MATERNAL HEALTHCARE NUR 2633 - 28 PRINCIPLES OF
GROWTH AND DEVELOPMENT LATEST STUDY GUIDE 2026
Children progress through predictable stages of growth and development. Healthcare visits
provide an opportunity to assess these stages and provide anticipatory guidance to caregivers
(Hagan et al., 2017). Incorporating growth and development is essential to the development of
effective nursing care plans. Box 28.1 shows Healthy People 2030 goals that directly relate to
aspects of growth and development.
Nursing Process Overview PROMOTION OF GROWTH AND DEVELOPMENT
ASSESSMENT
Growth is defined as an increase in physical size, including the measurements of height, weight,
and head circumference. Obtain and record height and weight on a standard growth chart for
children at all well-child visits. Head circumference measurement is obtained for children ages 2
years and younger (AAP, 2021). Growth charts, which plot growth patterns, are available from
the Centers for Disease Control and Prevention (CDC) and the World Health Organization
(WHO). Development refers to the progression toward maturity in mental, physical, and social
markers. Obtain a developmental health history from caregivers and the child (if age-
appropriate) including nutritional intake, sleep, elimination, and a description of behaviors that
reflect past and current development (see Chapter 34). Observe specific activities of the child to
determine whether developmental milestones (major markers of normal development) are
achieved within an age-appropriate timeframe (Fig. 28.1).
Periodic screening tests should be provided following the periodicity schedule of the American
Academy of Pediatrics (AAP, 2017, 2021). NURSING DIAGNOSIS
Examples of nursing diagnoses applicable to growth and development include: Delayed growth
and development risk related to lack of age-appropriate activities Delayed growth and
development related to prolonged illness Readiness for enhanced family coping related to
caregivers seeking information about a child’s growth and development Health-seeking
behaviors related to appropriate stimulation for infants Malnutrition related to parental
knowledge deficit regarding a child’s needs Knowledge deficiency related to potential long-term
effects of obesity in the school-aged child
OUTCOME IDENTIFICATION AND PLANNING
To provide holistic nursing care, consider the physical, emotional, cultural, cognitive, spiritual,
and social aspects of health. Children achieve milestones at a predictable age range. Identifying
delays encourages prompt evaluation and intervention. Providing anticipatory guidance to
parents/caregivers provides them with realistic expectations for their child’s achievements.
Unrealistic parental/caregiver expectations are factors that can lead to a child experiencing an
unintentional injury (see Chapter 52). A child’s growth and development proceeds within a
family context. Children need emotional support from family and others who provide care to
develop psychosocially, just as they need nutritional support to grow physically. Parents of a
child with a developmental delay may use denial as a protective mechanism. Planning may have
to focus on acceptance of the current situation and providing appropriate resources.
IMPLEMENTATION
Interventions to promote growth and development include providing age-appropriate activities
and social interactions. Role modeling is an intervention that can demonstrate problem solving
,and is more effective than “acting out” behaviors.
OUTCOME EVALUATION
Evaluation of growth and developmental milestones (see Chapters 29 through 33) is monitored
throughout childhood. Provide follow-up at subsequent visits if there are any concerns.
Evaluation must be comprehensive. Developmental aspects include social, language, and fine
motor and gross motor skills. Examples of appropriate visit outcomes may include:
Parents/caregivers describe how they have made a safe space in their home for the 9-month-old
infant to crawl. Parents/caregivers express confidence that they will be able to guide the toddler
past the stage of the “terrible twos.” Parents/caregivers describe how they plan to phase out high-
carbohydrate, nonnutritive snacks for the preschooler. Parents/caregivers list household tasks
appropriate for the 6-year-old child.
The Role of the Nurse
Assessing for growth and development milestones is part of the nurse’s role in the care of both
well and ill children.
HEALTH PROMOTION AND ILLNESS PREVENTION
Determining a child’s developmental stage is often the primary focus of a well-child assessment.
Caregiver style and competence influence the overall health of children and should be considered
when providing developmental anticipatory guidance. For example, discussing home safety for
an infant who is approaching the age for crawling is necessary to prevent injury and the ingestion
of harmful products. Caregivers should think about installing stairway gates and locks on
accessible cabinets where hazardous materials are stored. Caregivers of a 1-year-old child should
be informed that their child’s appetite might decrease in the following year. This prevents the
misinterpretation of a child’s rejection of food as the beginning of a feeding problem, but rather a
normal developmental stage. Anticipatory guidance should be provided in a timely manner.
