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BASIC HUMAN NEEDS

Definition:-
A basic human need is want of something or requirement for biological, social or spiritual
functioning experienced by a person without which a person cannot survive
Hierarchy.:-
Hierarchy means that in any list of items some items are classed as more important than
others.
Maslows Hierarchy of Human Needs:-
Abraham Maslow identified in 1968 five basic level of basic human needs that are arranged
in the order of priority for satisfaction. They are:-
Basic Human Needs And Related Nursing Action:-



Physiological needs:- they are the lower level needs. They have the highest priority
overall the other needs because they are essential to life. They include the needs for
air, food, water, temperature maintenance, rest or sleep, elimination, sexuality and
avoidance of pain. Some physiological needs are more important to survive than
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others eg.:- the need for oxygen takes priority over the need for the food or water.
Also the body can survive longer without food than without water.
A primary nursing function is to meet these needs as they are vital to the survival of
patients.
Safety and security needs:- these needs come next in priority. They can be aliened
through adequate shelter and protection from harmful factor in the environment.
Safety means physical as well as psychological safety. Individual usually feel most
secure in a familiar environment eg. Home, with people they can trust and the things
they can know.
An important function of the nurse is the promotion of patients physical safety and
emotional security in a health care setting. Eg :- bed railing for an unconscious
patient.
Love and belonging needs:- once individuals are satisfied with the basic
physiological safety and security needs, they seek their need for love and belonging
(higher level needs). These needs include understanding, group acceptance, affection,
mutual trust, and the feeling of the belonging to other. Ever individual either sick or
well desires the companionship and recognition of his family or friends.
The nurse should always consider love and belonging needs of the patients by way of
care and by establishing a nurse client relationship based on mutual understanding
and trust.
Self esteem needs:- it is necessary to feel pride, to feel a sense of accomplishment, in
what one does, and to believe that others also share this regard. Self esteem gives the
individual confidence, independence, worth, strength, adequacy, usefulness and
importance.
Lack of self esteem gives a feeling of inferiority, inadequacy weakness and
helplessness. The feeling of self dislike leads to frustration and sense of failure.
Nurses can meet patients self esteem needs by accepting their values and beliefs,
encourages them to set attainable goals and facilitating support by family or friends.

Self actualization needs:- self actualization is the highest level of human needs.
When the need for self esteem is satisfied the individual strives for self actualization,
of ones potential through full development of ones unique capabilities.
Cognition (the need to know and understand) is a strong desire of a human being. The
intelligent individual seeks information, analysis it, and searches for meaning of her
or himself.
The nurse must focus on the strength and capabilities rather than on problem to meet
patients self actualization needs. She must aim at caring the total individual need
(holistic care), and must provide a sense of hope to maximize his potentials.



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Implication of HUMAN NEEDS in nursing practice:-
Knowledge of human needs helps nurses to:-
Understand themselves, so that they can meet their personal needs outside the health
care setting, eg:- maintenance of body temperature.
Set priorities as in giving care. Eg:- working and playing will assume a low priority
during a period of critical illness.
Better to understand patients behavior so that they can respond therapeutically rather
than emotionally.
Relieve the distress of patients, eg:- helping a patient to meet his unmet need of love
and affection.
To get used to all ages and in all health care setting both at health and illness. It is an
approach for holistic nursing care.
Help client to develop and grow, eg:- nurse can help clients to move towards self
actualization by helping them to find meaning on their illness experience.
Provide a framework and be applied the nursing process at the individual and family
level.
















