Growth And Development ,paediatric Nursing

SEMINAR PRESENTATION

ON

CONCEPTS AND THEORIES OF GROWTH AND DEVELOPMENT AND INFANCY

Submitted on:09 /05/2018

CONTENTS

1.

INTRODUCTION

2.

OBJECTIVE  GENERAL  SPECIFIC

3.

TERMINOLOGY

4.

CONTENTS a) b) c) d) e)

DEFINITION: GROWTH AND DEVELOPMENT. PRINCIPLES CHARACTERISTICS THEORIES OF GROWTH AND DEVELOPMENT GROWTH AND DEVELOPMENTS OF INFANCY

CONCLUSION BIBLIOGRAPHY

INTRODUCTION The period of growth and development extends throughout the life cycle. However, the period in which the principal changes occur is from conception to the end of adolescence. This most important period of growth and development is a complex one, in which two cells joined as one, becomes a normally thinking, feeling person who eventually takes a responsible place in society.

OBJECTIVES GENERAL OBJECTIVE: After completion of the class, the students will be able to understand the various aspects related to growth and development. SPECIFIC OBJECTIVE: After completion of the seminar students would be able to:      

define the terms growth and development describe the principles affecting growth and development discuss the characteristics of growth and development list various stages of growth and development explain the developmental theories of piaget, kohlberg, erikson, freud and fowler recognise the growth and development of infancy period

TERMINOLOGIES  CEPHALOCAUDAL- Head to tail, babies lift their head before they sit up, make sounds before they walk.  CONCEPTION – The process of pregnancy  DEVELOPMENT- A change in body function  GROWTH- A change in body size and structure  LANUGO- Fine hair covers most of the body.

 MATURATION- The process of becoming fully developed and grown.  PROXIMODISTAL – From the centre to outside  TRIMESTER- The period of gestation. DEFINITION

GROWTH: It refers to an increase in physical size of the whole or any of its part and can be measured in inches, or centimeters, pound or kilogram. It results because of cell division and the synthesis of proteins. It causes a quantitative change in the child’s body. DEVELOPMENT :It refers to a progressive increase in skill and capacity to function. It causes a qualitative change in the child’s functioning.

PRINCIPLES Growth and development are continuous and orderly processes that have predictable consequences. Although the rates of progress vary, all human beings go through the same stages on their way to their way to their physical increase in size and maturation of neuromuscular functions. The principles that regulate growth and development are: 1. Growth proceeds in cephalocaudal direction that proceeds from head down to the tail. E.g. Before birth the head end of the embryo and foetus enlarges and develops before the tail end does. Postnatally, the infant can control the movement of head before being able to stand and control the feet. 2. Growth proceeds in proximodistal direction or from the centre or midline of the body to the periphery. E.g. During prenatal period, the limb buds develop before the rudimentary fingers and toes. During infancy, the large muscles of the arms and legs are subject to voluntary control earlier than the fine muscles of hands and feet. 3. General movements become more specific. Generalized muscle movements can occur before fine muscle control is possible. E.g. A first, infants can make only random movements of the arms. Gradually they learn to use the whole hand in picking up a small object, and then learn to pick it up with pincer grasp i.e. between thumb and forefinger.

4. Interrelatedness of growth and development: Although growth and development proceed at different rates they are so interrelated that the result is a progressive development of the whole child, from infancy to adulthood.

CHARACTERISTICS INDIVIDUAL DIFFERENCES Every child is an individual and should never be considered as a typical boy or girl, or a unit of a group who are all alike. Each child has an individual rate of growth, but the pattern (characteristics) of growth shows less variability. E.g. an infant will be able to sit before standing alone. READINESS FOR CERTAIN TASKS Measurable periods, lasting from a few days to a few weeks, during which the learning of certain behaviors occur are termed as critical periods Critical period is defined as those points at which the maximal capacity to for an aspect of development is first present or at which, structures to be developed are undergoing rapid growth. The timing of critical period varies according to the individual child. If parents encourage the development of skills too early without waiting for the critical periods, the child is apt to learn slowly or not at all. If too late, the child may learn rapidly but never acquire the same skill or proficiency of learning at a more appropriate time. RATE OF DEVELOPMENT During the period of growth and development of the total body and its subsystem, growth is sometimes rapid and at times it slows down. Rapid growth occurs during gestation and infancy. In the preschool years, growth levels off and then slows down during school years. A spurt of growth occurs in puberty and early adolescence. It appears earlier CHANGING GROWTH RATES OVER THE YEARS Children today are growing taller at each age level and maturing sexually at a younger age than children did at the turn of the 20th century. Nutritional status and higher socioeconomic levels are the main causes. However height is an inherited trait. Geographic mobility permits the members of tall and short statured groups to mate, which has brought about an increase in the average height of their children.

