In the female, puberty ends with menarche. In the male, puberty ends with the production
of sperm. The major changes associated with puberty include rapid physical growth,
change in body proportion, and development of primary and secondary sex
characteristics.
Primary sex characteristics affect the growth and maturation of the gonads or sex glands.
The male gonads are the testes that, when mature, produce sperm and male sex hormone.
The release of sperm, known as ejaculation, indicates functional maturity. In the female,
the gonads are the ovaries. The production of ova and female hormones signals their
maturity. Menarche is the first menstrual period. This will occur monthly from puberty
until menopause.
Secondary sex characteristics refer to all the changes that have no direct role in
reproduction. These changes include hair growth, increased activity of the sweat glands,
voice changes, and widening of the female hips and pelvis. Youth of this age tend to
spend more time by themselves and move away from earlier friendships. In many
settings, teens are argumentative, causing their family relationships to change.
Adolescence is a transitional period that begins with sexually maturity and ends with
physical maturity. This stage bridges the gap between dependence and independence,
childhood and adulthood. Dating begins around 15 to 16 years of age. Dating helps
establish a means of social status, recognition, and recreation within the peer group. Sex
is given high priority at this time.
Teens usually experience a great deal of pressure to conform to their peer group’s
standards. Many teens engage in sexual intercourse during the adolescent period. Sex
education must be provided in the home and further reinforced in school. Masturbation is
considered to be a regular part of sexual expression. Sex education needs to be provided
early before the teenage period of development. During the teenage years, adolescents
will continue to need advice about prevention of sexually transmitted diseases,
pregnancy, and sex education.
The major characteristics of adolescence include stormy emotions, feelings of insecurity,
an introspective nature, interest in experimentation and learning, and testing of values and
beliefs. According to Erikson, the psychosocial task for this stage is the search for
identity. Identity begins with the separation of the individual from the family. The
movement away from the family expresses the teen’s need for freedom and
independence. Adolescents are ambivalent about many issues including loving and hating
their families, wanting freedom and needing supervision, and wanting to be a part of a
group and wishing to be alone. Some of the commonly expressed emotions are anger,
fear, worry, jealousy, envy, and happiness. Peer relationships are very important at this
stage. Peers share with one another the same age, feelings, experiences, goals, and
doubts, which they do not share with parents. Teens form cliques, groups, and gangs.
They have a strong need to be accepted by the members of these groups. Group
acceptance makes them feel happy and confident, whereas non-acceptance causes
feelings of alienation and resentment. Society places many demand on teenagers. Teens
are expected to select vocations and think about their futures. Maturation of the central
nervous system causes a shift from concrete thinking to formal operational thought
processes. This thinking style is more logical. Teens can think abstractly and can reason
scientifically. School is at the center of activity for the teenager. Success in school largely
depends on socioeconomic background, family relationships, peer influences, and social
pressures. Moral judgment is based on the learned principles of right and wrong.
Adolescents also develop spiritual awareness. They question and philosophize and
compare religions. Discipline during adolescence is very important. Many of the conflicts
between parents and teen are based on choices of friends and issues of dating. The rapid
growth that occurs during adolescence calls for an increase in their nutritional
requirements. Eating habits change during adolescence: meats and potatoes are favored
over fruits and vegetables. Snacks are chosen for their accessibility and taste.
In early adolescence, teens have an increased need for additional sleep. About 8 hours of
sleep is needed for the teen to be fully rested. Staying up late causes teens to be tired and
irritable in the morning. Lack of enough sleep appears to relate to poor school
performance. Exercise is important to help maintain the teen’s state of health. The
leading cause of death during adolescence is related to accidents. A teen’s general state of
health is reflective of his or her habits and nutritional practices. Teens require yearly
medical checkups. Proper nutrition and other healthy practices will help contribute to an
overall healthy lifestyle.
The incidence of depression is higher than at earlier stages of development. This may be
related to the increased stress and demands experienced at this stage. Any indication of
prolonged sadness or depressed mood must be carefully assessed and monitored. Suicide
prevention is an important safety measure to be familiar with when dealing with
teenagers. Experimentation with alcohol, drugs, and tobacco is common during this stage
of development. Teens often engage in these unhealthy practices to gain acceptance from
their peers.