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GROWTH AND DEVELOPMENT
The term growth and development both refer to dynamic processes often used
interchangeably, these term have different meaning. The period of growth and development
extends throughout the life cycle; however, the period in which the principle changes occur is
from conception to the end of adolescence.
Definition of terms:-
Growth:-
i) According to the Dorothy Marlow,
Growth refers to the increase in physical size of the whole or any of its parts and can be
measured in inches or centimeter and in pounds or kilograms. Growth results because of cell
division and the synthesis of proteins. It causes a quantitative change in the childs body.
ii) According to Potter and Perry,
Growth refers to the changes that can be measured and compared, for example- taking the
height and weight of a pediatric client and comparing the measurements to the standardized
growth charts.
Development:-
It is an increase in the complexity of function and skill progression.
It is a capacity and skill of a person to adapt to the environment.
Development is the behavioral aspect of growth. Eg:- a person develops the ability to
walk, to talk and to run.
Development takes place from birth to death.
Growth and Development are independent, interrelated processes. For eg:-an infant muscle,
bones and nervous system must grow to a certain point before the infant is able to sit up or
walk.
Characteristics of Growth and Development :-
1) I ndividual differences:- each child has an individual rate of growth, but the pattern of
growth shows less variability.
2) Readiness for certain tasks:- the critical periods; measurable period lasting from a
few days to few weeks, during which the learning of certain behaviours occur, are
termed as critical periods. These are defined as those points in which the maximal
capacity for an aspect of development is first present or at which structures to be
developed are undergoing rapid growth.
3) Rate of development :- during the period of growth and development of the total body
and its subsystems, growth is sometimes rapid and at times it slows down.

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Stages or Period of Growth:-
Prenatal period:-
Ovum - 0-14 days
Embryo -14 days
Fetus 9wks birth
Perinatal period:-
28 weeks of gestation to 7 days after birth
Postnatal period:-
New born 1
st
four weeks after birth
Infancy 1
st
year of birth
Toddler 1-3 years
Pre schooler -3-6 ears
Schooler 6-10years (girls)
6-12years (boys)
Adolescents :-
Pre pubescent 10-12 yrs (female) & 12- 14 yrs (male)
Pubescent 12-14 yrs (female) & 14-16 yrs (male)
Post pubescent 14-18 yrs (female) & 16-20 yrs (male)
Adult hood:-
Young adulthood 20-40 yrs
Middle adulthood 40-60 yrs
Late adulthood - <60 yrs
Old age:-
Over the age of 65
Stages of prenatal development:-
1. Pre embryonic stage:- (zygote or fertilized ovum) from conception to 2 weeks
2. Embryonic stage:- 3 8 weeks
3. Fetal satge:- 9 weeks to till birth
Development of fertilized ovum:-
When the ovum has been fertilized, it continues its passage through the uterine tube and
reaches the uterus 3 or 4 days later. During this time segmentation or cell division takes place
and the fertilized ovum divides into 2 cells, then into 4, then 8, 16 and so on until a cluster of
cells is formed known as the morula (mulberry). These divisions occur quite slowly, about
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once every hour. Next, a fluid filled cavity or blastocele appears in the morula which now
becomes known as the blastocysts. Around the outside of the blastocyst there is a single layer
of cells known as the trophoblast. The remaining cells are clumped together at one end
forming the inner cell mass. The inner cell mass become the fetus and amnion.
The inner cell mass:-
While the trophoplast is developing into the placenta, which will nourish the fetus, the inner
cell mass is forming the fetus itself. The cells differentiate into three layers, each of which
will form particular parts of the fetus.
The Ectoderm mainly forms the skin and nervous system.
The Mesoderm forms bones and muscles and also the heart and blood vessels, including
those which are in the placenta. Certain internal organs also originate in the mesoderm.
The Endoderm forms mucous membranes and glands,
The three layers together are known as the embryonic plate. Two cavities appear in the inner
cell mass, one on either side of the embryonic plate.

The Embryo:-
This name is applied to the developing offspring after implantation and until 8 weeks after
conception. During the embryonic period all the organs and system of the body are laid down
in rudimentary form so that at its completion they have simply to grow and mature for a
further 7 month. The conceptus is known as a fetus during this time.
Growth and Development of Embryo and fetus
0-4 weeks after conception
Rapid growth
Formation of embryonic plate
Primitive central nervous system forms
Heart develops and begins to beat.
Limb buds form
04-8 weeks
Very rapid cell division
Head and facial feature develop.
All major organs are laid down in primitive form
External genitalia develop but sex not distinguishable.
Early movements.
Visible on ultrasound on 6 weeks
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08-12 weeks
Eye lids fuse
Kidneys begin to function and fetus passes urine from 10 weeks
Fetal circulation functioning properly
Sucking and swallowing begin
Sex apparent
Fetus moves freely
Some primitive reflexes present