STAGES OF GROWTH AND DEVELOPMENT The various stages include:

1. Prenatal Period: Conception to birth, encompassing the embryonic period (conception to 8 weeks) and the foetal period (8-40 weeks, ending in birth) 2. Newborn (Neonatal) Period: From birth to 4 weeks 3. Infancy Period: From 4weeks to 1 year 4. Toddler Period: From 1-3 years

5. Early Childhood (preschool): From 3-6 years 6. Late childhood (school): From 6-12 years to puberty 7. Adolescence: From puberty to the beginning of adult life.

THEORIES OF DEVELOPMENT Many theories have been devised to study the development of children. They include:  INTELLECTUAL DEVELOPMENT: Jean Piaget According to Piaget, maturation and growth have certain signposts. The child gradually develops an integration or coordination of various sensory inputs from touch, taste, smell, sight and sound into an organized and objective understanding of reality. The child does not understand the objects that cannot be seen. The ability to use symbols to represent reality is another important stage in development. For advanced cognitive functioning to occur, children must move through various stages of differentiating themselves from objects around them to learning to separate their own thoughts from those of others. The 4 major stages of development are: 1. SENSORIMOTOR STAGE(0-2):Children are primarily concerned with learning about physical objects 2. PREOPERATIONAL STAGE(2-7): They are preoccupied with symbols in language, dreams and fantasy.  Preconceptual (2-4): uses representational thought to recall past, represent present and anticipate future.  Intuitive (4-7): Increased symbolic functioning, transductive reasoning. 3. CONCRETE OPERATIONAL(7-11): They move into the abstract world, mastering numbers and relationships and how to reason about them 4. FORMAL OPERATIONAL (11-15): They tackle purely logical thought, thinking about their own thinking as well as those of others

 MORAL DEVELOPMENT: Piaget and Kohlberg According to Piaget, moral development parallels development and consists of two stages – ‘Respect for rules’ and ‘sense of justice’.

mental

The first stage is from about 3-11 years of age. In this stage, rules are considered sacred because they are laid down by the parents or other adults in authority. The second stage of moral development occurs from 12 years onwards, in which the adolescents can think abstractly and is becoming increasingly sensitive to other persons. According to Kohlberg, a moral sense is acquired through an internal and personal series of changes in attitudes. There are 6 stages of potential moral development organized within 3 levels. I.

PRECONVENTIONAL MORALITY- Egocentricity Children make moral judgements only on the basis of what will bring them a reward or punishment. This level is divided into three stages: Stage 0 (0-2 years): The good is what I like and want. Infants and young toddlers are egocentric, liking or loving that which helps them and disliking or hating that which hurts them. Stage 1 (2-3 years): Punishment-obedience orientation. The older toddlers and young preschool children believe that if they are not punished, their acts are right. If they are punished their acts are wrong. Stage 2 (4-7 years): Children focus on the pleasure motive. They consider those actions right that meet their own needs or those of others. They carry out rules to satisfy themselves or because of what others might do if they did not carry them out.

II.

CONVENTIONAL MORALITY Correct behavior is that which those in authority will approve and accept. If behavior is not acceptable, children feel guilty. There are 2 stages at this level. Stage 3 (7-9 years): Orientation to interpersonal relations. Children of early school age are socially sensitive and want to gain the approval of others. Stage 4 (10-12 years): Maintenance of social order, fixed rules and authority. Children want to do what they consider to be their duty. They obey rules and see justice as reciprocity between individuals and social system. When carrying out their duties, they show respect for those in authority. They want to maintain order among their peers.

III.

POSTCONVENTIONAL MORALITY Adolescents make choices on the basis of principles that have been thought about, accepted and internalized. Whatever actions conform to these principles, they are considered right in spite of the praise or blame of others. This level also has two stages: Stage 5: Higher law and conscience orientation. Adolescents give importance for values on attitudes and actions that benefit society. They are concerned that good laws be created that

will maximize the individual’s welfare. They think in rational terms. They give as well as take, they do not something without paying for it, and if they belong to a group they work towards its goals. Stage 6: Universal ethical principle orientation. In this level of highest moral value, individuals motivate and evaluate themselves. They have reached the level of selfactualization. They have internalized standards and integrity is of utmost importance to them. Regardless of what others say, they do what they think is right. They can obey the law but feel guilty if they have gone against their own principles.  EMOTIONAL DEVELOPMENT – Erik H. Erikson In each stage of a child’s emotional development a central problem exist for which a solution should be found. Solving each problem at the child’s particular stage of development lays the basis for the progress to the next stage. THE INFANT (0-1 YEAR): Sense of trust vs mistrust The infant learn to trust the adults, usually the parents, who care for them and are sensitive to their needs. A negative outcome of the period of infancy is a sense of mistrust. THE TODDLER (1-3 YEARS): Sense of Autonomy vs shame and doubt If children succeed in the developmental task of this stage in their maturing process, they will have a degree of self-control caused not by fear but by feelings of self-esteem. If they do not succeed they will doubt their own worth and that of others and will have a sense of shyness, doubt and shame. THE PRESCHOOL CHILD (3-6 YEARS): Sense of initiative vs guilt Children at this age want to learn what they can do for themselves. They have active imaginations, imitating adult behavior and wanting to share in adult activities. The positive outcome of this force within children is a sense of initiative. The negative is a personality overwhelmed by guilt. THE SCHOOL-AGE CHILD (6-12 YEARS): Sense of industry vs inferiority Children in this age group have a strong sense of duty. They want to engage in task in their social world that they can carry out successfully and they want their success to be recognized by adults and by their peers. The danger of this period is the development of a sense of inferiority.

