Unit - III.pptx

UNIT – III
GROWTH AND
DEVELOPMENT IN
CHILDREN AND
ADOLESCENTS
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing (Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.
1

INTRODUCTION
• Continual change is the essence of life. The rapid changes in size that we
call growth, and the rapid changes in form, function and behaviour that we
call development, are the core of paediatrics.
• Growth is a form of motion. Growth means the increase in the size of the
various parts and organs of the body by multiplication of cells and
intercellular components during the period commencing from fertilization to
physical maturity
• Child development refers to the sequence of physical, language, thought and
emotional changes that occur in a child from birth to the beginning of
adulthood. During this process a child progresses from dependency on their
parents/guardians to increasing independence
2

DEFINITION
• Growth
It is the process of physical maturation resulting an increase in size of the
body and various organs. It occurs by multiplication of cells and an increase
in intracellular substance. It is quantitative changes of the body.
• Development
It is the process of functional and physiological maturation of the
individual or It is progressive increase in skill and capacity to function and
It is related to maturation and myelination of the nervous system which
includes psychological, emotional and social changes. It is a qualitative
aspects. 3

DIFFERENCE BETWEEN GROWTH AND
DEVELOPMENT
4
GROWTH DEVELOPMENT
Growth refers to physiological
changes
Development refers to overall changes in
the individual. It involves changes in an
orderly and coherent type towards the
goal of maturity.
Changes in the quantitative
respect is termed as growth. The
changes produced by growth are
subjects of measurements. They
may be quantified and
observable in nature
Development changes in the quality
along with quantitative aspect and it
brings qualitative changes which are
difficult to measure directly. They are
assessed through keen observation of
behaviour in different situations.
Growth does not continue
throughout life and its stops
after maturation
Development continues throughout life

5
GROWTH DEVELOPMENT
Growth is cellular it occurs due to the
multiplication of cells
Development is organizational which
occur due to both maturation and
interaction with the environment
Growth is one of the part of the
developmental process
Development is a wider and
comprehensive term
Growth may be referred to describe
the changes in particular aspects of the
body and behaviour of the organism
Development describes the changes in
the organism as a whole
Growth is structural and external
process
Development is considered as
functional and an internal process
Growth is influenced by the
development
Development is independent it does not
depend upon growth
Growth changes the physical changes
of a person
On the other hand, development
changes the character of a person.
DIFFERENCE BETWEEN GROWTH AND
DEVELOPMENT

1. Growth and Development proceeds from the head down to the tail or
cephalocaudal direction
2. Growth and Development proceeds from the centre of the body towards
peripheral or Proximodistal direction
3. Growth and development proceed from the general to specific.
4. Growth and development is a continuous process.
5. Development depends on maturation and learning.
6. Development proceeds from the simple (concrete) to the more complex
7. Early Development is more critical than later Development
8. There are individual rates of growth and development.
6

9. Development is sequential.
10. Development is Predictable
11. The child development as a unified whole
12. Each Development takes place in stages
13. Each Developmental stage has certain characteristic trait
14. There are period of accelerated growth and decelerated growth
15. Development is influenced by Heredity and Environment
16. Development proceeds at different rates or different behaviour
7

FACTORS AFFECTING GROWTH AND
DEVELOPMENT
8
Factors
Influencing
Growth and
Development
Heredity or
Genetic
factors
Sex
Race and
Nationality
Environment
Prenatal
Postnatal

9
Maternal
Malnutrition
Maternal Infections
Maternal Substance
Abuse
Maternal
Illness
Hormones
Miscellaneous
DEVELOPMENT
Prenatal Factors

10
DEVELOPMENT
Postnatal Factors
Post natal
Factors
Growth Potential
Nutrition
Childhood illness
Physical Environment
Cultural Influences
Socioeconomic status
Climate and season
Play and Exercise
Birth Order of the child
Intelligence
Hormonal Influence
Learning and reinforcement

STAGES OF GROWTH AND
DEVELOPMENT
3
PRE NATAL
OVUM ( 0 to 14 days of conception)
EMBRYO ( 14 days to 8 Weeks)
FETUS ( 8 Weeks to birth)
POST NATAL
NEONATES ( from birth to 28 days)
INFANCY ( first year of life)
TODDLER ( 1 to 3 year of life)
PRESCHOOLER ( 3 to 5 year of life)
SCHOOL-GOING (6 to12 year of life)
ADOLESCENCE ( 12 to 21 year of life) 11

GROWTH AND
DEVELOPMENT
OF INFANT

The word infant is derived from the Latin word,
‘infans’ which means ‘unable to speak’.
During the infancy stage, babies cannot speak.
Infants can be considered children anywhere
from birth to 1 year old. At this stage, the infant
is still very dependent on its mother, but it can
now breathe independently, and cry when it feels
hungry, cold, hot, or generally uncomfortable.
INTRODUCTION
2

NEEDS OF INFANT
Love and security
Nutrition (Breast feeding and weaning above 6 month babies)
Sensory Stimulation
Need for human Contact
Immunization and Play facilities
Hygienic needs , Growth and development monitoring,
Prevention of infection
Prevention of accidents and safety measures.
14

WEIGHT :
Formula For calculating weight is
Age in months +9
2
1-6 months – 30 gm/day
7-12 months- 15 gm/day
The infant will double his birth weight by 4-5 months and triple it by 10-12
months of age
LENGTH :
<6 months- 2.5 cm/month
7-12 months- 1.5 cm/month
Height at 1 year -75 cm
PHYSICAL OR BIOLOGICAL
DEVELOPMENT OF INFANT
15

HEAD CIRCUMFERENCE :
Increase 1.5 cm per month during first 6 months
0.5 cm in next 6 months
CHEST CIRCUMFERENCE :
Usually 1-2 cm lesser than HC
HC and CC will be equal by 1 year
PULSE :
100- 150 be/mt
RESPIRATION :
35 + or – 10 be/mt
BLOOD PRESSURE :
80/50 + or – 20/10
16

