Growth and development are important considerations nurses should remember when dealing with children. Growth and development is a critical aspect of the holistic nature of nursing.

Growth is the quantitative (measurable) change in physical size of the body and its parts, including increases in cells, tissues, structures, and systems. Development is a qualitative term that refers to behavioral changes and increasing competency in functional abilities and skills. Maturation depends on biological growth, functional changes, and learning. Certain developmental tasks (goals) must be achieved in each stage of the life cycle. The critical period is the time of the most rapid growth or development in a particular stage of the life cycle.

Certain principles are basic in growth and development. (1) development occurs in a cephalocaudal (head-to-toe) direction; (2) development occurs in a proximodistal manner (from areas close to the body to areas away from the body), such as from upper arm to fingers; (3) development occurs in an orderly manner from simple to complex and from the general to the specific; (4) the pattern of growth and development is continuous, orderly and predictable, though growth and development do not proceed at a consistent rate; (5) every person proceeds through stages of growth and development at an individual rate; (6) every stage of development has specific characteristics; (7) growth and development may temporarily stall or regress during critical periods; (8) each state of development has certain tasks to be achieved or acquired during a specific time and tasks of one developmental stage become the foundation for tasks in subsequent stages; (9) some stages of growth and development, such as the first three months of fetal development, are more critical than others.

Growth and development is influenced by a child’s genetic/hereditary pattern, life experiences, health status, and cultural expectations. The five dimensions of growth and development are the physiological, psychosocial, cognitive, moral, and spiritual dimensions. Physiological growth is influenced primarily by the interaction of genetic predisposition, the central nervous system, the endocrine system, and maturation. The psychosocial dimension consists of subjective feelings and interpersonal relationships and self-concept (the view of one’s body image, self-esteem, and ideal self), which is the most important key to a person’s success and happiness.

The psychosocial theories that explain the development of self-concept are intrapsychic (psychodynamic) theory and interpersonal theory. Intrapsychic theory, exemplified by the theories of Sigmund Freud, Erik Erikson, and Havighurst, focus on an individual’s unconscious processes (feelings, needs, conflicts, and drives) that are considered to be motivators of behavior, learning, and development. Interpersonal theory, exemplified by Harry Stack Sullivan, states that relationships with others influence how one’s personality develops.

The cognitive dimension characterizes the intellectual process of knowing, including perception, memory, and judgment. The major theorist in the cognitive dimension is Jean Piaget who theorized that children learn to think by playing. Piaget’s proposed several phases of cognitive development: the sensorimotor, preoperational, concrete operations, and formal operations phases. The individual learns by interacting with others and the environment through assimilation, accommodation, and adaptation.

The moral dimension consists of a person’s value system that helps in differentiating right and wrong. Moral maturity is the ability to independently decide what is “right.” Both Piaget and Lawrence Kohlberg have studied the development of moral judgment. Piaget theorized that children are amoral until the age of seven, when they move to the moral realism stage, in which actions are judged as totally right or totally wrong. During middle childhood or early adolescence, children move into the stage of autonomous morality, in which they are able to consider the intentions behind the action and the consequences of the action. Kohlberg identified three levels of morality: the preconventional level, based on obedience or punishment; the conventional level, a good boy/nice girl orientation; and the postconventional level, when reasoning focuses on abstract principles of right or wrong.

The spiritual dimension, characterized by a sense of personal meaning, refers to relationships with one’s self, with others, and with a higher power or divine source. Fowler has developed a theory describing several stages of faith: undifferentiated, intuitive-projective, mythical-literal, and individual-reflective.

Nurses need to understand the various stages of the life cycle in order to deliver appropriate care. The first is the prenatal period, beginning with conception and ending with birth. The prenatal period includes the germinal stage, the 10 to 14 days following conception; the embryonic stage, two to eight weeks after conception; and the fetal stage, from eight weeks to birth. Pregnant women need regular physical examinations and screenings during the prenatal period. They also need good nutrition and stress management techniques. The fetus is vulnerable to poor nutrition and to toxic substances, such as tobacco and alcohol, in the uterus. Smoking can cause premature birth, retarded growth, learning difficulties, and fetal death. Alcohol ingested in the first trimester can cause fetal alcohol syndrome, characterized by certain physical attributes and intellectual problems. Other teratogenic substances have been known to cross the placental barrier and impair normal growth and development.

During the neonatal period, the first 28 days of life, the infant stabilizes. The major psychological task during this period is the bonding, or attachment, between parents and child. The nurse should assess the infant thoroughly during this period and promote bonding, good nutrition, infection control, care of the umbilicus, incorporation of the infant into the family unit, and the use of an infant car seat. During infancy, from one month to one year old, the nurse’s focus should continue to be on safety, preventing infection, and incorporating the child into the family. During the toddler period, from 12-18 months to age three years, the child learns toileting skills and is learning to interact with family. The child, attempting to assert autonomy, frequently uses the word “no.” The nurse needs to teach parents realistic and consistent parenting during this period. Toddlers are vulnerable to major stress when hospitalized if they are separated from their parents. Toddlers are at risk for injuries, such as accidental poisoning, since they are curious and increasingly mobile.

During the preschool stage, from ages three to six, physical growth slows and psychosocial and cognitive development are accelerated. The child begins to develop relationships with others during this period. They learn from play and are increasingly at risk for accidents. During the school-age period, from six to 12 years old, the child’s world and social networks expand. They need academic, sports, and social activities to promote creativity and expression. They can understand health teaching but are at risk for injuries occurring during play.

During the preadolescent period, the later school-age years from 10-12, children experience the hormonal changes that result in puberty, in which the secondary sex characteristics appear. During this period, children need to learn about the growth spurts they will be going through, accompanied by the needs for good nutrition and rest.

During adolescence, from the onset of puberty to the ages of 18-20, the child experiences numerous physiological changes and rapid physical growth. The teenager begins to get a sense of personal identity and is very concerned about appearance. They are at risk for eating disorders, such as anorexia nervosa, bulimia, and obesity; injuries; smoking, alcohol, and other substances; nutritional and dental problems; pregnancy; sexually transmitted diseases; mental health problems; and sexually transmitted disease. Nurses should provide information about nutrition, hygiene, the bodily changes they should expect, and the challenges of adolescence with a nonjudgmental attitude.