EARLY ADOLESCENCE (>12 YEARS): Sense of identity vs identity diffusion Adolescents want to clarify who they are and what their roles in society are to be. Success in this period brings self esteem. The danger is identity diffusion, for they face in reality and in their dreams of the future life full of conflicting desires, possibilities and chances.

LATE ADOLESCENCE: Sense of intimacy vs isolation In adolescence, young people develop a sense of intimacy with individuals of their own and their opposite sex and with themselves. Failure to establish such intimacy results in psycho logic isolation.  SPIRITUAL DEVELOPMENT – James W. Fowler According to Fowler, faith is an ongoing process in which individuals form and reform their way of seeing the world. Persons may acquire their religious beliefs and preferences in childhood and may deepen those convictions as their faith develops, or they may change religious beliefs in adulthood . STAGE 1- PRIMAL FATH (INFANCY): This stage embodies the trust between parents and infants. The primary caregiver provides the infant and young child with a variety of experiences that encourage the development of mutuality, trust, love and dependence. STAGE 2- INTUITIVE-PROJECTIVE FAITH (EARLY CHILDHOOD): This stage is characterized by the child forming long lasting images and feelings. Imagination, perception and feelings are the mechanism by which the child explores and learns about the world at large. STAGE 3- MYTHIC-LITERAL FAITH (LATE CHILDHOOD): They are able to differentiate their thinking from that of others. Stories become the gateway to learning about life. In valuing the stories, practices and beliefs of the family and the community the child reaches the stage 3 of faith development. STAGE4- SYNTHETIC-CONVENTIONAL FAITH (ADOLESCENT AND BEYOND): In this stage, a person’s experience extends beyond the family to peers, teachers and other members of society. As a result of cognitive abilities, the individual is aware of the emotions, personality patterns, ideas, thoughts and experiences of self and others. As a result, the individual has a cluster of values and beliefs in concert with others.

 DEVELOPMENT OF SEXUALITY- Sigmund Freud According to Sigmund Freud, the sexual feelings do not suddenly emerge during puberty and adolescence but are present from infancy and gradually change from one

form or state to another until adult sexual life is achieved. It centers almost on the early years of life and include the following stages: a) b) c)

THE ORAL STAGE: During this period, the oral region or the sensory area of mouth provides the greatest sensual satisfaction for the infant THE ANAL STAGE: The greatest amount of sensual pleasure for the toddler is obtained from the anal and urethral areas THE PHALLIC STAGE: The greatest sensual pleasure is derived from the genital areas. The oedipal stage occurs in the later part of the phallic period. During this stage,

the child “loves” parent of the opposite sex as the provider of sensual satisfaction. The parent of same sex is considered to be a rival d)

e)

THE LATENCY STAGE: At the beginning of the latency stage the child has resolved or is resolving the oedipal conflict. During the latency period children form close relationship with others of their own age and sex THE PUBESCENT STAGE: During puberty, secondary sexual characteristics appear in both sexes. The same psychosexual conflicts that occured during the oedipal priod are revived. If children resolve the conflicts, they are free to enter into heterosexual relationships as adults.

GROWTH AND DEVELOPMENT:INFANCY Infant become children and children become adolescents passing through their parents lives &disappearing into adulthood, full-fledged person with lives and future of their own. Growth and development are terms often used interchangeably. Each depends upon others and in normal child, they are parallel each other. but the term are not the same .Growth and development, usually referred to as a unit, the process of growth and development starts before the baby born i.e from

the conception in the mother’s womb. The period extends throughout the life cycle. Each child has individualized pattern of growth and development .promotion of child

NORMAL PHYSICAL GROWTH:health and care of children depend upon understanding of growth &development

The physical growth and development can be divided into three areas-Biologic growth, motor development, 7sensory development. Changes in general body growth:Changes result from different rates of growth in different parts of the body during consecutive stages of development. for eg-The infant head constitutes one fourth of the entire length of the body at birth, whereas the adults head is only one eight of body length. Growth during childhood is primarily linear and in the nature of a filling out process until adult proportions are reached. Length and height:Average length of full term baby is 45-50 cm at birth. Height increases at the following rate:First 5 month length increases by 2.5cm/month.