 Posterior fontanel closed at 6 to 8 weeks of age
 Drools between 3 and 4 months of age indicating increased production of
saliva .Unable to swallow it, therefore, it runs from mouth.
 Ultimate color of iris is established at 7 month
17
TEETING :
Age Teeth Development
6 (+ or – 2 ) Month Two lower central incisors erupt
Begins to bite and chew
7(+ or – 2 ) month Upper central incisors erupt
9 (+ or – 2 ) month Upper lateral incisors erupt
12 (+ or – 2 ) month Has 6 to 8 deciduous teeth

Age in Month Gross motor Development
1 month old Turns head when prone, Back completely rounded when sitting, head forward
2 month old Hold chest up when prone
3 month old Head partly lags when child pull to sitting
4 months old Begins to roll front to back, head steady in sitting, Lifts up on elbows
5 months old “Swims” in prone position, Lifts up on hands, No head lag when pulled to sitting
from supine, Roll back to front, sit with pelvic support
7 months old Sits independently, rolls over, rocks on hands and knees, free head lift in prone
position
8 months old Get in to sitting position when supine, Supports weight standing, bounces when
held
9 months old Sits alone well, may crawl, pulls to stand
10 months old Cruises, pivots while seated, walk with two hand support
11 month old Stand alone , walk with one hand support
12 months old Walks without support, stands alone momentarily
GROSS MOTOR DEVELOPMENT OF INFANT
18

Age in Month Fine motor Development
1 month old Holds Hands in tight Fists
2 month old Hold hands unfisted half the time
3 month old Bats at object; sustain grasp if an object is placed on palm
4 months old Reaches for objects when supine, Brings hands together in midline Plays with
fingers, Thumb apposition in grasping occurs between third and fourth months
5 months old Tries to obtain object beyond the reach, Ulnar-palmar grasp, transfer object
from hand to mouth to hand
6 months old Radial-palmar grasp, transfer object from hand to hand; immature rake
7 months old Radial-digital grasp
8 months old Transfers a toy from one hand to the other, usually successfully, Bangs cubes
on table, Holds cup
9 months old Shows inferior pincer grasp, uncover hidden objects,
10- 11 month old Voluntary release of an object, points with index finger
12 months old Picks up pellet with pincer grasp, attempt 2 block tower
FINE MOTOR DEVELOPMENT OF INFANT
19

Age in Month Sensory Development
1 month old Startled by sound and Visual acuity approaches 20/100
3 month old Binocular coordination (Vertical and Horizontal vision ) when an
object is moved from right to left and up and down in front of face
4 months old Beginning Hand - eye coordination
4-5 months old Can fixate object more than 3 feet away
Visual acuity 20/200
6-7 months old Localizes sounds made above the ear, Moves in order to see an
object
7-8 months old Has preferences in taste for food
7-9 months old Recognizes familiar words and sounds
9-10 months old Able to follow objects through transition from one place to
another
12 months old Visual acuity; 20/100 to 20/50
SENSORY DEVELOPMENT OF INFANT
20

Age in Month Psychosocial Development
1- 3 month old Complete dependence on care giver, Establishes Eye Contact
Smiles Briefly
6 months old Recognizes parents, Recognizes strangers (5th and 6 month ) as
different from family members.
7-8 months old Actively clings to a familiar person when distressed, Affection
for or love of family members
9- 10 months old Expresses several beginning recognizable emotions such as
anger, sadness, jealousy, anxiety, pleasure, excitement, and
affection, Play social games with adults such as “pat-a-cake”
and “peek-a-boo”
11-12 months old Shows emotions, such as jealousy, affection (may hug or kiss
on request)
PSYCHOSOCIAL DEVELOPMENT OF INFANT
21
SENSE OF TRUST VS MISTRUST

PSYCHOSEXUAL DEVELOPMENT OF INFANT
22
ORAL STAGE
Oral – dependent or oral-passive ; need for sucking pleasure
SPIRITUAL DEVELOPMENT OF INFANT
UNDIFFERENTIATED
MORAL DEVELOPMENT OF INFANT
PRECONVENTIONAL MORALITY
Stage 0 (0 to 2 Yrs) The Good is what I like and want

23
Age in Month Intellectual Development
1 to 4 months
old
Primary Circular Reaction : Hand to mouth
movement permits sucking
4 to 7 months
old
Sensorimotor stage : Secondary Circular
Reaction
Repeats actions that affect an object to get a
response (Shaking a Rattle )
8- 12 months
old
Sensorimotor Stage : Secondary circular
reaction and coordination of secondary schemas
INTELLECTUAL DEVELOPMENT OF INFANT

LANGUAGE DEVELOPMENT OF INFANT
24
Age in Month Receptive Language Expressive Language
1 to 3 months old Attends to voice, turns head or
eyes
Startles to loud sounds ,Quiets
in response to voice Smiles
Undifferentiated but strong cry
Coos and gurgles
Single-syllable repetition g, k, h, and ng appear
3 to 6 months old Actively seeks sound source
May look in response to name
Responses may vary to angry
or happy voice
Respond to changes in the tone of caregiver’s
voice.
Pay more attention to music and, perhaps, coo
along with the music.
Imitate familiar sounds and actions.
Begin to babble with repetitive syllables,
starting with vowel sounds (“oh” and “ah”)
and moving on to new sounds and
combinations with “p,” “m,” “b,” and “d” in
them.

LANGUAGE DEVELOPMENT OF INFANT
25
6 to 9 months May look at family member when
named
Inhibits to “no” Begins interest in
pictures when named
Individual words begin to take on
meaning
Try to communicate using actions or
gestures
Babbles tunefully
Increased sound combinations Uses m, n, b,
d, t
Initiates sounds, such as click or kiss
Uses nonspecific “mama” and “dada”
Use their voices to express pleasure and
displeasure
9 to 12 months Follow simple instructions,
especially if vocal or physical cues
are given, such as “drink your milk,”
and simple commands, such as “no.”
Recognize their name when called.
Understand the names of familiar
objects or people
Responds with gestures to “bye-bye”
Try to mimic familiar sounds, such as car
and animal noises.
Focus on the speaker’s mouth and try to
imitate words and practice inflection.
Say a few two-syllable words, such as
“dada,” “mama,” and “uh-oh.”
Accompanies vocalizations with gestures
Jargon increases

PLAY STIMULATION OF INFANT
26
Age in Month Play Stimulation
1 month Hold, Touch, Rock infant gently
Talk and sings softly to infant at close range
2 month Offer a rattle
Hold or Dangle toy in front of infant to encourage eye
movement.
3 month Hold bright toys in front of infant to encourage reaching
Provide greater variety of toys as baby shows interest in play
things.
4-5 month Light tickling stimulates laughter.
Shake rattle placed in infant hand
Encourage splashing in bath water
Provide variety of small multi textured (fuzzy, smooth) and
colored objects that infant can hold but not swallow.