Important Things to Know:
List four physical changes that occur during puberty.
A growth spurt occurs in this period of development. Change in body proportion,
development of primary sex characteristics, and the development of the secondary sex
characteristics also occur.
List four physical characteristics of adolescence.
There is an increase in height and weight. The hips and shoulders broaden. Muscle
strength and endurance increase. The weight and volume of the lungs increase. The
stomach and intestines increase in size and capacity.
Describe three developmental milestones seen during the adolescent period.
Motor development improves, increasing hand-eye coordination. Same sex friendships
are formed. Sexual maturity is attained.
Describe the primary psychosocial task of adolescence as identified by Erikson.
Adolescents are searching for their identities and moving away from families. This can
lead to feelings of ambivalence.
Describe the cognitive level of functioning during the teenage period of development.
There is a shift from concrete thinking to formal operational thought processes. They are
able to attain scientific reasoning.
State how teens develop moral reasoning.
Moral judgments are based on the earlier learned principles of right and wrong.
List four factors that help to promote wellness in teens.
Diet, healthy habits, yearly medical checkups, and avoidance of substance abuse help
promote wellness in teenagers.
Describe three special concerns that may adversely affect the adolescent’s health.
Alcohol, drug, and tobacco usage can adversely affect the adolescent’s health and wellbeing.
Young Adulthood
Early adulthood covers the ages from the 20s through the early 40s. This is generally
described as a stable period of growth. Physical growth is completed in adulthood. Most
individuals have reached peak efficiency during the early portion of this stage. Muscle
strength and coordination peaks in the 20s and 30s with a slow decline between ages 30
and 60. Gingivitis affects many adults and is considered preventable. Wisdom teeth make
their appearance in early adulthood. Early changes may be noticed in sensation and
perception. After age 40, there may be a decreased ability to see objects at close
distance. This condition is known as presbyopia and is treated with corrective lens. The
adult may detect some loss of high-frequency hearing.
The reproductive organs are functioning at peak efficiency during this stage. In the
female the menstrual cycle is usually well established. Those females with irregular
cycles or with menstrual discomfort should seek medical advice. Generally the male is
free of any reproductive problems during this stage. If infertility arises, the couple should
be referred to their physician for testing and guidance. Cardiac changes include a gradual
decline in cardiac output and a loss of elasticity in the muscle and vessels. These changes
may contribute to an increase in blood pressure. Peak respiratory function occurs during
the 20s.
The major developmental milestones for this age group include choosing and establishing
a career, fulfilling sexual needs, establishing a home and family, expanding social circles,
and developing maturity. Erikson viewed the psychosocial task for the adult as that of
intimacy. He described a broader meaning of intimacy as that with a lover, parent, child,
or friend. Formal operational cognitive functioning will further develop during the adult
period. Adults are capable of being objective and of looking at issues from a wider
perspective. Adults are at the postconventional stage of moral development. Similar to
other developmental issues, moral development progresses at a highly individualized rate.
Diet is crucial to health. Caloric intake is based on an adult’s age, body size, amount of
physical activity, and gender. Males generally need between 1600 and 1800 calories per
day, whereas females need 1200 to 1450 calories per day. On average, an adult needs 7 to
9 hours of sleep each night. Many factors may contribute to problems of insomnia
including stress, diet, over fatigue, and poor health. Physical fitness can improve at any
age with regular participation in exercise. Accident prevention continues throughout the
adult years. Improper use or care of the sensory organs can lead to disease or injury.
Protection of injury during sports includes training and using protective clothing. Safety
concerns continue in the adult period. Adults’ concerns about safety widen to include
concerns for not only themselves but for their children and family members.
Yearly visits to the physician’s office are generally recommended for adults. Cancer
prevention is very important during adulthood. Many cancers are preventable by avoiding
carcinogens in the environment and by practicing healthy living. Excessive exposure to
ultraviolet rays, especially by light-skinned persons, may cause cancer of the skin. Proper
prevention includes using sun blocks and wearing protective clothing when outdoors.