Information given too early may be forgotten by the time it is needed and if given too late,
caregivers may have already addressed the issue possibly inappropriately. Recognizing the
predictable stages of growth and development, from newborn through late adolescence, enables
nurses to provide appropriate anticipatory guidance (The Nemours Foundation, 2016).
HEALTH RESTORATION AND MAINTENANCE
It is equally essential to consider the developmental stage of a child when providing care during
illness and in preparation for procedures. For example, when preparing a 5-year-old for surgery,
the nurse must understand how to explain medicine, procedures, and recovery in a
developmentally appropriate way to the child. Growth and development knowledge is utilized to
assess whether a child can swallow oral tablets and capsules and accurately rate pain on a
standard scale. Disease affects children differently at various stages of growth, making physical
growth an important factor. A 12-year-old child with a fractured long bone has a potentially more
serious fracture than an 8-year-old who fractures the same bone. The 8-year-old must metabolize
enough calcium to meet two major needs: healing the fracture site and maintaining healthy bone
cells. The 12-year-old, who is undergoing a period of rapid growth, must meet three needs:
calcium for healing, maintaining existing healthy bone cells, and an additional amount for rapid
bone growth. If a child does not take in adequate calcium during the healing period to supply the
extra amount for growth, the optimal rehabilitation of the limb could be affected.
Principles of Growth and Development
Growth and development are complex phenomena with many interrelated facets. Children do not
, merely grow taller and gain weight as they get older; the ability to perform skills, think, relate to
people, and to trust or have confidence in themselves also develops. The terms “growth” and
“development” are often used interchangeably but they are very different terms. Growth
describes an increase in physical size (a quantitative change). Growth in weight, for example, is
measured in pounds or kilograms; growth in height is measured in inches or centimeters.
Development indicates an increase in skill or ability to function (a qualitative change). A child’s
development is assessed by observing a child’s ability to perform specific tasks, by recording the
parent’s description of a child’s progress, or by using standardized tests. Maturation is a synonym
for development. Psychosocial development refers to Erikson’s stages of personality
development. Kohlberg’s theory of moral development refers to the ability to know right from
wrong and to apply it to real-life situations. Cognitive development refers to the ability to learn
or understand from experience, to acquire and retain knowledge, to respond to a new situation,
and to solve problems. It may be assessed by intelligence tests and by observing a child’s ability
to function in different environments.
PATTERNS
Physical growth, as well as maturation, typically occurs in a predictable pattern governed by
several principles (Box 28.2). As shown in Figure 28.2, the pattern for general growth, such as
respiratory, digestive, renal, musculoskeletal, and circulatory tissue, proceeds predictably during
childhood. Certain body tissues mature in spurts. For example, neurologic tissue grows so
rapidly during the first 2 years of life that the brain reaches mature proportions by 2 to 5 years of
age. Lymphoid tissue also grows rapidly during infancy and childhood to provide early
protection against infection. For example, in 5-year-olds, tonsillar tissue has already reached its
peak size and the back of the throat of young children appears to be “all tonsils.” Although the
spleen is not usually palpable in adults, the spleen is palpable 1 or 2 cm below the left ribs in
preschool children as another example of this rapid immune tissue growth. In contrast, genitalia
show little growth until puberty.
Factors Influencing Growth and Development
Social determinants of health greatly influence whether a child achieves their growth and
development potential. Prenatal care, access to medical and dental care, adequate nutrition, a safe
environment, access to play areas, well-equipped childcare centers and schools, and access to
developmentally appropriate play items can affect optimal growth and development (Hagan et
al., 2017). More details on social determinants of health are presented later in this chapter.
GENETICS
In utero, the basic genetic makeup of an individual is present. In addition to physical
characteristics such as eye color and height potential, a child may inherit a genetic abnormality,
which could result in disability or disease.
SEX DIFFERENCES RELATED TO PHYSICAL GROWTH
On average, females are born weighing less (by an ounce or two) and measuring shorter (by an
inch or two) than males. Males tend to keep this height and weight comparison until prepuberty,
at which time females begin their puberty growth spurt (typically around 6 months to 1 year
earlier than males). By the end of puberty, usually around 14 to 16 years old, males tend to be
taller and weigh more than females. The difference in growth patterns is why specific growth
charts are utilized to monitor physical growth for males and females.