PLAY STIMULATION OF INFANT
27
Age in Month Play Stimulation
5- 6 month Provide sound making toys.
Provide more complex soft cuddly toys
Encourage infant to look in a mirror; repeat names of parts of
face, such as mouth, nose, and eyes.
Place infant in a sitting position and encourage leaning
away from the wall that improve balance
7-8 month Help infant learn to stand.
Encourage banging of toys and clapping hands
Provide a larger environment in which the infant can move
safely; crawling, creeping
Place toys under blanket and encourage infant to find it

GROWTH AND
DEVELOPMENT
OF TODDLER

INTRODUCTION
• The word is derived from “to toddle”, which means to walk
unsteadily, like a child of this age. The toddler period
extends from age 1 year to approximately 3 years of age.
The toddler who learned to trust the parents during infancy
now can use this trust in exploration and investigation of a
world beyond the parent’s arms. The toddler years are a
time of great cognitive, emotional and social development.
29

CHARACTERISTICS OF
TOODLER
Physical and
physiological
Characteristics
of toddler
Potbelly
Abdomen
Physiological
anorexia
Bowed Legs
30

CHARACTERISTIC BEHAVIOURS OF TOODLER
 Recognize themselves in pictures or
a mirror;
 Imitate the behavior of others,
especially adults and older
children.
 Beginning of reading and writing.
 Short attention span.
 Negativistic attitude and
Independence.
 Ritualistic behavior.
 Temper tantrums.
 Regression
 Egocentric
 Dawdling
 Ambivalence
31
Curious and more energetic.
Babbling; beginning to develop
language.
Judgment based on perception,
rather than logic.
Recognizes parents and special
people, attaches to special toys,
objects.
Expresses feelings through
crying, facial expressions, body
language, sounds.
Understands words;
communicates via sounds,
gesture.
Show greater independence;
begin to show defiant behavior;

Love and security
Nutrition
Hygienic Measures especially Dental care
Toilet Training according to the readiness of the toddler
Immunization and Play facilities
Consistency in discipline and control of temper tantrums.
Prevention of accidents and safety measures.
NEEDS OF TODDLERS
32

WEIGHT :
Age in year X 2 + 8
2 years-12kgs
2.5 years- 4 times to birth weight
HEIGHT :
Formula For calculating Height is
Age in years X 6 +77
2 years -85cm
PULSE :
90- 130 be/mt
DEVELOPMENT OF TODDLER
33
RESPIRATION :
26 + or – 5 be/mt
BLOOD PRESSURE :
100/60 + or – 20/20
ANTERIOR FONTANEL CLOSED
BETWEEN 12 – 18 MONTHS
DENTITION
2 years-16 teeth
2.5 yrs- 20 teeth ( Primary teeth
Completes)

Body System Developmental Changes
Gastrointestinal • By 2 years, the salivary glands reach adult size.
•During the second year, the liver matures and becomes
more efficient in vitamin storage, glycogenesis, amino
acid changes, and ketone body formation. The lower edge
of the liver may still be palpable.
•Stools are more like those of adults.
Renal •A 2-year-old may excrete as much as 500 to 600 mL of
urine a day.
34

GROSS MOTOR
Age Gross motor Development
12 – 13 month Pulls self to stand
Stands alone for 3 to 5 seconds
Walks holding on to furniture , Creeps up stairs
Lowers self from standing to sitting without falling Rolls a ball
15 months Stands alone well
Walks forward and backward
Stoops and recovers
Climbs up stairs without alternating feet
Pulls a pull toy
18 months Throws while aiming
Walks well independently
Pushes and pulls toys , Seat self in small chair Climbs on furniture
Pulls toy while walking backward 35

GROSS MOTOR
Age Gross motor Development
24 month Throws overhand
Runs well
Climbs up on furniture
Kicks large ball
Walks up and down stairs both feet on one step at a time, holding
onto a railing or the wall,
Can Walk with heel-to gait
Runs , Jumps up
30 months Jumps with both feet
Climbs stairs alternating feet
Stands on one foot for 1 second
Walks on tiptoes
Stands on one foot alone momentarily 36

FINE MOTOR DEVELOPMENT
OF TODDLER
Age Fine motor Development
12 – 13 month Uses pincer grasp
Stacks two blocks
Clasps hands together
Scribbles spontaneously
15 months Puts blocks in a cup
Stacks two blocks
Scribbles spontaneously
Pats pictures in books and begins to turn pages
18 months Stacks three - four blocks
Turn pages in a book two or three at a time
Imitates a vertical stroke with crayon
Puts block in to hole
37

FINE MOTOR DEVELOPMENT
OF TODDLER
Age Fine motor Development
24 month Builds tower of seven cubes
Circular scribbling
Imitates folding paper once
Turns doorknob
Turns pages one at a time
30 months Builds tower of nine cubes
Draws vertical and horizontal lines
Imitates circle
Hold crayon with finger instead of entire hand
Adds chimney to train of cubes
38

SELF CARE DEVELOPMENT OF TODDLER
Age Feeding Skills Dressing skills Toileting and
Grooming Skills
15 month Enjoys finger
feeding
Hold a cup with all
fingers grasped
about it.
Removes socks
Sticks out arm and
leg to help in
dressing
Indicates when
diaper is wet or
soiled
18 months Holds cup with
both hands.
Eats with spoon ;
turn spoon in
mouth. Spills
frequently
Removes Simple
garments
( mittens, shoes)
and unzips
garments
May complain
When wet or
soiled or give
indication of need
to toilet
39

