PRINCIPLES OF GROWTH AND DEVELOPMENT

PRINCIPLES OF GROWTH AND DEVELOPMENT

The term “Growth” and “Development” are occasionally used interchangeably but are different.

GROWTH is generally used to denote an increase in physical size or quantitative change.

DEVELOPMENT is used to denote an increase in skills or ability to function.

COGNITIVE DEV’T is the ability to learn or understand from experience, to retain knowledge and to solve problems (Intelligence).

Principles of Growth and Development

• Growth and development are continuous processes from conception until death
• G & D proceed in an orderly sequence
• G & D are predictable stages at different rates
• All body system do not develop at the same rate
• Development is cephalocaudal
• Development proceeds from proximal to distal body parts
• Development proceeds from gross to refined skills
• There is an optimum time for initiation and experiences or learning
• Neonatal reflexes must be lost before development can proceed
• Skills and behavior are learned by practice

Factors affecting Growth and Development

1. Genetic Influences                             6. Environment

2. Gender                                                          7. Nutrition

3. Race and Nationality                          8. Socio-Economic Level

4. Intelligence                                        9. Parent-Child Relationship

5. Health                                                           10. Ordinal Position (Family)

PEDIATRIC NURSING HEALTH ASSESSMENT

I.              Head-to-toe assessment

A.    Measurements ( height, weight, circumference)

B.    General appearance _____________________________________

C.    Skin _________________________________________________

D.    Hair __________________________________________________

E.    Nail __________________________________________________

F.    Lymph nodes __________________________________________

G.    Head _________________________________________________

H.    Eyes _________________________________________________

I.      Nose and sinuses _______________________________________

J.     Mouth ________________________________________________

K.    Neck _________________________________________________

L.     Chest ________________________________________________

M.   Lungs ________________________________________________

N.    Heart _________________________________________________

O.    Abdomen _____________________________________________

P.    Genitalia ______________________________________________

Q.    Anus _________________________________________________

R.    Musculo-skeletal________________________________________

S.    Neurologic_________________________________________________________________________________________________________

PHYSICAL ASSESSMENT IN NEWBORN:

1. WEIGHT
• Average 3000 to 3400 at term
• Variation:

                                          i.    Below 2500 grams (5 ½ lbs) – Small for Gestational Age (SGA)

                                         ii.    Above 4100 grams (9 lbs) – Large for Gestational Age (LGA)

2. LENGTH
• 45.7 to 55.9 cm (18-22 in)
• Variation:

                                          i.    Below 45.7 cm (18 in) – SGA

                                         ii.    Above 55.9 cm (22 in) – LGA

3. HEAD CIRCUMFERENCE
• Average: 33-33.5 cm (13-14 in) if significant molding or caput succedaneum is present
• Variation:

                                          i.    Below 31.7 cm (12 ½ in) – microcephaly SGA

                                         ii.    Above 33.5 cm (14 ½ in) – hydrocephaly LGA

4. CHEST CIRCUMFERENCE

5. ABDOMINAL GIRTH.
• Maybe measured if indicated
• Consistent placement of tape is important for comparison and identification of abnormalities.
• Measurement is done before feeding, as abdomen relaxes after feeding

6. SKIN
• Color in Caucasian infants is usually pink; however it varies among ethnic group
• Pigmentation increase after birth
• Skin may be dry
• Acrocyanosis of hands and feet are normal for 24 hours
• May develop newborn rash (Erythema toxicum neonatorum)
• Small amount of lanugo and vernix is still seen
• Variation:

                                          i.    Milia – blocked sebaceous glands, usually on nose and chin (normal)

                                         ii.    Stock bites – capillary hemangiomas above the eyebrows and at the back of the neck (not normal)

                                        iii.    Mongolian Spots – darkened areas of pigmentation over sacral area at buttocks are normal and fade during the 1^st year of age; usually blue-back in appearance

                                        iv.    Excess lanugo and vernix caseosa – possible prematurity

7. FONTANELS
• Anterior – diamond-shaped; closes at 18 months
• Posterior – triangular-shaped; closes by 2 months
• Should be flat and open
• Variation:

                                          i.    Bulging – possible increase ICP

                                         ii.    Depressed- possible dehydration

                                        iii.    Hair – coarse or brittle- possible endocrine disorder

                                        iv.    Scalp – edema present at birth (caput succedaneum) from pressure of cervix against presenting; crosses suture lines

                                         v.    Skull – collection of blood between a skull and its periosteum (cephalhematoma) from pressure during delivery; does not cross suture line; appears 12-24 hours after delivery and regresses in 3-6 weeks

8. EARS
• Should be even with canthi of eyes
• Cartilage should be present and firm
• Variations:

                                          i.    Lack of cartilage – possible prematurity

                                         ii.    Low placement of ears – possible kidney disorder or Down’s syndrome  

9. EYES
• Maybe irritated by instillation, some edema/ discharges present
• Variation:

                                          i.    Strabismus – or occasional cross eyed; it is normal characterize by the presence of wide space between eyes is seen in FAS (fetal alcohol syndrome)

10. NOSE
• Variation: presence of copious drainage  associated with syphilis
11. MOUTH
• Variation:

                                          i.    Oral thrush – appears as white patches in the mouth associated with candida albicans passed from mother during passage thru the birth canal

                                         ii.    Esophageal atresia – tongue movement and excess salivation

12. NECK
• Webbing- masses of muscles

13. UMBILICAL CORD
• Variation:

                                          i.    Fewer than 3 vessels may indicate congenital anomalies

14. NODULE of tissue present in the breast
• Variation:

                                          i.    Breast enlargement and milk secretion from breasts (Witch’s milk) is result of the withdrawal of maternal hormones; usually self-limiting

15. GENITALIA
• Testes descended in the inguinal canal
• Rugae covers the scrotum
• Meatus at the tip of the penis
• Variation:

                                          i.    Epispadias

                                         ii.    Hypospadias

                                        iii.    Pseudomenstruation

16. LEGS
• Bow legged
• No click or displacement of head of femur observed when hips flexed and abducted
17. FEET
• Flat
• Soles covered with creases in fully mature infant
• Variation 

                                          i.    Upper extremities – extra fingers, webbed fingers

                                         ii.    Lower extremities – extra toes, webbed toes, congenital hip dysplasia

                                        iii.    Asymmetric movement – possible trauma or fracture

18. MUSCLE TONE
• Predominantly flexed
• Occasional transient tremors of mouth and chin
• NB can turn head from side to side in prone position
• Needs head supported when held erect or lifted

19. ANUS
• Lack of meconium after 48h, may indicated imperforated anus or obstruction