12-16 weeks
Rapid skeletal development visible on x-ray.
Meconium present in gut.
Lenugo appears.
Nasal septum and palate fuse.
16- 20 weeks
Quickening- mother felts fetal movement
Fetal heart beat heard on auscultation
Vernix caseosa appears
Finger nails can be seen
Skin cells begin to be renewed
20-24 weeks
Most organ become capable of functioning
Periods of sleep and activity
Respond to sound
Skin red and wrinkled
24-28 weeks
Survival may be expected if born
Eyelids reopen
Respiratory movements.
28-32 weeks
Begins to store fat and iron
Estes descend into scrotum
Lenugo disappears from face
Skin becomes paler and less wrinkled

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32-36 weeks
Increased fat makes the body more rounded
Lenugo disappears from the body
Head hairs lengthens
Nails reach tips of the fingers
Ear cartilage soft
Planter creases visible
36-40 weeks
Term is reached and birth is due
Contours rounded
Skull firm
Growth and Development Of The New Born
New born:-
The term new born refers to the baby ages from birth to four weeks. First week of age is
known as early neonate period. Late neonate period ranges from 7-28 days of life.
Adjustment to extra uterine life to all system:-
Respiratory system:- the most critical immediate physiologic changes required of the new
born is the onset of breathing The stimuli that help to initiate respiration are primary.
a) Chemical stimuli- chemical factor in the blood (low oxygen, high carbondioxide and low
ph ), which initiate impulses that excite the respiratory centre in the medulla.
b) Thermal stimuli- it is the sudden chilling of the infant who leaves warm environment and
enters a relatively cooler atmosphere. This abrupt change in temperature excites sensory
impulses in the skin that are transmitted to the respiratory centre.
The initial entry of air into the lungs is opposed by the surface tension of the fluid that filled
the fetal lungs and alveoli. However fetal lung fluids that filled the fetal lungs and alveoli is
removed by the pulmonary capillary and lymphatic vessels. Some fluid is also removed
during the normal forces of labour and delivery. As the chest emerges from the birth canal,
fluid is squeezed from the lungs through the nose and the mouth. Following emergence of the
newborns chest brisk recoil of the thorax occurs. Air enters the upper airway to replace the
lost fluid. In the alveoli the surface tension of the fluid is reduced by a surfactant. This
surfactant reduces the surface tension of the fluid that lines the alveoli and respiratory
passages resulting in uniform expansion and maintenance of lung expansion at low intra
alveolar pressure. Deficient surfactant production causes unequal inflation of alveoli on and
expiration.

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Circulatory System:-
Equally important as the initiation of respiration are the circulatory changes that allow blood
to flow through lungs. This change occurs more gradually and is the result of pressure
changes in the lungs, heart and other major blood vessels. The transition from fetal
circulation ensures that the most vital organs and tissue receive the maximum concentration
of oxygenated blood.
Once the lungs are expanded the inspired oxygen dilates the [pulmonary vessel which
decreases the pulmonary vascular resistance and consequently increases the pulmonary
blood flow. As the lungs receive blood, the pressure in the right atrium, right ventricle and
pulmonary artery decrease. At the same time there is progressive rise in systemic vascular
resistance from the increased volume of blood through the placenta at cord clamping. This
increases the pressure in the left side of the heart. Since blood flows from an area of high
pressure to that of low pressure, the circulation of blood through fetal shunts is reversed.

Changes in fetal circulation at birth.
Structure Before birth After birth
Umbilical vein Bring arterial blood to the
heart
Obliterate: becomes round
ligament of the liver
Foramen Ovale Connects right and left
auricles
Obliterated usually.
Lungs Contain no air and very little
blood; filled with fluid,
Filled with air and well
supplied with blood
Pulmonary arteries Bring little blood to lungs Bring much blood to lungs
Ductus Arteriosus Shunts arterial and some
venous blood from the
pulmonary artery to aorta
Obliterated; becomes
ligamentum arteriosum.
Umbilical Arteries Bring arterio venous blood to
placenta
Obliterated; becomes vesical
ligame on anterior abdominal
wall.
Ductus venousus hunts bring arterial blood
into inferior vena cava
Obliterated; becomes
ligamentum venosum.