TEMPERAMENT
Temperament is the reaction pattern of an individual or an individual’s characteristic manner of
GROWTH AND DEVELOPMENT LATEST STUDY GUIDE 2026
Children progress through predictable stages of growth and development. Healthcare visits
provide an opportunity to assess these stages and provide anticipatory guidance to caregivers
(Hagan et al., 2017). Incorporating growth and development is essential to the development of
effective nursing care plans. Box 28.1 shows Healthy People 2030 goals that directly relate to
aspects of growth and development.
Nursing Process Overview PROMOTION OF GROWTH AND DEVELOPMENT
ASSESSMENT
Growth is defined as an increase in physical size, including the measurements of height, weight,
and head circumference. Obtain and record height and weight on a standard growth chart for
children at all well-child visits. Head circumference measurement is obtained for children ages 2
years and younger (AAP, 2021). Growth charts, which plot growth patterns, are available from
the Centers for Disease Control and Prevention (CDC) and the World Health Organization
(WHO). Development refers to the progression toward maturity in mental, physical, and social
markers. Obtain a developmental health history from caregivers and the child (if age-
appropriate) including nutritional intake, sleep, elimination, and a description of behaviors that
reflect past and current development (see Chapter 34). Observe specific activities of the child to
determine whether developmental milestones (major markers of normal development) are
achieved within an age-appropriate timeframe (Fig. 28.1).
Periodic screening tests should be provided following the periodicity schedule of the American
Academy of Pediatrics (AAP, 2017, 2021). NURSING DIAGNOSIS
Examples of nursing diagnoses applicable to growth and development include: Delayed growth
and development risk related to lack of age-appropriate activities Delayed growth and
development related to prolonged illness Readiness for enhanced family coping related to
caregivers seeking information about a child’s growth and development Health-seeking
behaviors related to appropriate stimulation for infants Malnutrition related to parental
knowledge deficit regarding a child’s needs Knowledge deficiency related to potential long-term
effects of obesity in the school-aged child
OUTCOME IDENTIFICATION AND PLANNING
To provide holistic nursing care, consider the physical, emotional, cultural, cognitive, spiritual,
and social aspects of health. Children achieve milestones at a predictable age range. Identifying
delays encourages prompt evaluation and intervention. Providing anticipatory guidance to
parents/caregivers provides them with realistic expectations for their child’s achievements.
Unrealistic parental/caregiver expectations are factors that can lead to a child experiencing an
unintentional injury (see Chapter 52). A child’s growth and development proceeds within a
family context. Children need emotional support from family and others who provide care to
develop psychosocially, just as they need nutritional support to grow physically. Parents of a
child with a developmental delay may use denial as a protective mechanism. Planning may have
to focus on acceptance of the current situation and providing appropriate resources.
IMPLEMENTATION
Interventions to promote growth and development include providing age-appropriate activities
and social interactions. Role modeling is an intervention that can demonstrate problem solving
,and is more effective than “acting out” behaviors.
OUTCOME EVALUATION
Evaluation of growth and developmental milestones (see Chapters 29 through 33) is monitored
throughout childhood. Provide follow-up at subsequent visits if there are any concerns.
Evaluation must be comprehensive. Developmental aspects include social, language, and fine
motor and gross motor skills. Examples of appropriate visit outcomes may include:
Parents/caregivers describe how they have made a safe space in their home for the 9-month-old
infant to crawl. Parents/caregivers express confidence that they will be able to guide the toddler
past the stage of the “terrible twos.” Parents/caregivers describe how they plan to phase out high-
carbohydrate, nonnutritive snacks for the preschooler. Parents/caregivers list household tasks
appropriate for the 6-year-old child.
The Role of the Nurse
Assessing for growth and development milestones is part of the nurse’s role in the care of both
well and ill children.
HEALTH PROMOTION AND ILLNESS PREVENTION
Determining a child’s developmental stage is often the primary focus of a well-child assessment.
Caregiver style and competence influence the overall health of children and should be considered
when providing developmental anticipatory guidance. For example, discussing home safety for
an infant who is approaching the age for crawling is necessary to prevent injury and the ingestion
of harmful products. Caregivers should think about installing stairway gates and locks on
accessible cabinets where hazardous materials are stored. Caregivers of a 1-year-old child should
be informed that their child’s appetite might decrease in the following year. This prevents the
misinterpretation of a child’s rejection of food as the beginning of a feeding problem, but rather a
normal developmental stage. Anticipatory guidance should be provided in a timely manner.