From 6 to 12 month At 9 month

1.5cm/month 70cm

One year

75cm

Two year

85cm

Three tear

95cm

Four year

100cm

Height increases by 2.5cm(1inch) a month during the 1st 6month and slows during the second 6 months. Increases in the length occur in sudden spurts, rather than in a slow gradual

pattern. Average height is 65cm (25.5 inches)at 6 months and 74cm (29inches)at 12 months. By 1 year the birth length has increased by almost 50%.This increases occurs mainly in the trunk, rather than in the legs& contributes to the characteristics physique of the infant.

Weight:a) The average weight of full term baby at birth is 2.5 to 3kg. b) During the 3 to 4 days of birth 10% of his birth weight loss due to adjustment with the environment, inadequate feeds and digestive adaptation. c) By the 10th day of life he regains his birth weight. d) Infant gain about 150 to 210g (about 5 to 7 ounces) weekly until approximately age 5 to 6 month, when the birth weight has at least doubled. An average weight for a 6 month old child is 7.3kg (16 pound) weight gain slows during the second 6 month. e) By 1 year of age the infant birth weight has tripled,2 year increases 4 times,3 years 5 times,5 years birth weight increases to 6 times,10 years it increases to 10 times. Head circumference:The circumference of head is an important measurement since it is related to intracranial volume. At birth it is 33 to 35cm about 2.5 to 3cm more than the chest. A 3 month 40cm and 12 month 45cm.Boys have slightly larger head than girls. Passing a measuring tape over the head to overlie the most prominent part of the occiput and area just above the eyes brows or just above the supra orbital ridges in front. Posterior fontanels closed closed by 6 to 8 weeks of age Chest circumference:At birth the circumference of chest is about 2.5 to 3cm less than the head circumference. The circumference of head & chest comes equal by one year. By the age of 5years,chest circumference is 5cm more than head circumference. For measuring this type should be kept at the level of nipple line and should be taken in midway between inspiration &expiration Reflexes:-

a) At 1 month of age child develops sucking, rooting, swallowing and asymmetric tonic neck reflex (head turned to one side, one arm extended on the same side, the other arm flexed to shoulder.) b) At 3 month grasping reflex absent &landau reflex appears an infant suspended in a horizontal prone position with the head flexed against the chest reflex draws the legs up against the abdomen. c) At 4 month tonic neck, moro, sucking rooting reflexs absent. d) At 6 month two lower central incisors erupt begin to bite and chew. e) At 7 month sucking & rooting reflex disappear parachute reflexes appear between 7 to 9 month. An infant suspended in a horizontal prone position and lowered suddenly l

extend the hands forward and to provide protection from falling.Upper central incision erupts &lower lateral incisors erupt. f) At 8 month beginning of a pattern in bowel and bladder elimination. g) At 9 month planter grasp absent upper lateral incisors erupt. h) At 10 month macula is well developed so that the visual discrimination can be made. i) Anterior fontanels closed by 12 to 18 month, Babinski, landau reflex disappear between 12 to 24 month. Physiologic stability achieved &maintained during first year. NORMAL DEVELOPMENT:In this section, you will learn about the expected developmental milestones to be achieved at different ages. The child develops is assessed in four separate segments i.e a) gross motor b)fine motor &adaptive c)personal social d)language. A] GROSS MOTOR DEVELOPMENTGross motor development involves control of the child over his body. Development of the child is observed in the following positions:Ventral suspensionThe baby is held in prone position and then lifted up from the bed, with the examiner supporting the chest or the abdomen of the baby with the palm of his hand.  

In the newborn child, the head flops down. From the age of 4 weeks to 12 weeks the infant learns to lift and control his head in the horizontal plane and then above the horizontal plane.

Supine position-

The infant is placed in the supine positions and is gently pulled up by the arms to a sitting position. Movement of his head and curvature of his spine are observed.  In the newborn infant, the head lags behind completely and the back appears rounded.  The infant gradually gains control of his head between the ages of 12 &20 weeks and the curvature of his spine becomes less prominent. Prone positionThe examiner observes the baby while it is lying in the prone position.  Within a few days of birth the head can be turned to one side.

 At 1 month, the baby lifts the chin up momentarily in the midline.  At 3 month, the infant lifts his head and upper part of forearms.  By 6 months he can lift his head &greater part of his chest while supporting weight on extended arms.  Between the age of 5 and 8 month, he learns to roll in bed at 1st from back to side and then from back to stomach.  By the age of 8 month he crawls in bed.  By 10month the child creps, keeping his abdomen off the ground. SittingThe infant learns to control his body in the sitting position from the age of 5 month onwards, initially, he needs several pillows or support of the examiner’s hand at his lower back so as to remain steady.  By the age of 8 month he can maintained steady, sitting position with straight back.  By the age of 10th months, he can pull himself up from the supine to sitting position. Standing and walkingAn infant can bear some weight of his body with straight legs in the months.

mothers lap by 4

 By 9 month, he makes early stepping movements when feet are placed on the surface of the table.  By 10th month or so the infants starts cruising around the furniture.  By 1 year, the child can stand without support for 10seconds or more and can usually take a few steps in walking without tipping from side to side in the next one or 2 month.  Child walks alone between 13-15 months of age.

