Learning Objectives
By the end of this section, you will be able to:
- Identify normal developmental changes from newborn to older adult
- Discuss different types of play and its importance in development
Though growth and development are often used interchangeably, they serve different purposes for the patient. The term growth refers to an increase in physical size. In the case of a patient, this includes the physical size of the whole body and of all corresponding body parts. The term development, on the other hand, is the process by which a person gains various skills and functions (Table 38.1). Most development occurs during the infancy and childhood periods (Figure 38.2); however, development can occur throughout the life span. The typical pattern of growth and functional motor development is cephalocaudal, meaning from head (cephalic region) to toe (caudal region). The cephalocaudal pattern reflects the idea that growth and development often follow a sequential order, with skills and abilities emerging in a top-down manner. While this pattern is a general trend, it's important to note that individuals may vary in their developmental trajectories, and some may demonstrate unique patterns or exceptions to this overall sequence.
| Growth | Development |
|---|---|
| Height | Cognitive development |
| Weight | Psychosocial development |
| Head circumference | Personality |
| Skeletal growth | Communication |
| Bone density | Sexuality |
| Muscle mass | Motor |
Growth and Development over Time
Cognitive, psychosocial, personality, communication, sexuality, and motor function development can impact many aspects of nursing care. Thus, nurses working in any arena of health care must have a baseline understanding of how patients grow, develop, and mature over time (Centers for Disease Control and Prevention (CDC), 2022). The timeline of achievement for these milestones can be assessed in a multitude of ways. Formal tools, such as the Prescreening Developmental Questionnaire (PDQ-II) and the Denver II Developmental Screening Test (DDST-II), may be used to assess development of fine motor skills (precise movements of small muscle groups), gross motor skills (coordination of large muscle groups), personal-social skills, and language skills in young children. The PDQ-II is a prescreening tool used to determine if additional screening is needed with the DDST-II. Using the PDQ-II as a prescreening tool assists healthcare providers in efficiently identifying children who require further assessment. In addition to such tools, nurses can determine where a patient stands developmentally through a health history, interview, or physical assessment.
Link to Learning
Explore how to administer the Denver II Developmental Screening Test.
This section covers the highlights of growth and development for the following age groups: newborn, infant, toddler, preschool, school age, adolescent, young adult, adult, and older adult. Detailed information about these populations is covered in later chapters: Chapter 39 Conception Through Adolescence, Chapter 40 Young and Middle-Aged Adults, and Chapter 41 Older Adults. For additional information regarding nutrition considerations for these populations, see Chapter 21 Nutrition.
Link to Learning
Watch this video overviewing stages of developmental milestones for pediatric patients.
Newborn (0–28 Days of Life)
The newborn (neonatal) stage, spanning from birth to 28 days of life, is characterized by rapid growth and development. On average, a newborn weighs about 7 lbs (3.4 kg) and measures 20 in (50 cm) in length, with a head circumference of 14 in (35 cm). Within the first seven days of life, newborns typically lose about 10 percent of their body weight due to the elimination of excess fluid and nutrients acquired from their mothers. As they begin feeding on breast milk or formula, they gradually regain fluid volume and exhibit an average weight gain of 1 oz
(30 g) per day, typically reaching their birth weight again within ten to fourteen days.
Infant (0–12 Months)
The infancy stage is the period from birth to 12 months of age. Weight, length, and head circumference all increase rapidly during this period. Infants may grow up to 1 in (2.5 cm) per month and gain 5 to 7 oz (142–198 g) per week for the first six months. Between 6 to 12 months, they can grow 3/8 in (1 cm) a month and gain 3 to 5 oz
(85–142 g) a week. The average infant is expected to double their weight by about 5 months of age and triple their birth weight by about 12 months of age.
During the infancy stage, many vital organs undergo significant and integral changes. Externally, infants are also achieving great milestones. By the end of their first year, children typically will have begun interacting with other people and toys as well as babbling, sitting, crawling, standing, starting to walk, and saying a few words; teeth eruption will also have begun.
