I. INTRODUCTION

Growth and development are the main themes of every baby's life; the

physical and mental activities that parents call,” growing up".

Since this process has everything to do with health at the juvenile stages

of life, it is a fundamental topic in pediatrics. The normal growth and development

of infants has a known course and range of values for most characteristics

considered important enough to measure. These include height, weight, head

circumference and other physical parameters, as well the ages that an infant can

manage relatively complex and volitional body movements. Certain of these

behaviors, like sitting up and walking, are called developmental milestones,

because the age and order in which they occur are markers of the normal

progress of the maturation of neuromuscular development.

There are very short periods during any stage when a youngster is mainly

just getting bigger; but infancy, childhood and adolescence are never focused on

a mere increase in size. Instead, growing-up alters the shape, composition, and

abilities of body and mind. In the first era of life the newborn baby changes, in a

certain sense, transforms- into an entirely different creature: the toddler. No one

word in English encompasses that concept, and in life sciences, "growth and

development" is the conventional term for these serial changes that occur from

birth to maturity in each normal individual.

II. PATIENT’S PROFILE

Name : x

Address : x

Birth Date : x

Sex : Female

Height : 67cm

Weight : 6.8kg

Mother : x

Occupation : x

Father : Mother refused to mention

Occupation : Mother refused to mention

Physical Assessment:

Date 06/25/07 07/09/07 08/05/07 9/15/07weight 4.5kg 5.5kg 5.61kg 6.8kgheight 52cm 57.5cm 58.2cm 67cmNo. of teeth 0 0 0 0Drooling yes no no noPosterior fontanels

open open closed closed

Temperature 36.9°C 36.8°C 36.8°C 37.2°CPulse 115bpm 110bpm 127bpm 124bpmRespiration 44cpm 49cpm 51cpm 46cpm

Hermione Fiona Halasan an eight month old infant from Barra Opol,

Misamis Oriental is the only child of Ms. Shane Abigail Halasan. She was born in

their house at Barra Opol, Misamis Oriental at about 3:15 P.M through normal

spontaneous delivery. Her 1st BCG, DPT and OPV immunization was on March

20, 2007. Her 2nd immunization of DPT and OPV was given on May 15, 2007,

followed by her 3rd immunization on June 19, 2007. Her 1st immunization of Hepa-

B was given on March 27, 2007, followed by the 2nd on April 24, 2007 and lastly

on May 22, 2007. These significant documentations were kept well by her loving

mother.

III. THEORIES

Freud’s Psychoanalytic Theory

Freud termed the infant period the oral phase because the infants are so

interested in oral stimulation or pleasure during this time (Berger, 2001).

According to this theory infants suck for enjoyment or relief of tension, as well as

for nourishment. The infant receives sensation from the total surface of their body

through touch from activities such as cuddling, caressing, sucking, and being

given physical care. This touching of infants plays important role in the

individual’s subsequent sexual development.

FREUDS STAGES OF DEVELOPMENT

Stage Age Characteristics Implications

Infant Birth to 1 year Mouth is the center of pleasure. Fixation; difficulty in trusting

others, nail biting, drug abuse, smoking,

overeating, alcoholism. Argumentativeness and

over dependence.

Feeding produces pleasure and sense of

comfort and safety. Feeding should be

pleasurable and provided when

required.

Erik Erickson’s Developmental Theory

According to Erikson, the developmental task for infants is learning trust

versus mistrust (other terms might be learning confidence or learning to love).

Infants whose needs are met when those needs arise, whose discomforts are

quickly removed, who are cuddled, played with, and talked to, come to view the

world as a safe place and people as helpful and dependable. However, when

their care is inconsistent, inadequate, or rejecting, it fosters a basic mistrust:

infants become fearful and suspicious of basic mistrust: infants become fearful

and suspicious of the world and the people. Like a burned child who avoids fire,

emotionally burned children may shun the potential pain of further emotional

involvement and carry this attitude through later stages of development. Such

children can be “stuck” emotionally at this stage, although they continue to grow

and develop in other ways.

Fortunately, because not all children achieve developmental tasks readily,

each task need not to be resolved once and for all the first time arises. The

problem of trust versus mistrust, for example, is not resolved forever during the

first year of life but arises again at each successive stage of development.

Children who enter school with a sense of mistrust may come to trust a teacher

with whim they form a relationship; given this second chance, children may

overcome early mistrust. On the other hand, children who come through infancy

with vital sense of trust intact may still have sense of mistrust activated at later

stage if their parents are divorced or separate under unpleasant circumstances.