Climbing stairsThe child can climb the stairs by the age of 2yrs.In the process, he brings both his feet up on one step before he climbs to the next.

B] FINE MOTOR AND ADAPTIVE DEVELOPMENT:This includes co-ordination of eyes, hand eye coordination, hand mouth co-ordination &skills for manipulation with hands. The ability of the child to perform fine motor activity and maneuvers is tested with the aid of particular test objects such as a) a red ring of diameter 6.5cm,tied to a red string b)a pen torch c)red cubes d)a pellet e)cup with handle f)a spoon g)a book of thick pages h)a red pencil or craynon i)paper j)wooden blocks k)a doll and l)mirror.  Hand eye co-ordination –  Red ring-At the age of 4 month, the infant tries to grasp the red ring on rattle dangling in front of him. Initially, he may overshoot, but eventually gets it to his mouth.  Red cube – by the age of 5 month, he can reach for a red cube, which is held within reach. He holds the cube in his palms in a crude manner by 7 months of age pincer grasp with the index finger and thumb apposition is acquired by 9-10 months. He can transfer object from one hand to other by 5-6 months.  Pellet-He develops fine more co-coordinated hand skills by the age of 9 month. When he can scoop on a pellet crudely with his palm. By 10months he can pick it up neatly, using ends of his thumb and index finger.  Eye coordination  Looks at and plays with own finger.  Holds hand in front of face and stares at them by the age of 3 month  Red ring-if a ring tied to a string or lighted torch is brought in front of the infant, he can regard if it is kept at a distance of 20cm by the age of 4weeks. Within the next 2 week(age 6 weeks) he follows the object which is moved from side to side by several unsteady excursion of eyes. By the age of 2-3 months the infant follows the object with steady movement of the eye .By time he can also coverage and focus his eye.  Binocular vision- develops by 3-6 month. Depth perception begins by 6-8 months but is not very accurately established till the age of 6-7years

 Hand to mouth coordination Infant readily brings object from hand to mouth at the age of 2-4 months  By the age of 8 months drinks from cup with assistance.  Holds own bottle with good hand –mouth coordination. puts nipple in and withdraws it from mouth at will by 9 months.  Feeding-this is assessed by observing the feeding behaviors with spoon and cup. By the age of 1 year the baby tries to feed himself with a spoon but in the process he often rotates the spoon and spills the contents  By the 15 months he learns to feed himself with spoon without spilling its contents

 Hand skills At one month infant holds hand in tight fist. Can grasp an object placed in the hand(palmar grasp) but can drops it immediately.  At 3-4 month holds object with both hand with active grasp and brings hands together in midline plays with fingers.  At 5-6 month tries to obtain objects beyond reach and holds one object while looking at another.  7-8 month begins to transfer object from one hand to other. pincer grasp beginning to develops, using the fingers against the lower portion of the thumb.  10-12 month picks up small objects up with index finger &thumb. Removes cover from boxes &takes toy out of box or cup. beginning to hold a craynon &make a mark on paper and turn pages in a book but usually not one at a time. C] PERSONAL SOCIAL DEVELOPMENT: The domains relates to interpersonal and social skills.  Social smile and recognition of mother:The infant intently regards the face of the mother or the examiner by the age of 1 month he smiles back (social smile) when the examiner tries to speak to him or smiles to him without the infant tries to grasp touching him at 2 months .the child recognizes the mother by the age of 3 month. at the age of 6 month the infant enjoys watching his own image in the mirror. He shows anxiety on meeting strangers as he becomes 7-8 month old Toys-the child resist if a toy is pulled from his hand by the age of 7monyh.He makes determined effort to get a toy kept a little out of his reach by the age of 9 month. Mimicry-at one year of age the child repeats any performance which evokes appreciative response from parents and mimics the actions carried out by the mother at home.

Other interactions-He waves bye bye at 9 month and plays a simple ball game at 1year and knows his gender at 3 years . D] LANGUAGE DEVELOPMENT: Hearing-at one month he turns his head towards the sound of a bell or rattle.  Sounds-by 6 month he produces monosyllable sound like da,ma,but without attaching any meaning to them(this is not true speech) bisyllables(baba,mama)are spoken by 9 month of age.