SELF CARE DEVELOPMENT OF TODDLER
Age Feeding Skills Dressing skills Toileting and Grooming
Skills
24 month Drinks well from
a small glass
held in one hand
Plays with food
Imitates eating
habits of other
Pulls on Own, simple
garments- coat, elastic
pant, shoes(laces
untied)
Removes most of on
clothing (hat, pant)
•Usually urinates when taken
to toilet,
•May brush teeth with help
•Verbalizes toilet needs
30 Month Pour from
pitcher; often
spills
Uses fork, but is
held in fist
Put arm through large
armhole
Buttons one large
front button and
unbuttons large front
button
Usually has mastered
daytime bladder control ,
Beginning of night time
bladder control
May go to toilet by self (for
bowel movement 26 months,
for urination 30 months) and
needs assistance with wiping
40

SENSORY DEVELOPMENT OF
TODDLER
Age Sensory Development
15 months Binocular vision fully developed
18 months Identifies various shapes
Can see better, thus has intense interest in picture
24 months Visual acuity 20/40
30 Months Visual Acuity 20/30
Recall Visual Images
41

PSYCHOSOCIAL
Age Psychosocial motor Development
15 month Egocentric, Separation anxiety, Hugs and kisses parents
18 months Begins to have temper tantrums if things go wrong
Imitates parent’s domestic activities (sweeping, Dusting)
Beginning awareness of ownership (“my toy”)
24 months Has great sense of “mine”, little of “yours”; Possessive
Violent temper tantrum decreasing
Negativism and dawdling , would like to make friends but does not know how
30 months Separates more easily from parent
Begins to notice gender differences; knows own gender
Emotions expand to include pride, shame, guilt, embarrassment
Negativism and dawdling continue 42
SENSE OF AUTONOMY VS DOUBT AND SHAME

PSYCHOSEXUAL DEVELOPMENT OF TODDLER
PRECONVENTIONAL MORALITY (1 to 3 Years)
Stage 1: Child if punished is wrong, if not punished it is right 43
ANAL STAGE (1 to 3 Years) Obtain pleasure from
feeling of a distended bladder from masses of feces in the
rectum and from the release contents from those organs
SPIRITUAL DEVELOPMENT OF TODDLER
INTUTITE PROJECTIVE (1 to 3 Years) Imitates
religious behaviors such as bowing the head in prayer, but does
not understand the meaning
MORAL DEVELOPMENT OF TODDLER

INTELLECTUAL DEVELOPMENT OF
TODDLER
44
Age in Month Intellectual Development
15 months old Sensorimotor stage : (Tertiary circular reaction) Children
become captivated with object properties and start to solve
problems using trial and error methods. An example of tertiary
circular reaction is dropping food on the floor to see what happens
18 months old Sensorimotor stage : Substage IV ( Invention of new mean
through Mental combination) From 18 months to 2 years, the
child begins to use insight and creativity An example of
beginnings of thought would be a child playing with an imaginary
friend.
24 & 30 months
old
Preoperational stage : Preconceptual phase (2 to 4 Yrs)
Young children are able to think about things symbolically. Their
language use becomes more mature. They also develop memory
and imagination, which allows them to understand the difference
between past and future, and engage in make-believe.

LANGUAGE DEVELOPMENT
OF TODDLER
45
12 to 18 months Follows one-step commands Each
week understands new words
Increased interest in naming
pictures
Differentiates environmental
sounds
Points to familiar objects and
body parts when named
Understands simple questions
Begins to distinguish “you” from
“me”
Uses all vowels, many consonants
Increased use of real words
Jargon is sentence-like
Likes to use negatives (i.e., says “no”
often)
Names a few pictures
By 18 months old, articulates 15 to 20
words and understands 50
Imitates non-speech sounds (e.g., cough,
tongue click) Names some body parts

LANGUAGE DEVELOPMENT
OF TODDLER
46
18 to 24 months Follows two-step commands
Vocabulary increases rapidly
Enjoys simple stories and songs
Recognizes pronouns
Imitates two-word combinations Dramatic
increase in vocabulary
Speech combines jargon and words
Names self Answers some questions
Begins to combine words
Begins to use pronouns
24 to 30 months Understands prepositions in and on
Seems to understand most of what
is said
Understands more reasoning
(“when you are finished, then …”)
Identifies object when given
function (wear on feet, cook on)
Babbles less
Two-to three-word sentences
Repeats two numbers
Increased use of pronouns
Asks simple questions
Joins in songs and nursery rhymes
Can repeat simple phrases and sentences

PLAY STIMULATION OF TODDLER
47
Age in Month Play stimulations
15 months old Provide Balls, Stuffed animals, Dolls, Musical toys, Picture books,
Stacking discs or blocks
18 months old Wooden blocks, pull toys, clay, large crayons, stuffed toys, sand toys,
Enjoy Solitary play, Imitates parental action Enjoy playing with balls
24 months old Pulls wagon
Enjoys hearing stories
Manipulates play materials such as clay
Brush paint, Large crayons Large crayons
30 months old Motor Play :- Provide Large Cars, trucks, pushes and pull toys
Creative Play:- Provide clay, finger paint, large wooden puzzles,
large crayons.
Dramatic Play:- Provide Baby doll and doll equipment's, play
telephone, Toys for house keeping (Small broom, dust cloth etc...
PARALLEL PLAY

GROWTH AND
DEVELOPMENT
OF
PRESCHOOLER

INTRODUCTION
• The preschool period is the period between 3 and 5 years of age. The pre-
school years is also known as “the years before formal schooling begins.
This is a time of continued growth and development. Physical growth
continues much more slowly compared to earlier years however the child
achieves several milestones in life which also serve as basic foundation of
learning and development.
• Preschoolers have more control in there body, since they have their center
of gravity at a lower level, right about near the belly button. This gives
them more ability to be stable and balanced than the toddler. The
preschooler moves from the unsteady stance of toddlerhood to a more
steady bearing. They no longer “toddle”, that wobbly way that toddlers
walk. This also allows the preschooler to move more “successfully” than
the toddler.
49