ERIK ERICKSON’S DEVELOPMENTAL STAGES

Stage Age Control task Indicators of positive

resolution

Indication of negative resolution

InfancyBirth to 18

monthsTrust versus

mistrustLearning to trust others

Mistrust, withdrawal,

estrangement

Piaget’s Theory of Cognitive Development

Piaget refers to the infant stage as the sensori motor stage.

Sensorimotor intelligence is practical intelligence, because word and symbols of

thinking and problem solving are not yet available at this early age. At the

beginning of infancy, babies relate to the world through the senses, using only

reflex behavior. As infants progress through this stage (which includes the

schemas of primary and secondary reactions and coordination of secondary

reactions), they learn the basic concept that people are entities separate from

objects. Piaget uses the term “primary” to refer to the activities related to the

child’s own body and term “circulatory reaction” to show that repetition of

behavior occurs (the infant accidentally brings his or her thumb to the mouth,

enjoys the sensation of sucking, and so repeats it)

The term “secondary” refers to the activities that are separate from the

child’s body. An example of secondary schema learning is when a baby hits a

mobile, notices that this makes it move, and so hits it again. During this

secondary schema, infants also learn that objects in the environment -- bottle,

blocks, bed or even a parent -- are permanent and continue to exist even though

they are out of sight or changed in some way.

According to Piaget, cognitive development is and orderly sequential

process in which a variety of new experiences (stimuli) must exist before

intellectual abilities can develop, this is divided into five major phases, in each

phase the individual uses three primary abilities: Assimilation, accommodation

and adaptation. Assimilation is a process through which human encounter and

react to new situations by using mechanisms they already possess,

accommodation is a process of change whereby cognitive process mature

sufficiently to allow the person to solve problems that were unsolvable before and

adaptation a coping behavior or the ability to handle the demands made by the

environment.

JEAN PIAGET’S PHASES OF COGNITIVE DEVELOPMENT

Phases and stages Age Significant behavior

Sensorimotor phase Birth to 2 years

Stage 1 use of reflexes Birth to 1month Most action is reflexive

Stage 2 primary circular reaction

1 to 4 months Perception of events is centered on the body.

Objects are extension of self

Stage 3 secondary circular reaction

4 to 8 months Acknowledges the external environment.

Actively makes changes in the environment

Stage 4 coordination of secondary schemata

8 to 12 months Can distinguish a goal from a means of attaining

it

Stage 5 tertiary circular reaction

12 to 18 months Tries and discovers new goals and ways to attain

goals. Rituals are important

Stage 6 Inventions of new means

18 to 24 months Interprets the environment by mental images. Uses make-

believe and pretend play

Havighurst’s Developmental Task Theory

Havighurst’s promoted the concept of developmental tasks, which he

defines as a task which arises at or about a certain period in life of an individual,

which leads to his happiness and to success with later tasks, while failure leads

to unhappiness in the individual, disapproval by society, and difficulty with late

tasks. Havighurst’s developmental tasks provide a framework that the nurse can

use to evaluate a person’s general accomplishment. However some nurse’s find

that the broad categories limit its usefulness as a tool in assessing specific

accomplishments

HAVIGHURST’S DEVELOPMENTAL TASK

Infancy in early childhood

1. Learning to walk2. Learning to take solid food3. Learning to talk

4. Learning to control the elimination of body waste5. Learning sex differences and sexual modesty6. Achieving psychological stability7. Forming simple concepts of social and physical reality8. Learning to relate emotionally to parents, siblings and other people9. Learning to distinguish right from wrong and developing a conscience

IV. Growth and Development Assessment

First Visit (x) Data Gathered

During my first visit, the baby is 5 months old. Child’s weight was 4.5kg,

with a height of 52 cm. Tooth is not yet erupted, and drooling was observed will

minimal amount of saliva. The posterior fontanel was still open, and vital signs

were taken during the assessment, and everything was all normal and was

recorded. The child’s head wasn’t anymore sag, can turn to side from back. She

has no teeth and she has normal vital signs of 36.9°c, pulse rate of 115bpm, and

respiration of 44cpm.

Implication

Trust is in the family members especially in the mother. The baby is

drooling, holds hands in fists, holds hands in front of her, plays with her hands

and knees, holds and releases toys, and pays attention if someone is speaking.

Second visit (x)

Data Gathered

During our second visit, there are changes in his height (57.5 centimeter)

and weight (5.5kilograms). She has no teeth yet, and she has normal vital signs

of 36.8°c, pulse rate of 110bpm, and respiratory rate of 49cpm. We observed that

there are changes in her; she now pushes her feet against a hard surface to

move oneself forward, can lift her head and chest while lying in her abdomen,

can hold rattle for a brief period of time, can carry hand the object to mouth at

will, and plays his feet and puts them in her mouth.