 Understanding-by 10th month ,he can understand spoken speech and respond in an appropriate manner to verbal request made without an accompanying gesture,eg,where is dady? Where is the light?  True speech-by the age of 1 year child can use 2 words with meaning for objects of daily use.  E] PSYCHOSOCIAL AND EMOTIONAL:According to erikson, the first and the probably most important of these is the development of the sense of trust. it can be strengthened or weakened by the experiences after the 1st year of course, but the foundation is laid in infancy. if this sense of trust in others is not learned, the reverse a sense of mistrust is acquired. During the 1st 6 month the concept of mutual regulation between mother and infants, especially as it applies to feeding must be established if the infant is to trust her.  At 1st month-beginning development of sense of trust. child is totally egocentric, complete dependence on caregiver, usually mother, establish eye contact.  At2-3 month-distinguish “mother” as primary caregiver from others and is more responsive to that person. eye to eye contact is maintained, face orientation, smiling, vocalization are the evidences of attachment between infant &parent. smile back in response to another stop crying when familiar person approaches.  4-5 month-initiates social play by smiling or vocalizing, shows interest in new stimuli. smiles at self in mirror. play with own feet.  6-7 month-recognizes parents & strangers as different from family member actively clings to familiar person when distressed &unhappy. respond socially to name &close lips tightly when disliked food is offered.  At 8-9 month-greets strangers with coy or bashful behavior turning away, cry or even screaming, separation or strangers anxiety. knows what “no” means, begins to play simple games with adult such as Bye-bye.

 At 10-12 month-express several recognizable emotion such as anger, sadness, jealous, anxiety, pleasure activity. start to play social games with adults such as “pat-a cake” “peekboo”. Respond to request for affection such as a kiss or hug. cooperates in dressing put arms through sleeves. F] PSYCHOSOCIAL DEVELOPMENT:According to Freud there are 5 phases of psychosocial development center almost exclusively on the early years of life. Oral stage(period of infancy the 1st year of life)during this period the oral region or the sensory area of the mouth, provides the greatest sexual satisfaction for the infant.

The source of bodily pleasure is concentrated in zones around the mucocutaneous junctions. These erotogenic zones displace one another in sequence as the child matures. Initially, the infant erotogenic zone is the mouth thus gratification of the id is derived through oral satisfaction. During the 1st- 6 month of life, the infant is in the oral dependent or oral passive stag as evidenced by sucking. after 1st teeth erupts at about 5-7 month of age, the infant enter the oral aggressive stage with biting &sucking as the means of gratification. Infant enjoy sucking and later biting anything that touches the erogenous zone of the lips and mouth. some infants enjoy this oral activity more than others. while some may be satisfied by sucking at the breast or bottle, other require pacifiers, toys & another objects that can be orally manipulated. The young infant operates on the basis of primary narcissism or self love, wanting what is wanted immediately and unable to tolerate a delay in gratification. This id process the pleasure principle later becomes part of ego structure that operates on the reality principle giving up what is wanted now for something better in the future G] SPIRITUAL DEVELOPMENT:Fowlers describes spiritual development during the period of infancy as stage 1 primal faith. During the early years, the infant forms an attachment for parents that develops trust, hope &autonomy as a result of the give and take relationship. H] INTELLECTUAL OR COGNITIVE DEVELOPMENT: Piaget theory posits that intellectual development follows a sequence of stages over a period of time, just as other type of development with each stage having unique characteristics.

Piaget theory describes four major cognitive process Schema is the category of thought or a classification for behavior or an action.  Assimilation is the process during which stimuli are recognized absorbed and incorporated into an already existing schema.  Accommodation is the creation of a new schema or the modification of an old one.  Equilibrium or the achievement of a balance between 2 elements like assimilation &Accommodation. The sensory motor stages composed of six sub stages. Four sub stages are during the st 1 year of life &other two sub stages are presented when the intellectual development of the toddler is discussed.

 Sub stage 1(birth -1 year) The biologic reflexes are the basis for the neonate survival. During the assimilation or the repetition of reflexive action such as sucking even though not hungry Generalized assimilation-occurs when the infant no longer sucks only the breast or bottle but other non-nutritive items like a fist. Recognitory assimilation-occurs when the hungry infant will not accept a substitute for the breast or bottle.  Sub stage 2(1-4 month) voluntary actions replacing reflexive behavior .infant repeat simple acts what infant learns during this time is related to their bodies. Palmar reflexes fade between 2-3 month. Through sucking a fist, infant learn that sucking a thumb is much better. At 1 st infant bring the mouth to the thumb and only later bring thumb to the mouth. Infant try this action many times before it accomplished. Sucking the thumb thus becomes a deliberate act. During this stage the infant hear &see that belong to the same experience become mentally co-ordinated .for eg. hungry infants at first will stop crying only when the nipple is placed in their mouth. if mother consistently speaks or sing to their infant immediately before feeding. the infant associate these acts and will eventually stop crying. when mother voice is heard, before the nipple is feet. This early coordination of sensory experiences is the basis for the establishment of object permanency.  Sub stage 3(4-8 month)

The secondary circular reaction occurs in this sub stage. This reaction involves event that are removed from the infant’s body. event that occur by accident in the environment are repeated by accident in the environment are repeated by the infant if they produce interesting results. they are secondary because they are intentinal. for eg. A rattle will make a noise accidentally. The infant will try to repeat the action to make this noise by coordinating many schemas, finally reproducing the action consistently. The original voluntary grasping of a rattle has now become banging and snaking.