Patient Conversations
Addressing Caregiver Concern
Scenario: Anne is the mother of Tatum, a 7-month-old child. She has one other child, who is now 4 years old and at home with her husband. Jeff is the nurse currently working in the pediatrician’s office. Jeff just completed a head-to-toe assessment on Tatum.
Nurse: Tatum looks great and is a very happy baby. Did you have any questions or concerns about his growth and development?
Patient’s caregiver: I have been a little concerned about him struggling to pick up his snacks with his fingers. He has been able to hold rattles and toys for a while now, but he still can’t use his fingers to pick up bits of cereal, for example. I don’t remember how old my other son was when he could easily pick up his snacks by himself. Should I be concerned?
Nurse: I understand why you might have a concern regarding specific milestones. There are many gross and fine motor skills that develop during this first year of life. Babies are able to hold a toy or rattle placed in their hand around 1 month of age. This typically involves using their entire hand to grasp the object. Children develop a different grasp, called a pincer grasp, later. A pincer grasp involves using the thumb and index finger—that is, their forefinger or pointer finger—to pick up small objects. This skill usually develops around 9 months of age. It is what Tatum will use when he starts picking up his cereal. It is an important fine motor skill, as it sets the foundation for other skills such as holding a pencil, zipping a zipper, or buttoning a button. Though there are outlined ages for all milestones, it is important to remember that each child will develop on their own timeline. Your two children may reach their milestones at slightly different times.
Patient’s caregiver: All right, but when should I become concerned if Tatum continues to struggle?
Nurse: We can provide you with some resources for general milestone landmarks to take home with you. We also keep an eye out at all medical appointments to ensure Tatum is on track overall. If you’re still concerned at Tatum’s next appointment, we can discuss it further.
Toddler (1–3 Years)
During the toddler stage—between 1 and 3 years of age—there are dramatic changes in cognitive, physical, emotional, motor, and language skills. Though their rate of growth and food intake slows, toddlers typically quadruple their birth weight during this period. Additionally, by 2 years of age, children are approximately one-half of their adult height. Toddlers are known for “toddling” around as they practice walking and finding their voice with short sentences and a growing vocabulary. They are also known for exploring their independence and pushing boundaries. Major gross motor milestones obtained during this stage include walking independently, climbing stairs, and standing on tiptoes. Many fine motor skills are also developed during this stage; they include using their index fingers to point, removing their socks or shoes, building towers of blocks at various stages, and undressing.
Preschool (3–5 Years)
A preschooler is a child from 3 to 5 years of age. They increase their social activities and contacts during this stage—especially if placed in a more formal educational or care setting for at least part of their week. Motor skills improve as they learn from other children and mimic their behaviors, both negatively and positively. Dramatic play, utilizing their vast imagination, is key during this stage to foster growth and learning.
Middle Childhood (6–11 Years)
The middle childhood is the period between 6 and 11 years of age. It is the bridge between preschool and adolescence, when children start to refine their previously accomplished motor skills. They also focus more on activities they enjoy and excel at, such as art, writing, physical games, theater, music, cooking, and science activities. Play becomes more formalized and rules become a large part of how these children operate. Though peers become more important during this stage, the family unit is still a crucial influence on development.
Link to Learning
The Centers for Disease Control and Prevention (CDC) is an excellent resource for healthcare providers, as well as caregivers, to gather reputable information about growth and development in children.
Adolescent (12–17 Years)
The adolescence is the period from 12 to 17 years of age; it marks the end of childhood and the transition to adulthood. The onset of puberty begins a time of significant growth and developmental changes, as sex organs and sex characteristics develop and individuals become capable of reproduction. The average age for onset of puberty in people assigned female at birth is 11 years old; in people assigned male at birth, it is 12 years old. However, pending any additional complications, it is acceptable for children to begin puberty between 8 and 13 years of age. As adolescents become less reliant on caregivers for transportation and funding, peers become an increasingly important influence. Activities become more dangerous with access to motor vehicles and ancillary activities stemming from independence.
Link to Learning
As the largest professional association of pediatricians in the United States, the American Academy of Pediatrics website is a credible source for parents and providers to learn more about growth, development, and care of pediatric patients.