CHARACTERISTICS OF
PRESCHOOLERS
• Gain strength ,Coordination and Body awareness
• Jealousy and attention seeking
• Less Egocentric and Independence
• Make friends
• Ritualistic Behavior continues
• Developing an increased attention span
50

Love and
Affection
Independence Guidance
Safety and
security
Immunizatio
n
Dental care
Health
check – Up
Opportunity
to play and
Social
interaction
Schooling
(Nursery)
NEEDS OF PRESCHOOLERS
51

DEVELOPMENT OF PRESCHOOLERS
52
WEIGHT :
Age in year X 2 + 8
HEIGHT :
3 years- 90.5-101.5 cm
4 years- 95-109 cm
5 years- 103-115 cm
PULSE :
90 - 110 be/mt
RESPIRATION :
26 + or – 5 be/mt
BLOOD PRESSURE :
95/55 + or – 20/10

PHYSICAL DEVELOPMENT OF
PRESCHOOLERS
53
Neurologic Continued myelinization and cortical development occurs. Fine motor
movements are more detailed and sustained. Gross motor skills are
smoother and more coordinated. Sensory function is more mature
Cardiovascular By the fifth year, the heart has quadrupled in size since birth.
By 5 years, the heart rate is typically 70 to 110 bpm.
The hematologic system should produce only adult hemoglobin by the
fifth year.
The hemoglobin level stabilizes at 12 to 15g/dL.
Pulmonary Abdominal respiratory movements continue until the end of the fifth or
sixth year.
Respiratory rate slows to about 30 breaths per minute.

PHYSICAL DEVELOPMENT OF
PRESCHOOLERS
54
Gastrointestinal The stomach becomes more bowed and increases its capacity
to about 500 mL. Many children still require a nutritious
snack between meals because of small stomach size
Renal A 4-to 5-year-old excretes between 600 and 750 mL daily
Endocrine Quiescent time for sexual growth, with few physical or
hormonal changes.
Growth hormone stimulates body growth.

GROSS AND FINE MOTOR
DEVELOPMENT OF
PRESCHOOLERS
Age Gross Motor Development Fine Motor Development
3 years Climbs ladders
May pedal tricycle
Balances on one foot 2 to 3 seconds
Kicks ball with direction Catches a ball
Walks on tip toes
May try to dance, but balance may not
be adequate
Build a tower of 9 – 10 blocks
Copies a circle
Shows preference for handedness
Can help with simple house hold tasks
(dusting, etc..)
Puts beads on string
4 years Tries to skip using alternate feet
Catches a bouncing ball
Runs around corners lightly on toes and
stops voluntarily
Stands on one foot for 5 seconds
Uses scissors successfully to cut out
picture following outline
In drawing, copies square, traces cross
and diamond
55

GROSS AND FINE MOTOR
DEVELOPMENT OF
PRESCHOOLERS
Age Gross Motor Development Fine Motor Development
Walks down stairs alternating feet
Throws ball underhand
Jumps from greater height
5 years Catches bounced ball most of the time
Stands on one foot for 7 to 8 seconds
Gallops (combination of skipping and
running)
Does a somersault
Hops Skips successfully
Imitates dance steps if taught
Copies a triangle
Cross vertical lines
Copies letters; May be able to print own
name
Draws a three part man
56

SELF CARE DEVELOPMENT
OF PRESCHOOLERS
57
Age Feeding Skills Dressing skills Toileting and Grooming
Skills
3 years • Can put an coat without assistance
• Can undress self in most instance
• Can pull pants up and down
• Can go to toilet alone
• Brushes teeth with help
4 Years • Manage spoon
with little spilling
• Eat with fork held
in fingers
• Buttons side buttons, small buttons
• Can put on socks with help
• Knows back from front
• of clothes
• Put on shoes (not lace) without help
• May bath self with assistance
• Wash and dries hands without
supervision
5 Years • Selects fork over
spoon when
appropriate
• May be able to lace shoes
• Manages Zippers in back
• Wipes self independently
• Flushes toilet after each use
• Bath self and combs hair with
help
• Can blow nose when asked

SENSORY DEVELOPMENT OF
PRESCHOOLERS
PSYCHOSOCIAL DEVELOPMENT OF
PRESCHOOLERS
58
Visual acuity 20/20
Age Psychosocial development
3 years May have fears, especially of dark and going to bed
Knows own gender and gender of others
Egocentric in thought and behavior
Less dependent on parents but needs reassurance and help
Sense of Initiative Vs Guilt

PSYCHOSOCIAL DEVELOPMENT OF
PRESCHOOLERS
59
Age Psychosocial development
4 Years Very independent
Tends to be selfish and impatient
Aggressive physically as well as verbally
Takes pride in accomplishments
Has mood swings
5 Years Continues to be egocentric
Separates easily from parents
Has fantasies and day dreaming
Independent and trust worthy
Eager to do things right and to please; tries to “live by the
rules” Has better manners
Sense of Initiative Vs Guilt

PSYCHOSEXUAL DEVELOPMENT OF
PRESCHOOLERS
60
PHALLIC STAGE
(Demonstrates strong attachment for parents of opposite sex)
SPIRITUAL DEVELOPMENT OF
PRESCHOOLERS
INTUITIVE – PROJECTIVE FAITH
MORAL DEVELOPMENT OF
PRESCHOOLERS
PRE CONVENTIONAL MORALITY
• Stage 2 :-You do it for me ; I will do it for you

INTELLECTUAL DEVELOPMENT
OF PRESCHOOLERS
61
AGE INTELLECTUAL DEVELOPMENT
• 3 years • Is egocentric in thought and behavior
• Has beginning understanding of time; uses many time-oriented expressions, talks about past and
future as much as about present, pretends to tell time
• Has improved concept of space, as demonstrated by understanding of prepositions and ability to
follow directional command
• Has beginning ability to view concepts from another perspective
• 4 years • Judges everything according to one dimension, such as height, width, or order
• Obeys because parents have set limits, not because of understanding of right or wrong
• Is beginning to develop less egocentrism and more social awareness
• 5 years • Begins to question what parents think by comparing them with age-mates and other adults
• May begin to show understanding of conservation of numbers through counting objects
regardless of arrangement
• Uses time-oriented words with increased understanding