Weight management is very important to an adult’s overall health picture. Obesity can
lead to the development of many disorders such as diabetes, heart disease, and stroke.
The best approach to weight control is through education, leading to a change in behavior
that lasts a lifetime. Stress management can help persons handle stress more effectively
through learning how to manage time, say no, and deal directly with stress.
Important Things to Know:
List four goals for the early adult period of development.
The major developmental milestones for this age group include choosing and establishing
a career, fulfilling sexual needs, establishing a home and family, expanding social circles,
and developing maturity.
Describe three physiological changes that occur during early adulthood.
Physical growth is completed in adulthood. Most individuals reach peak efficiency during
this stage. Muscle strength and coordination peaks in the 20s and 30s.
Describe the psychosocial task as identified by Erikson for the early adulthood period.
Erikson viewed the psychosocial task for the adult as intimacy. He described a broader
meaning of intimacies as those with a lover, parent, child, or friend.
Name three nutritional concerns for young adults.
Three nutritional concerns for young adults include limiting the use of fats and
cholesterol, including complex carbohydrates in the diet, and making the diet rich in
sources of fiber.
Describe two health-screening tests important for women in the early adult period of
development.
Pap tests to help detect cervical cancer and breast self examinations are two important
screening tests for the early adult years.
Middle Adulthood
Middle adulthood, or middle age, covers the mid 40s through the early 60s. Today many
women entering the workforce delay marriage and childbearing to enhance their career
efforts. Middle age is a natural consequence of development and a time of growth and
progression rather than decline and regression.
During this stage, adults reach their peak performances and maturity levels.
Most physiological changes appear gradually and at different times for different
persons. There is loss of muscle tone and elasticity in the connective tissues and weight
gain. Bones lose mass because of demineralization. This causes the bones to become
porous and brittle. Periodontal disease is common and can be prevented with proper
mouth care and maintenance. The skin loses elasticity and becomes wrinkled. Hair
growth slows, and thinning and graying of the hair occurs. The eyes lose accommodation
and their ability to focus on near objects. A loss of hearing acuity is noticeable at this
stage.
Several goals have been identified for this stage including establishing and adjusting to
new family roles, securing economic stability for the present and future, maintaining a
positive self-image, and evaluating or redesigning career options. The major role changes
that middle-aged adults experience include focusing on themselves as a couple, the
empty-nest syndrome, grand parenting or new parenting, and parenting the parent. Adults
hope to establish economic security and reach peak job status during middle age.
Menopause indicates the cessation of menses and loss of reproductive ability. Menopause
usually begins between the ages of 45 and 55 years. There is no significant physiological
change of life for males. Men remain capable of producing sperm well into their 80s. The
main change that men experience relates to their thinking patterns and self-images.
According to Erikson, the task of middle age is called generativity. This means that
individuals will demonstrate concern and interest in their communities. Non-achievement
of generativity results in self-absorption and stagnation. Mental ability and memory
remain at peak levels. This is a time when adults look into themselves and reassess their
values and beliefs. Middle-aged adults have a clear understanding of what constitutes
personal needs, moral duties, and society’s demands.
The nutritional needs of the middle-aged adult remain similar to the needs of the young
adult. This age group must pay close attention to diet, exercise, and healthy lifestyles.
Middle-aged adults require less sleep than they did at earlier stages. Some adults
experience difficulty falling or staying asleep. Leisure time activities vary and are
important in preparing the person for retirement. Heart disease and cancer continue to be
the leading causes of death for this age group. Thorough physical examination and health
screening must be performed yearly to help detect and treat any existing medical
problems.
Important Things to Know:
List three physiological changes that occur during the middle-age period.
Three physiological changes that occur during middle age include loss of muscle tone
and elasticity in the connective tissues, bone loss through demineralization, and weight
gain.
Describe the psychosocial task that Erikson identified for this stage.
According to Erikson, the task of middle age is called generativity. This means that
individuals will demonstrate a concern and interest in their communities.
List three goals unique to this stage of development.
Establishing and adjusting to new family roles, securing economic stability for the
present and future, and maintaining a positive self-image are three goals.