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Physiologic status of other systems:-
Thermoregulation
Heat regulation is the most critical to the newborns survival. Although the newborns capacity
for heat production is adequate several factors predispose the newborn to excessive heat loss
.they are:-
a) Newborns large surface area facilitates heat loss to the environment. Newborn
produces only two third as much as heat per unit area .however the large body surface
is partially compensated for by the newborns usual position of flexion, which
decreases the amount of surface area exposed o the environment.
b) Radiation of conservation of body heat due to a thin layer of subcutaneous fat. Since
core body temperature is approximately 100F higher than the surface body
temperature, this temperature gradient causes a heat transfer from a higher to lower
temperature.
c) Newborn mechanism for producing heat .unlike adult ,who can increases heat
production through shivering ,a chilled neonate cannot shiver but produces heat
through non shivering thermogenesis ( NST ).it is produced by stimulating cellular
respiration the resulting oxygen consumption can be three times of any other body
tissue.
A unique thermogenic source to a full term newborn is brown adipose tissue (BAT)or
brown fat. It has greater capacity for heat production through intensified metabolic
activity than does ordinary adipose tissue. Heat generated in the bat is distributed to other
parts of the body through blood. Superficial deposition of BAT is located between the
scapulae, around the neck, in the axilla and behind the sternum. Deeper layers surround
the kidneys, trachea, esophagus, some major arteries and adrenals.
Hemopoetic Systems
The blood volume of the newborn depends upon the amount of placental transfer of blood.
The blood volume of the full term infant is about 80-85 ml/kg of body weight. Immediately
after birth the total blood volume averages 300ml, but depending on how long the newborn is
attached to the placenta, as much as 100 ml can be added to the blood volume.
Fluid And Electrolytes
Changes occur in total body .water volume, ECF volume and ICF volume during transition
from fetal to postnatal life. At term the fetus is composed of 73% fluid as compared to 58%
in adults. The infant has a proportionately higher ratio of ECF than the adult, and
consequently has a higher level of total body sodium, chloride and a lower level of
potassium, magnesium and phosphate. The rate of fluid exchange is 7 times higher than in
adult and the metabolism is twice as great in relation to body weight. As a result twice as
much acid is formed leading to more rapid development of acidosis. In addition immature
kidneys cannot sufficiently concentrate urine to conserve body water. These factors make the
newborn more prone to dehydration, acidosis and over hydration.
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Gastrointestinal System
The ability of the newborn to digest, absorb and metabolize food stuff is adequate but limited
to certain functions. Enzymes are available to catalyse proteins and simple carbohydrates but
deficient production of pancreatic amylase impairs utilization of complex carbohydrates. A
deficiency of pancreatic lipase limits the absorption of fats, especially with ingestion of food
that has high saturated fatty acids content such as cows milk. Liver is the most immature
organ of the digestive system. The activity of glucoronic treansferase is reduced to
conjugation of bilirubin with glucoronic acid, which contribute to physiologic jaundice of the
newborn. Some salivary gland is functioning at birth but majority do not begin to secreate
saliva until 2-3 months, when drooling is common,the stomach capacity is limited to 90ml,
thus newborn require small and frequent small feeds. The infants intestine is longer in
relation to body size than in adults. So there are larger number of secreatory glands and a
larger surface area for absorption as compared with adult. These waves combined with an
immature, relaxed cardiac sphincter, makes regurgitation a common occurance. Progressive
changes in the stooling pattern indicating functioning of GI tract, which includes the
following- Meconium-infants first stool. Composed of amniotic fluid and its constitutes,
intestinal secreations, shed mucosal cells and possibly blood. The passage of meconuim
should occur within the first 24-48 hours although it may be delayed upto 7days in a very
LBW baby. Transitional stools-usually appear by third day day after initiation of feeding,
greenish brown to yellowish brown, thin and less sticky than meconium, may contain some
milk curds. Milk stool-usually appears by fourth day. In feeding newborn stools are yellow to
golden, is pasty in consistency and has an odor similar to that of sour milk. In formula feeds
the stools are pale yellow to light brown ,are firmer in consistency and has an offensive odor.
Genito-Urinary System
All structural components are present in the renal systems, but there i s a functional
deficiency in the kidneys ability to concentrate urine and to cope with conditions and to cope
with conditions of fluid and electrolyte fluctuations, such as dehydration or a concentrated
solute load. The total urinary output per 24 hours is about 200-300ml by the end of first