Young Adult (18–35 Years)
Adulthood ranges from 18 years of age until death, with various subsets of categories in between. A person who is 18 to 35 years of age is considered a young adults. These individuals typically spend a lot of time and energy figuring out who they are and what they want for the future. This path often includes a choice between higher education or moving directly into the workforce. Most decisions during this time frame set the stage for later years of adulthood.
Adult (36–64 Years)
A person within the ages of 36 to 64 years is generally considered an adult. During their adult years, individuals continually make decisions regarding life partnerships, child rearing, and the maintenance of friendships. In addition, adults make career decisions, experience periods of work productivity, and manage life circumstances that have significant impacts on their future. During this stage of development, individuals typically seek to create or nurture things through such activities as volunteering, mentoring, or raising children.
Older Adult (65 Years and Older)
A person who is 65 years and older is considered an older adult. Developmental stages in the older adult population range greatly from those who are still working and conducting their day-to-day lives, as they did in their adult stage, to those who are focusing on retirement or choosing a path for the remainder of their life. As we age, there may be more health concerns; comorbidities may develop as the body responds to physical aging and lifestyle changes. It is important to remember that age does not determine the level of health, activity, cognitive ability, or happiness of a person.
Types of Play
In addition to understanding the changes patients face over their life span, nurses must be able to identify how patients encounter these changes and assist in this process. Generally, nurses can perform a head-to-toe assessment to assess their patient for the most needed information; however, when working with children, watching how they play can provide a significant amount of information about their developmental state. Play is considered the work of children. It is how children from a young age learn to conduct themselves in relation to objects and other people in the world. Play reinforces growth and development for a child regarding physical, emotional, social, cognitive, and moral development. Additionally, play can help children use and refine reasoning skills, enhance creativity, and work to form conclusions. As patients age, play looks different and serves a different purpose with each stage.
While the foundations of play are developed during childhood, play is still present in adults (American Academy of Pediatrics, 2022). Some adults consider competitive activities such as board games, trivia, or playing sports to be play. Others “play” by completing tasks such as writing a story or solving a puzzle or a math-based challenge. In adults, the intent and mental attitude toward an activity is important when determining play behaviors. For example, if an adult is completing a puzzle and feels content, challenged, and interested in the activity, it would be considered play. If the adult is completing a puzzle and is feeling angry, disengaged, or burdened, then it is not play. Adults can partake in all types of play present in childhood.
There are several observable types of play, which generally appear in a particular developmental order. They include solitary, parallel, associative, cooperative, and onlooker/observer play. Though play may look different at each stage, play helps children physically navigate the world, practice patience, cooperation, teamwork, critical thinking, and problem-solving. Play can help all people, no matter the age, reduce stress, boost creativity, build friendships, and build resilience.
Solitary Play
The act of independent play is called solitary play, shown in Figure 38.3. During this type of play, participants choose to play with an object that no one else is using at the time. This type of play is most common in infancy as children are learning how to navigate their world.
Parallel Play
When participants play side by side but not with one another, this is known as parallel play. Participants may use the same type of object for this play, but they do not have cooperative involvement with those around them. This type of play typically occurs in the toddler stage, but it can be seen in any age group. Two children in a preschool setting, for instance, may engage in parallel play when they are both playing with toy blocks near each other but not directly interacting with each other. While each child is absorbed in constructing their own structures, there is minimal communication or collaboration between them.
Associative Play
During associative play, participants involve others around them to engage in the activity. Though the participants have a similar goal during the play period, this type of play lacks formal organization. There are no set rules or true structure, but there is involvement across participants. This type of play is most common in the preschool stage, but it can also be seen at the tail end of the toddler stage.
Cooperative Play
Cooperative play has the most formal structure of all types of play. During cooperative play, participants establish rules—which may include restrictions on participation—and all participants are expected to follow those rules. Typically, one or more leaders are chosen. Team sports is one of the earliest forms of cooperative play, which is most common in middle childhood but can be seen starting in the late preschool stage.
Onlooker/Observer Play
Those participating in onlooker play watch others perform a task or engage in some form of play. There is no effort put forth by the onlookers to engage in the activity. Onlooker play occurs most often in the toddler stage but can take place at any age.