Describe three areas of health concern for the middle-aged adult.
Maintaining good dental care and supervision promotes good dental health. Proper diet
and nutrition focuses on limiting the use of fats and cholesterol- rich foods. Having
yearly cancer screenings helps to prevent disease.
Late Adulthood
Old age is divided into three periods—young old, old, and very old. Young-old age
extends from 65 to 74, old from 75 to 90, and very-old age from 90 on. Those in the oldage category are among the fastest growing population in this country. Life expectancy is
longer for females than males. The single most effective predictor of one’s life
expectancy is one’s biological parents’ ages. No one concept completely explains the
aging process.
Several theories exist and attempt to explain aging. The biological theories include
clockwork, free-radical, wear-and-tear, immune-system-failure, and autoimmune. Several
other psychosocial theories are used to explain how aging affects socialization and life
satisfaction. Examples of these theories include disengagement, activity, and continuitydevelopmental. Many physical changes occur as a part of the normal aging process.
Psychosocial tasks for old age include accepting and adjusting to changing body image;
accepting changes in family roles; adjusting to changes in work, retirement, or leisure;
adjusting to changes in sexuality; and facing the inevitability of death. According to
Erikson, the older individual, having accomplished the first seven developmental tasks,
can now set out to achieve the task of integrity. People who lack integrity develop a sense
of helplessness and despair. Older persons use the process of reminiscing, or life review,
to help give meaning to their lives and reinforce their senses of self-worth. Older
individuals usually retain their cognitive abilities until late in life. Memory shows slight
changes with advancing age. Older persons tend to show greater losses in short-term than
in long-term memory.
Moral beliefs come from a lifetime of experiences and interactions with others. Many
elders find peace and satisfaction through spirituality and religion.
Good nutrition has been shown to prevent late-life diseases and improve a person’s
response to treatment. Older individuals need more rest and less sleep than younger
adults. Rest and sleep help to restore the body’s energy reserve and prevent fatigue.
Exercise has been recognized as a means to help maintain physical fitness across the life
span.
Older persons are more likely to suffer from at least one chronic condition, and many
have multiple conditions. The leading causes of death among elderly persons are heart
disease, cancer, stroke, arteriosclerosis, diabetes, lung disease, and cirrhosis of the liver.
The focus of health promotion and health maintenance is on exercise, diet modification,
and healthy lifestyles. Accidents can be prevented by recognizing the increased risk
factors unique to this age group. Sensory perception changes, gait changes, and
neurological disorders may increase the older person’s risk for falls. Crime and elder
abuse cross all social, cultural, and economic boundaries. Social Security, Medicare, and
Medicaid are programs that provide assistance to older persons. Depression and suicide
in older people may result from their multiple losses, diseases, and medication use.
Important Things to Know:
Describe three demographic changes affecting the older population.
The older population is the fastest growing segment of people in the United States. Life
expectancy for this older population has increased because of improvements in medical
care. One-fifth of the total older population live at poor or near-poor levels.
Contrast the biological and psychosocial theories of aging.
Biological theories attempt to explain the physical changes that accompany aging,
whereas psychosocial theories attempt to explain how aging affects socialization and life
satisfaction.
List four normal physical age-related changes that occur during this stage of
development.
Body fat atrophies, giving the body a bony appearance. Loss of bone cell mass occurs.
Loss of elasticity in the lungs and changes in the thoracic wall occur. There is decreased
peristalsis and increased constipation.
Describe two developmental milestones associated with aging.
Adjustment is made to changing body appearance. There is acceptance of changing
family roles.
Describe Erikson’s psychosocial task for old age.
Ego integrity is the psychosocial task for the older adult. The individual who develops
this usually feels satisfied with his or her life accomplishments.
List three dietary changes important for this stage.
Three important changes for the older person’s diet include a diet of fewer calories,
addition of more fruit and fiber than at earlier stages, and addition of vitamins and
minerals through eating nature foods sources or taking daily supplements.
List two health-promoting activities important for old age.
Maintaining regular exercise is important, and receiving frequent health screening helps
to detect and treat any existing conditions.