 Sub stage 4(8-12 month) The secondary reaction the infant learned earlier are combined and extended deal with new situations. When coordination of secondary schemas and their applications to new situation occurs, the reaction of the infant are more flexible than they were earlier. Object constancy or the existence of objects even when they are out of sight progresses during sub stage 4.for eg if the mother hides a rattle the infant will search for it &find it even removing barriers to achieve this end. If the mother moved it from one place to another, however the infant would still search for it in the place where it was last found. The infant does not always research for objects where they disappeared but rather where they were found last time. During this sub stage the infants begins to perceive a relationship between cause and effect. Early problem solving ability &the beginnings of anticipatory and intentional behavior are developing. Although imitation begins at about 5-6 month of age, like imitating the sounds gestures of other persons in the environment.

I] MORAL DEVELOPMENT:As described by piaget moral development parallels mental development whereas Kohlberg divides moral development into 6 stages. i. ii. iii.

Preconventional morality. Conventional morality. Post conventional morality.

At Kohlberg level 1: preconventional morality stage 0 from birth to 2 year of age, infants &early toddlers are egocentric and unable to understand rules or to judge what is good or bad in terms of rules or authority. They are guided only by what they want to do &can do. What is pleasant is good What is unpleasant is bad. Both piaget &Kohlberg believe that social interaction &experience are the major determinants of now the child progress from one stage to another in moral development. parent or other person who interact with the child can hasten moral development if they know what the stages are and can help the child prepare for next stage.

J] LANGUAGE & SPEECH DEVELOPMENT:Children are born with the mechanism and capacity to develop speech and language skills. The environment must provide a means for them to acquire these skills. speech requires intact physiologic structure &function.(including respiratory, auditory &cerebral plus intelligence, a need to communicate &stimulation. The rate of speech development varies from child to child and is directly related to neurologic competence and cognitive development. research suggests that infant can learn sign language before vocal language and that it may enhance the development of vocal language. The infant learns to transmit non verbal messages by watching the facial expression, hand and arm movement &body gestures of other. The infant is receptive to language and express a type of communication from birth.  At 1 month infant open and closes mouth as adults speaks. and also responding to voices ,cries & begins to coo.  At 2 month cries becomes differentiated for eg hunger, sleepiness, or pain  At 3-4 month vocalizes in response to others; coos and chuckles ,may laughs aloud.  At 5-6 month begins to mimic sounds cries easily when withdrawing a toy. Respond when own name is spoken.  At 8 month Infant can combine syllables such as da-da, ma-ma but without specific meaning.  At 9-10th echolalia or correct imitative expression of sound made by others occurs. Understand meaning of bye-bye  At 11 month jargon well established, may speak two or more words besides ma-ma, da-da. knows name of increasing number of objects, imitates sounds animals.

Play and stimulation:Play contributes to all types of growth and development, both gross and fine motor activity are honed, and the senses exercised .Muscular movements become co-coordinated through batting at a crib mobile or shaking and banging a toy, thus making these activities easier to repeat. Play activities also help infants develop a sense of trust. the types of play activities under taken by infants depend on their levels of cognitive ability. Although the general purpose of play are the same for all infants. Play is an individual matter. The parent or nurse role in play is as a responder and facilitator.

Infant need to be stimulated at appropriate times by a change of environment, by a change in position, by contact with various textures of materials, by various sights and sounds, and by human contact. Play responses during infancy:Infants of all ages move from one activity to another rapidly because their attention span is so short. Types of play enjoyed by the infant include motor play, vocalization, and using toys in a variety of ways.  Birth to five month:-An early type of motor play, useful for exercise, is also thoroughly enjoyable to infants. The activities of kicking, wiggling, playing with their hands, reaching for objects, attempting to turn over, &vocalizing give both infant and parents pleasure.  Five to eight month:-At this age the infant still finds, pleasure in motor activity for its own sake, playing with the feet, and sitting, bouncing the body, grasping at anything that can be reached, and moving on the floor or in the play yard by hitching.  Eight to ten months:-Motor activity is the chief source of play, vocalization. Now the infant can sit alone. They like to lean over the side of the carriage or the arm of a high chair. Infant roll with ease, crawl, creep, pull into a sitting position and sitting position and stretch to obtain toys that are out of reach  Ten to twelve month:Infant can play alone for relatively long periods but now let the family know when their company or another toy is desired. Play is becoming more highly developed. Infant playing a sitting position creep about &enjoy pulling to a standing position &perhaps walking with slight assistance. Infant also play with several toys, picking them up and dropping them. They can grasp a ball and let it go and will take or give a toy by request or gesture. Injury prevention and control:-

House is an exciting place for infants and children to explore enjoy and invite troubles. As child grows, the child becomes more curious and mobile, requiring the parents to be more alert and cautions. An accident is defined as an “unexpected unplanned occurrence of an event which usually produces unintended injury, death or loss of property” The most common modes of accidents in infants include falls, aspiration of foreign body, mechanical asphyxiation, drowning, burns and poisonings.

