Growth is an increase in physical size (weight, length, head circumference). Development is a gradual increase in skill and capacity (motor, cognitive, language, social, emotional). Maturation is change driven by genetic timing. Nurses use developmental theories to predict what a child can understand, what a child fears, and how to communicate, teach, and play with them.

Principles of growth and development

• Directional: cephalocaudal (head to tail — head control before sitting, sitting before standing), proximodistal (center to periphery — shoulder and arm control before finger control), and general to specific (whole-hand grasp before pincer grasp)
• Sequential and predictable: every child passes through the same stages in the same order (e.g., head control → sitting → standing → walking)
• Rate varies: fast in the fetal period, infancy, and adolescence; slower in the preschool and school-age years; each child has an individual pace
• Critical (sensitive) periods: times when the child is especially responsive to positive or harmful influences (e.g., language exposure, visual input)
• Interrelated: physical, cognitive, and psychosocial areas influence each other; heredity and environment both matter
• Continuous and cumulative: earlier stages form the base for later ones

Temperament (Thomas and Chess) describes a child's behavioral style from infancy: easy (regular, adaptable, positive mood), difficult (irregular, intense, withdraws from new situations), and slow-to-warm-up (mild, adapts slowly). "Goodness of fit" between temperament and parenting style supports healthy development.

Freud — psychosexual theory

Erikson — psychosocial theory (each stage has a central task)

Piaget — cognitive theory

Sensorimotor substages: reflexes (0–1 month) → primary circular reactions (1–4 months; repeats actions involving own body) → secondary circular reactions (4–8 months; repeats actions that produce an interesting effect, like shaking a rattle) → coordination of secondary schemes (8–12 months; intentional, goal-directed behavior, searches for hidden objects) → tertiary circular reactions (12–18 months; experiments to see what happens) → mental representation (18–24 months; deferred imitation, early pretend play).

Kohlberg — moral development

Piaget's moral stages (useful for young children): heteronomous morality (about 4–7 years — rules are fixed and set by authority; wrongness is judged by the size of the consequence, not intent) → autonomous morality (about 10 years and older — rules can change; intentions matter).

Attachment (Bowlby, Ainsworth): an emotional bond with a primary caregiver, built through sensitive, consistent response to the infant's cues. Securely attached children use the caregiver as a safe base to explore. Stranger anxiety and separation anxiety appear in the second half of the first year as attachment forms.

Play development

Developmental screening tools identify children who may need a full evaluation. They are not diagnostic tests and do not measure IQ.

• Denver II (DDST-II): screens four domains — personal-social, fine motor-adaptive, language, and gross motor — from birth to 6 years; results are normal, suspect, or untestable. Its purpose is to identify children at risk of developmental delay. It is still a common exam item; in current US practice ASQ-3 and similar parent-report tools are preferred
• Ages and Stages Questionnaires (ASQ-3): parent-completed; widely used in primary care
• M-CHAT-R/F: autism screening at 18 and 24 months
• Full evaluation (developmental pediatrics, psychology, speech, occupational and physical therapy) follows a positive screen
• For preterm infants, use corrected age (chronologic age minus weeks born early) until about 2 years

This is a conceptual topic; "management" is early identification and early intervention.

• Developmental surveillance at every visit and standardized screening at set ages
• Referral to early intervention services for suspected delay; do not wait for a child to "grow out of it"
• Interdisciplinary team: pediatrician, nurse, therapists, educators, social worker
• Treat contributing conditions (hearing loss, vision problems, anemia, lead exposure, neglect)

Apply theory to everyday care. Listed from most to least urgent in a clinical setting.

1. Ensure safety matched to developmental stage — infants mouth objects (oral stage, sensorimotor), toddlers explore without judgment of danger, preschoolers think magically
2. Infant (trust): meet needs promptly and consistently; keep the same caregivers; support parent–infant contact; comfort after procedures
3. Toddler (autonomy): offer simple, real choices; allow self-feeding and dressing; keep routines; expect "no" and regression during illness
4. Preschooler (initiative; preoperational): explain with concrete words and therapeutic play; correct beliefs that illness is punishment; use bandages over puncture sites; limit explanations to what they will see and feel
5. School-age (industry; concrete operational): give tasks to complete (record fluid intake, help with dressings), use diagrams and models, praise effort, keep up schoolwork
6. Adolescent (identity; formal operational): explain the reasons and long-term consequences, involve in decisions, respect privacy, allow peer contact
7. Screen and refer abnormal development; document milestones

• Development follows a sequence, but timing varies — compare the child with their own progress and with the range for their age, not with siblings
• Responsive, warm caregiving builds trust and secure attachment; responding to a crying infant does not "spoil" them
• Toilet training works best when the child shows readiness; harsh or early training creates power struggles
• Provide age-appropriate play: it is the "work" of childhood and a main route to learning
• Report loss of skills or failure to meet milestones promptly

• Loss of previously acquired skills (regression) at any age outside of temporary stress-related regression — needs evaluation
• No social smile, poor eye contact, or no response to name in infancy; no babbling by about 12 months; no words by about 16–18 months; no two-word phrases by about 24 months
• Persistent primitive reflexes, asymmetric movement, or hand preference before about 12–18 months
• Lack of attachment behaviors or indiscriminate friendliness in a young child (possible neglect)
• Persistent problems at school, social withdrawal, or behavior change in older children

• Development is cephalocaudal, proximodistal, general to specific; the order is fixed, the pace varies
• Erikson: trust (0–1) → autonomy (1–3) → initiative (3–6) → industry (6–12) → identity (12–18)
• Piaget: sensorimotor (object permanence) → preoperational (symbolic play, egocentrism, animism, magical thinking) → concrete operational (conservation, reversibility, classification, seriation) → formal operational (abstract, hypothetical-deductive)
• Secondary circular reactions (4–8 months) = repeating an action for its interesting effect
• Freud: anal fixation → orderliness, stubbornness, stinginess; Oedipus/Electra complex = phallic stage (3–6 years)
• Kohlberg: "good boy–good girl" and law-and-order = conventional; social contract and universal principles = postconventional
• Piaget moral: preschoolers see rules as fixed (heteronomous)
• Play: parallel (toddler) → associative (preschool) → cooperative (school-age)
• Denver II screens for delay in 4 domains; it does not diagnose or measure IQ
• Use corrected age for preterm infants until about 2 years