Information given too early may be forgotten by the time it is needed and if given too late,
caregivers may have already addressed the issue possibly inappropriately. Recognizing the
predictable stages of growth and development, from newborn through late adolescence, enables
nurses to provide appropriate anticipatory guidance (The Nemours Foundation, 2016).
HEALTH RESTORATION AND MAINTENANCE
It is equally essential to consider the developmental stage of a child when providing care during
illness and in preparation for procedures. For example, when preparing a 5-year-old for surgery,
the nurse must understand how to explain medicine, procedures, and recovery in a
developmentally appropriate way to the child. Growth and development knowledge is utilized to
assess whether a child can swallow oral tablets and capsules and accurately rate pain on a
standard scale. Disease affects children differently at various stages of growth, making physical
growth an important factor. A 12-year-old child with a fractured long bone has a potentially more
serious fracture than an 8-year-old who fractures the same bone. The 8-year-old must metabolize
enough calcium to meet two major needs: healing the fracture site and maintaining healthy bone
cells. The 12-year-old, who is undergoing a period of rapid growth, must meet three needs:
calcium for healing, maintaining existing healthy bone cells, and an additional amount for rapid
bone growth. If a child does not take in adequate calcium during the healing period to supply the
extra amount for growth, the optimal rehabilitation of the limb could be affected.
Principles of Growth and Development
Growth and development are complex phenomena with many interrelated facets. Children do not
, merely grow taller and gain weight as they get older; the ability to perform skills, think, relate to
people, and to trust or have confidence in themselves also develops. The terms “growth” and
“development” are often used interchangeably but they are very different terms. Growth
describes an increase in physical size (a quantitative change). Growth in weight, for example, is
measured in pounds or kilograms; growth in height is measured in inches or centimeters.
Development indicates an increase in skill or ability to function (a qualitative change). A child’s
development is assessed by observing a child’s ability to perform specific tasks, by recording the
parent’s description of a child’s progress, or by using standardized tests. Maturation is a synonym
for development. Psychosocial development refers to Erikson’s stages of personality
development. Kohlberg’s theory of moral development refers to the ability to know right from
wrong and to apply it to real-life situations. Cognitive development refers to the ability to learn
or understand from experience, to acquire and retain knowledge, to respond to a new situation,
and to solve problems. It may be assessed by intelligence tests and by observing a child’s ability
to function in different environments.
PATTERNS
Physical growth, as well as maturation, typically occurs in a predictable pattern governed by
several principles (Box 28.2). As shown in Figure 28.2, the pattern for general growth, such as
respiratory, digestive, renal, musculoskeletal, and circulatory tissue, proceeds predictably during
childhood. Certain body tissues mature in spurts. For example, neurologic tissue grows so
rapidly during the first 2 years of life that the brain reaches mature proportions by 2 to 5 years of
age. Lymphoid tissue also grows rapidly during infancy and childhood to provide early
protection against infection. For example, in 5-year-olds, tonsillar tissue has already reached its
peak size and the back of the throat of young children appears to be “all tonsils.” Although the
spleen is not usually palpable in adults, the spleen is palpable 1 or 2 cm below the left ribs in
preschool children as another example of this rapid immune tissue growth. In contrast, genitalia
show little growth until puberty.
Factors Influencing Growth and Development
Social determinants of health greatly influence whether a child achieves their growth and
development potential. Prenatal care, access to medical and dental care, adequate nutrition, a safe
environment, access to play areas, well-equipped childcare centers and schools, and access to
developmentally appropriate play items can affect optimal growth and development (Hagan et
al., 2017). More details on social determinants of health are presented later in this chapter.
GENETICS
In utero, the basic genetic makeup of an individual is present. In addition to physical
characteristics such as eye color and height potential, a child may inherit a genetic abnormality,
which could result in disability or disease.
SEX DIFFERENCES RELATED TO PHYSICAL GROWTH
On average, females are born weighing less (by an ounce or two) and measuring shorter (by an
inch or two) than males. Males tend to keep this height and weight comparison until prepuberty,
at which time females begin their puberty growth spurt (typically around 6 months to 1 year
earlier than males). By the end of puberty, usually around 14 to 16 years old, males tend to be
taller and weigh more than females. The difference in growth patterns is why specific growth
charts are utilized to monitor physical growth for males and females.
TEMPERAMENT
Temperament is the reaction pattern of an individual or an individual’s characteristic manner of