1) FallThese are common in the age group of 4-12 months when the infant learns to roll over in the bed, or creeps in an attempt to reach for objects.     

Set the mattress at lower level and never let the infant play alone in a high cot. Use cribs with long rails. A soft pillow on the side alone may not suffice especially in an older infant who may fall over it. Do not keep the infant in high chair unless the child is able to sit without support. Do not lift the infant by his one limb; it may slip.

2) Aspiration /swallowing of foreign body Ensure that toys do not have small detachable parts that can be swallowed.  Use large soft toys with smooth edges.  Parents must ensure that small buttons, peanuts are not used or thrown in infant’s room.  3) suffocationIncludes mechanical obstruction of nose, mouth, airway or chest in such a manner that can effective respiration is hampered.    

Furniture in the home should be properly spaced to ensure the crawling infant does not get stuck in between them. Avoid use of nonporous films like plastic covers and bags, as the infant can inadvertently play by covering the face with them. Avoid use of same bed for an adult or an older child with the infant to prevent suffocation. Avoid use of large strings that an infant might wrap around the neck to cause suffocation.

4) Fire and burn:Diyas, cooking stove, chullas, steam press, open electrical sockets, loose hanging wires, crackers are common household ways of opening a fire. Burn is caused by open fire.    

Diyas should be kept well above reach of crawling infant and put off before going to sleep Discourage infants to enter in kitchen during cooking hours. Keep the matchbox, lighters, blowers, steam press, kerosene, and diesel away from infant’s reach. Turn of the gas knob and regulator after the use; ensure regular checking of the rubber tubes for any leakage.

5) Drowning:It can occur uncommonly in the bathroom in an infant more than 10 months of age   

Never leave the infant alone in a bathroom, The child can peep into the collection of water and drown himself in the bath tub or a bucket filled with water Keep the infant away from swimming pools or any other water bodies like wells and they should be well fenced. Always keep the door of bathroom locked unless in use.

6) Poisoning:A curious crawling infant who wants to explore his surroundings is most susceptible to ingestion of common house hold poisons.    

Always keep the fuel like kerosene, detergents, washing powder, insecticides, mosquito repellants, roddenticides, medicines, pills in a well locked high shelf well away from the reach of the infants Never take medicines and pills in front of the infants Never leave the medicines on kitchen table or bed side Never tell or teach your kids that the medicines is a sweet as they might self consume thinking it as a sweet

7) Other injuries:Common house hold objects and furniture can result in injury   

Avoid choosing furniture with sharp edges and protruding ends Keep infant away from pet animals, avoid rearing them during infancy Keep the sharps like knife, razor blade ,forks away from the infants reach.

Conclusion:-

Growth and development of the human organisms is a continuous process that begins before birth, each stage depends upon the preceding stage .all the infants and children progress similarly but the ages at which they achieve these stages vary. The diverse areas of growth and development are interrelated. All aspects- physical, psychosocial, emotional psychosexual, spiritual and intellectual, cognitive or moral, language &speech interact in various ways affect the other in the normal advance toward maturity. infant and children who are not given opportunities to learn by experience and from others at the optimal times-those periods in their development when they are best able to learn particular task-are hindered in the learning process.

Play also plays an important role in the development of infant since play of one type or another occupies almost all of a child waking hours It is important for the nurses to understand the early period as well as the total of an individual to better understand the behavior of parents and other adults who provide care for the child.Nursing strategies of the child includes incorporating the parents into the child’s care and fostering the child’s continued development. BIBLIOGRAPHY         

Dorothy R. Marlow, Barbara A. Redding, Textbook of Paediatric Nursing, 6th edition, 2005, W.B. Saunders Company, pg 163 – 181. Marilyn J. Hockenberry, David Wilson, Wong’s Nursing care of Infants and Children, 8 th edition, 2007, Elsevier Inc., pg. 500-517, 608-614. Parthasarathy A., IAP Textbook of Paediatrics, 4th edition, Jaypee brothers, pg 80-83. Ghai.OP and etal.Essential Paediatrics,6 th edition2004CBS publishers,NewDelhi pg44-47 Gupta.P.Essential Paediatric nursing 2nd edition 2007 CBS publishers page93-100,122-125 https://medlineplus.gov/ency/article/002456.htm http://pedsinreview.aappublications.org/content/18/7/224 https://www.emedicinehealth.com/infant_milestones/article_em.htm http://www.medbroadcast.com/channel/baby-health/your-babys-development/growth-anddevelopment-newborn-to-12-months