LANGUAGE DEVELOPMENT OF
PRESCHOOLERS
AGE RECEPTIVE EXPRESSIVE
3 years Can obey two
prepositional
commands (on,
under)
• Has vocabulary of about 900 words
• Uses primarily “telegraphic” speech
Uses complete sentences of three or four words
• Asks many questions
4 years Understands directives
(On, Under, Inback,
Infront)
• Has vocabulary of 1500 words or more
• Uses sentences of four or five words
• Questioning is at peak
• Tells exaggerated stories
• Knows simple songs
• Use ‘’I’’ and Counts to 5
5 years Carries out instruction
with three suggested
task to wash, dry, sit
down
• Names Primary colors.
• Ask meaning of words
• Count 1 to 10
• Has a vocabulary of 2100 words
• Knows names of days of week, months, and other time-associated words
62

AGE PLAY STIMULATION
3 Years • Crayons , paints
• Play telephone, Busy-box, Music record players
• Single puzzles, toy dishes, soap bubbles
4 Years • Play cooperatively with others
• Provide Hand puppets, doll house, doll nurse or doctor kit
• Provide Blackboard, chalk, paper , paste, scissors, clay , finger paints to stimulate creativity
• Sliding boards, swing, blocks of all sizes , Tinker toys to encourage motor activity
5 Years • Play Competitive games
• Love to transport things in trucks, Cars, Wagons
• Construction toys, paper dolls, opportunities for collecting nature specimens for creativity
activity
• See – Saw, jungle gym , Slides , jump rope and skates for motor activity
• Color sets, books and puzzles for quiet play 63
PLAY STIMULATION OF
PRESCHOOLERS

GROWTH AND
DEVELOPMENT
OF SCHOOL GOING
64

Introduction
• School-age children are those 6 to 12 years of age. This is a
stage of continuing growth and development for young child.
They will go through many changes in physical, mental, and
social development. While all children may grow at a
different rate, and they have different interests, abilities,
and personalities.
• School- age children become increasingly capable of self care.
They follow the values, belief and habits of the parents. So
Parents are still responsible for information giving and
explaining physiologic changes that occur during school age.
65

Subphases of School going
Early Childhood (5-7 Years)
Middle Childhood ( 8 – 10 Years)
Late Childhood ( 11 – 12 Years)
66

67
Needs for School
Going
Health
Information
Meeting
Emotional
Needs
Recreation
and Play
activities
Sex
Education
Regular
Health
Check-Up
Punishment
without
Humiliation
Nutrition

Physical or biological development
68
WEIGHT :
1 – 6 years - Age in year X 2 + 8
7 - 12 years - Age in year X 2 + 8
2
12 years-40kg (Increases 2-3
kg/year)
PULSE : 75 - 95 be/mt
RESPIRATION :
18 - 24 be/mt
BLOOD PRESSURE :
100/60 + or – 16/10
DENTITION
6 years - Central mandibular incisors erupt Loses first tooth
7 years- Maxillary central incisors and lateral mandibular
incisors erupt, Jaw begins to expand to accommodate
permanent teeth
8 - 9 years - Lateral incisors (maxillary) and mandibular
cuspids erupt
10 – 12 years - Remainder of teeth will erupt and tend toward
full development (except wisdom teeth)
HEIGHT :
6 yrs. - 116 cm
12 yrs-150 cm (Increase of 5cm per
year)

Body System Developmental Change
Skin and
lymph
• At about 6 years old, tonsils and adenoids reach their largest size.
• Prepubescence is characterized by more active sebaceous glands
and vasomotor instability that can lead to uncontrolled blushing.
Head, eyes,
ears, nose,
and mouth
• Head size becomes smaller in proportion to body size.
• Undeveloped sinus cavities contribute to increased susceptibility to
upper respiratory infections, sinus irritation, and sinus headaches.
• By 6 to 7 years old, the retina is fully developed, and visual acuity
is 20/20.
• By middle childhood, the Eustachian tube grows longer, narrower,
and more slanted.
• By 5 to 6 years old, first primary teeth are shed, and the first
permanent teeth erupt, usually the central incisors.
• Each year after 6 years old, approximately four teeth are replaced—
one set in the upper jaw, and one set in the lower jaw. 69

Pulmonary • Through childhood, the lungs gradually descend into the
thoracic cavity.
• By 8 years old, alveolar development is complete.
• During middle childhood, tidal volume increases; normal
adult respiratory rate is achieved (18 to 30 breaths per
minute).
• Increased maturation of the macro phagocytic activity of
mucus and ciliary function in lungs makes the child more
resistant to respiratory infections
Cardio
vascular
• By 7 years old, the left ventricle thickens; it is two to three
times greater in size than right; blood pressure increases to
90 to 108/60; cardiac volume increases; heart rate declines
to 60 to 100 bpm. 70

Gastro
intestinal
• By middle childhood, the GI system is of adult size and function.
Genito urinary • By 6 years old, elimination patterns are established; greater than 90%
of children are toilet trained.
• Bladder capacity continues to expand.
• Between 10 and 14 years old, puberty begins but can be normal in any
child after 8 years old for females and 9 years old for males.
• Delayed puberty is diagnosed if no secondary sex changes (e.g., breast
budding; penis or testicle growth) are noted at 13 years old in girls and
14 years old in boys.
Musculoskeletal • Long bones grow, leading to the taller, thinner school-age child. Spine
becomes straighter; legs become straighter. Facial bones are actively
changing as nasal accessory sinuses grow.
Immune system • Rapid maturation of the immune system during middle childhood.
• Allergic conditions may appear. 71

Gross And Fine Motor development
Age in
Years
Gross Motor Development Fine Motor Development
6- 8 years Rides tricycle without training
wheels
Runs, Jump, Climb, Hops and
Constantly in motion
Clumsy and awkward
Coordination improving
Knows right from left hand
Draw a person with 12-16 parts
Has improved eye-hand
coordination
Print words; learns cursive writing
8-10 years Performs tricks on bicycles; and
races
Begins to participate in
organized sports , like base ball
, soccer
Throws a ball skillfully, over
hand and underhand
Use both hands independently
Draws a person with 18-20 parts
and print fluently , cursive writing
improved
10 - 12 years Enjoy all physical activities Coordination continues to improve
72