Implication

At this point, the trust is still in his family members, most specifically to her

mother, but the mistrust is not yet developed because when someone comes

near to her especially new faces, she only stares and doesn’t even cry. There’s a

sign that every month she’s growing and developing the different theories.

Significant changes

In every visit, we noticed that she’s improving something. There were lots

of changes since our first visit. She changed a lot especially in her motor control

like move reflex present in her abdomen and holds back straight when pulled to

sitting position.

Third visit (x)

Data Gathered

During our third visit, there is really a big change on our pedia patient

where it came to the point on not familiarizing her because of the changes in her

physically.

She became bigger and that makes our conclusion right as we assess her

weight which is 5.61 kilograms already. Her height changes also from 57.5cm to

58.2cm. She still maintains the normal vital signs on her age. Her temperature

was 36.8c, pulse rate of 127bpm, and respiratory rate of 51cpm. As the months

goes by, she becomes more jolly and playful little angel.

Implication

The sense of trust was still there at the stage of the infant. She didn’t

experience having feared to someone whose strangers to her. She shows more

improvement especially to her reflexes now. She can sit but with the help and

guidance of her parents. Her muscles and bones are developing well to be strong

and flexible. She’s fun of grasping objects that she likes to hold with. She plays

with others and she utters throaty sounds as if she wants to talk.

Significant changes:

She shows many improvements towards her reflexes and starting to play

with other people and responds to them by trying to make sound as if she was

understood. Perceptions of events were centered on the body. Objects are

extension of self.

Fourth visit (September 15, 2007)

Data Gathered

During our last visit to our infant, we are so amazed because of the

changes he had improved. We keep on reminiscing the past things during our

assessment in her and it’s really different now because the baby is now more

matured compared to our first visit to her. She’s started to recognize things

around her and reject things she doesn’t like. She’s also starting to recognize

persons but since she’s more exposed to many people around her, she doesn’t

cry when she see strangers going near her. She still maintains the normal vital

signs at her age with the temperature of 36.5°c, respiratory rate of 38bpm, and

pulse rate of 108cpm. She increases in height with 70 cm. Through the whole

assessment we have conducted, we’ve learned that she was being breastfeed by

her mother.

Implication:

She loves biting things that she may hold. There are improved reflexes

and movements produced by our infant and acknowledge the external

environment and actively make changes in the environment. She became more

matured now.

Significant changes:

She learns new reflexes and starting to develop new tricks in playing and

to have fun beyond all this big differences, the most exciting was her little teeth

that was about to come out.

V. EVALUATION

The growth and development assessments of the different stages of a

child were a great and marvelous experience for us student nurses. We were

able to witness and observe the fulfillment and development of the youngsters

each passing month. The assessments and health teachings that we have

learned were also given to the child and taught to the parents for the promotion

of health and wellness in both mother and child.

The growth and development assessments provided us student nurses

the experience of giving assessments in both the mother and child, observing the

progress of the child, moreover, it also gave the parents of the children

knowledge about the proper health tips in breastfeeding, cleaning and giving the

right diet for her child. And thus, making us student nurses very proud of our

work for we have not only complied with the requirements, but also we have

helped the families during the assessments in our own little ways.

VI. REFERRALS

During our visits, there were many assessments given in the promotion of

health and wellness in both mother and child. One of the health teachings we

have shared was about maintaining the child’s proper hygiene. The nutritious

foods that the infants need for enhanced growth and development were also

mentioned during our visit. The continuation of the child’s immunization was also

a point that we emphasized because of its major role in the prevention of various

diseases. We also taught the mother how to provide tipid sponge bath (TSB) and

apply ice cap application in case of slight fever of the child, then to check the

temperature before and after the procedures. And if the fever persists, then it

should be better to consult their doctor so that appropriate medications will be

prescribed.

Health teachings were not all for the child only, since Ms. Hermione was a

breast feeding mother, we taught her the proper breast feeding and breast care

to provide efficient nutrition to her child and protect her child from risk for

infections and disease caused by improper hygiene.

VII. BIBLIOGRAPHY

Adele Pillitteri, Maternal and Child Health Nursing (volume 1), J.B. Lippincott Company, Philadelphia, U.S.A, 782-787

Emily McKinne et al., Maternal and Child Nursing (1st ed.), W.B Saunders Company 2000, 80-88

Barbara Kozier et al., Fundamentals of Nursing (7th edition), Pearson Education AsiaPte Ltd. 2004, 352-367

http://en.citizendium.org/wiki/Infant_growth_and_development

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