Self Care
Age in Years Feeding Skills Grooming and dressing skills
6-7 years At 6 years, likes to eat
with fingers, stuff food
into mouth, talkative
while eating
At 7 years, improved
table manners, less
talking may bolt food.
Self- care managed ; has a tendency to
dawdle in bath tub
Can brush and comb hair
May need some help with dressing
Leave clothes where they are removed
8-10 years Handles eating utensils
skillfully
Dressing self completely; enjoys
selecting own clothes
Unaware of dirty clothes and Need to be
reminded to brush teeth
11- 12 years Cooks or sews in small
ways
Washes and dries own hair; is
responsible for a thorough job of
cleaning hair but may need reminding to
do
May wear some clothes continually 73

Sensory development
Age in Years Psychosocial Development
6-8 years Continue to be egocentric, Bossy
Has a “ Know it all ” Attitude
Insists on being first in everything , Jealous of siblings
Return of temper tantrums may use Verbal, Physical attack
8- 10 years Concerned about relationships with others
Begins hero worship
Relationship with siblings improved
Aware of appropriate sexual role
74
Visual Acuity 20/20
Psycho Social development
Sense of Industry vs Inferiority

Age in Years Psychosocial Development
10- 12 years Congenial, Sincere, Confident
Respects parents and their role
Has short bursts of anger (10 yrs)
Able to control anger (12 yrs)
Hero worship of adult continues
Still fears the dark
75
Psycho Social development
Psycho Sexual
development
Latency Stage (6 – 12 yrs)
The superego or conscious is internalized. Energy is put
into acquiring cultural and social skills. Guidelines
established by the family are followed

76
Spiritual
Development
Mythical literal faith (6 – 12
years)
In this stage, information is
organized into stories and
together with moral rules are
concretely understood by the
child.
Moral
Development
Instrumental purpose orientation
Behavior is determined again by consequences. The
individual focuses on receiving rewards or satisfying
personal needs.
Developing Good Interpersonal Relationships:
Behavior is determined by social approval. The
individual wants to maintain or win the affection and
approval of others by being a "good boy-good girl“
Maintaining Social Order

77
Intellectual
Development
Age in Years Intellectual Development
6-7 years Pre operational thought Sub stage II (4-7Yrs)
Can tell time,Can describe objects in picture, knows their use
Can see difference more than similarities performs mental operation of
conservation of liquid vs solid amount
Age in Years Intellectual Development
8- 10 years Concrete Operational Stage
Memory span increasing, Time – usually punctual
Ashamed of failure, Learn to understand and us abstract
symbols and caries out mental operations
11- 12 years Formal Operational Thought
Develops abstract and deductive reasoning, Uses problem
solving method, Short interest span , Preoccupied with right and
wrong 77

Language development
Age in
Years
Receptive Language Expressive Language
6- 8 years Follows series of 3
commands, response
dependent on mood
Responds to praise and
recognition
Can repeat sentences of 10 to 12 words.
Has a vocabulary of 2500 words.
Knows number combinations up to 10
Develops a sense of humor; enjoys telling
jokes
8-10 years Follows suggestion better
than commands
Begins to use shorter and more compact
sentence
Is gregarious
10 - 12 years Follows suggestions better
than request
Is obedient
Oral vocabulary of 7200 words and
reading vocabulary of 50,000
Enjoy riddles
Uses parts of speech correctly
Uses numbers beyond 100 with meaning
78

79
Play Stimulation
• Provide Table games, board games for competitive and team play.
• Loves active play, prefers group play
• Provide Bicycles, Jump ropes, Punching bags, roller skates, bat/balls, gymnastic
equipment for motor activity
• Provide Puppets, dolls, paints, crayons, drawing materials ,clay, magic tricks,
dance lessons, musical instruments for creative activity
• Provide Books, puzzles records, tapes “ Collectibles” for quiet play.
For 8 -10 years Provide Bicycles, Jump ropes, Punching bags,
roller skates, bat/balls, gymnastic equipment for motor activity
For 10- 12 years Enjoy Athletic sports and Talking on
telephone Reading mystery and love stories

GROWTH AND
DEVELOPMENT OF
ADOLESCENCE
80

INTRODUCTION
• Adolescence is a period of psychosocial and emotional transition between childhood and
adulthood—a time of rapid physical, cognitive, social, and emotional maturation.
Adolescence, which literally means “to grow into maturity,” is generally regarded as the
psychological, social, and maturational process initiated by the pubertal changes
• Several terms are used to refer to this stage of growth and development. Puberty refers to
the maturational, hormonal, and growth process that occurs when the reproductive organs
begin to function and the secondary sex characteristics develop.
• This process is sometimes divided into three stages: prepubescence, the period of about 2
years immediately before puberty when the child is developing preliminary physical
changes that herald sexual maturity; puberty, the point at which sexual maturity is
achieved, marked by the first menstrual flow in girls but by less obvious indications in boys;
and postpubescence, a 1- to 2-year period after puberty during which skeletal growth is
completed and reproductive functions become fairly well established. 81

SUBPHASES OF
ADOLESCENCE
•
82
Early Adolescence (12 - 14 Years)
Middle Adolescence ( 15 – 17 Years)
Late Adolescence ( 18 – 21 Years)

NEEDS OF ADOLESCENCE
83
Health
Promotion
and illness
prevention
Meeting
Emotional
Needs
Recreation
and Play
activities
Sex
Education
Regular
Health
Check-
Up
Adult
Supervision
and
Guidance
Nutrition

PHYSICAL OR BIOLOGICAL OF
ADOLESCENCE
84
WEIGHT :
Formula For calculating weight is - Age in year X 2 + 8
HEIGHT :
Formula For calculating Height is Age in years X 6 +77
PULSE :
60 - 80 be/mt
RESPIRATION :
14 - 20 be/mt
BLOOD PRESSURE :
100/70 to 120/80 mmHg
12 – 14 years -Secondary sex
characteristics appear
15-17 years - Secondary sex
characteristics well advanced
18 – 21 years - Structure and
reproductive growth almost complete

CHARACTERISTICS
PHYSICAL DEVELOPMENT
OF ADOLESCENCE
SEXUAL MATURATION
85
Tanner
’s
Stages
Female Male
Breast Development Pubic Hair Breast Development Pubic Hair
Stage 1 Prepubertal: Papilla
Elevation Only
Prepubertal: No
pubic hair
Prepubertal: Papilla
Elevation Only
Prepubertal: No
pubic hair
Stage 2 Pubertal: Breast bud
stage- Small area of
elevation around papilla;
enlargement of areolar
diameter
Spare long,
slightly
pigmented hair
on labia majora
Pubertal: Breast bud
stage- Small area of
elevation around
papilla; enlargement of
areolar diameter
Initial enlargement
of Scrotum and
testes, Spare growth
of long, straight,
downy, slightly
pigmented hair at
the base of penis.
85

CHARACTERISTICS
OF ADOLESCENCE
SEXUAL MATURATION
86
Tanner
’s
Stages
Female Male
Breast
Development
Pubic Hair Breast Development Pubic Hair
Stage 3 Further enlargement
of areolar with no
separation of their
contours
Dark, coarse,
curled hair,
spreads sparsely
over entire pubis
(mons)
Further enlargement of
areolar with no
separation of their
contours
Initial Enlargement of
penis mainly in length,
testes and scrotum further
enlarge, Dark, coarse,
curled hair, spreads
sparsely over entire pubis
Stage 4 Projection of areola
and papilla to
to form a secondary
Pubic hair
denser, curled,
adult type hair
Projection of areola
and papilla to
to form a secondary
Increased size of penis
with growth in diameter
and development of 86

CHARACTERISTICS
OF ADOLESCENCE
SEXUAL MATURATION
87
Tanner
’s
Stages
Female Male
Breast
Development
Pubic Hair Breast
Development
Pubic Hair
mound (may not
occur in all girls)
limed to
pubis
mound (may not
occur in all girls)
glans, glans larger and broader,
scrotum darker, pubic hair more
abundant with curled, adult type
hair limed to pubis
Stage 5 Projection of papilla
only caused by
recession areola into
general contour
Adult type
hair,
distribution
to the medial
thigh.
Projection of papilla
only caused by
recession areola into
general contour
Testis, penis and Scrotum adult
in size and shape; Adult type
hair, distribution to the medial
thigh.
87

MOTOR AND SELF
CARE
88
Age in Years Motor and Self Care
12 – 21 years Eye – hand Coordination at adult level
Possesses manual dexterity
Clumsiness occurs due to rapid physical growth(12- 14 Years)
Motor Function comparable to adult
Visual Acuity 20/20
SENSORY DEVELOPMENT

PSYCHOSOCIAL DEVELOPMENT
89
12 – 14 years Sense of Identity Vs Self diffusion or Role confusion
• Preoccupation with body changes and image; self-conscious about
appearance
• High expectations of self yet this alternates with lack of confidence
• Peer group becoming more influential; less affection shown for
parents
•Searching for new people to love
•High levels of physical activity
•Many mood swings and impulsive
•Increased ability to think in a complex manner (for example, abstractly) and sense
of right and wrong
•More able to express feelings verbally, but often expresses feelings by action
•Most interest is in present and near future
•Tests rules and limits

90
15 – 17 years Sense of Identity Vs Self diffusion or Role confusion
• Greater desire for independence
• Self-conscious
• Peer group dominates social life; efforts to make new friends and
select role models
• Less conflict with parents, but sadness due to realizing
psychological “loss” of parents
•Increased ability to care and share so can develop more intimate relationships
•Risk behaviors more prevalent
•Sexuality is of great interest
•Improved work habits and sense of right and wrong (conscience)
•More concern about future plans and intellectual interests
•Unrealistically high expectations of self alternate with poor self-concept

91
• 18 – 21 years Sense of identity vs role confusion (12 –
18 yrs) and intimacy vs isoation (19 – 40yrs)
• Identity more firm, including sense of humour, interests, emotional
stability
• Able to compromise and develop useful insight
• Adult appearance, clear sexual identity
•More capable of orienting activities toward the future (setting goals and
following through), of mutual caring (for example, verbally expressing feelings)
and of internal control (for example, delayed gratification, thinking ideas through,
making decisions, self-reliance, self-esteem)
•Uncertainties about sexuality, future relationships and work possibilities
•Pride in own work
•Accepts social institutions and cultural traditions

92
PSYCHOSEXUAL
DEVELOPMENT
The individual develops a strong sexual interest in the opposite sex. This stage
begins during puberty but last throughout the rest of a person's life.
SPIRITUAL DEVELOPMENT
Synthetic – Conventional Faith (12 – 17 years) This stage is characterized
by the identification of the adolescent/adult with a religious institution, belief
system, or authority, and the growth of a personal religious or spiritual identity.
Adolescence starts to
question their own assumptions around the faith tradition. Along with questioning
their own assumptions about their faith, they start to question the authority
structures of their faith.

93
INTELLECTUAL
DEVELOPMENT
Formal Operational Thoughts
• Early Adolescence: Explores newfound ability for limited abstract thought,
Clumsy groping for new values and energies and Comparison of “normality”
with peers of same sex
• Middle Adolescence : Developing capacity for abstract thinking, Enjoys
intellectual powers, often in idealistic terms, Concern with philosophic,
political, and social problems
• Late Adolescence: Established abstract thought, Can perceive and act on
long-range options, Able to view problems comprehensively, Intellectual and
functional identity established

94
LANGUAGE
DEVELOPMENT
• Uses slang within and outside peer group
• Uses distinct meanings for words
PLAY STIMULATION
12 – 14 years
• Chooses activities according to
individual interests.
• Interest in world affairs
• Expressive arts, hobbies,
crafts.
15 – 17 Years
• Engages in organized competitive
sports
18 – 21 years
• Chooses more passive spectator sports

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