week. The bladder involuntarily empties when stretched by a volume of 15ml resulting in as
many as 20voiding per day. The first voiding occurs within 24hours.the urine is colourless
and odourless and has a specific gravity of 1.020. Male genitalia develop at birth, although
their maturation varies. The testes of male descend into the scrotum before birth.occasionaly
they remain in the abdomen or inguinal canal called undescended testes or
cryptorchidism.non retractability of the foreskin and glans penis is normal in newborn
(phimosis). Foreskin and glans separate, beginning in prenatal period. This process gradually
completed in 3-5 years. Female genitalia maybe slightly swollen .blood tinged mucus maybe
discharged from the vagina. This is due to hormonal withdrawal from the mother at birth.
I ntegumentary System :-
Newborn have all the structures within the skin present but many of their functions are
immature. Epidermis and dermis are loosely bound to each other and are very thin. Slight
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friction across the epidermis such as the removal of the tape, can cause separation of the
layers or blister formation or loss of epidermis. The sebaceous glands are very effective late
in fetal life and in early infancy because of high levels of maternal androgens. They are most
densely located on scalp, face and genitalia. plugging of the sebaceous gland cause milia.
Vernix caseosa :-
A cheese like substance that covers the skin of the newborn, is made of cells and glandular
secreation, is thought to protect the skin from irritations and the effects of watery
environment. Milia may be seen on nose and chin. And will be disappearing within a few
weeks. Stroke bite is seen on the nape of neck and on the eyelids. The eccrine glands are
functional at birth and palmar sweating on crying reaches levels equivalent to those of
anxious adults by 3 weeks of age. Observing palmar sweating is helpful in the assessment of
pain.the eccrine glands produces sweat in response to higher temperature as compared to
adults and retention can cause miliaria.the apocrine gland remain small and non-functional
till puberty.
Musculoskeletal System:-
At birth skeletal system contains large amount of cartilage than ossified bone, although the
process of ossification is fairly rapid during the first year. The nose for example is
predominantly cartilage at birth and is frequently flattened by the force of delivery. The six
skull bones are relatively soft and not yet joined. The sinuses are incompletely formed at
birth. Growth in size of the muscular tissue is caused by hypertrophy, rather than hyperplasia
of cells.
I mmune Systems:-
The neonate is born with several defenses against infection. The first line of defense is the
skin and mucus membranes which protect the body from invading organisms. The second
line of defense is the cellular elements of the immunologic system, which produces several
types of cells capable of attacking a pathogen. The neutrophills and monocytes and
phagocytes, cells that engulf, ingest and destroy foreign agents. Eosinophills also probably
have a phagocytic proprety, since in the presence of foreign protein they increase number.
The lymphocytes are capable of converted to other cell types such as monocytes and
antibodies. Although the blood has phagocytic properties in it, the inflammatory response of
the tissues to localize an infection is immature. The third line of defense is the formation of
specific antibodies to an antigen. This process requires exposure to various agents for
antibody production to occur. Infants are not capable of producing their own
immunoglobulins until the beginning of the second month of life but receive considerable
passive immunity in the form of immunoglobulin from the maternal circulation and from
human milk. They are protected against most childhood diseases including diphtheria,
measles, polio and rubella for about three months provided that the mother has developed
antibodies to these illnesses.

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Endocrine system:-
Generally the endocrine system of the newborn is adequately developed, but their functions
are immature. For eg- the posterior lobe of pituitary gland produces limited quantities of
ADH or vasopressin which inhibit diuresis. This renders the newborn highly susceptible to
dehydration. The effect of maternal sex hormone is particularly evident in the newborn. The
labia are hypertypical and the breast in both sexes may be engorged and secrete milk (witches
milk),during the first few days of life to as long as 2month of age. Female may have pseudo
menstruation due to sudden drop in progesterone and estrogen levels.
Neurologic System
At birth the nervous system is incompletely integrated but sufficiently developed to
extrauterine life. The autonomic nervous system is crucial during transition because it
stimulates initial respirations helps maintain acid base balance and partially regulate
temperature control. Myelination of the nervous system follows the cephalocaudal-
proximodistal laws of development and is closely related to the mastery of fine and gross
motor skills. Tracts that develop myelin earliest are the sensory, cerebellar and
extrapyramidal. This accounts for the acute senses of taste, smell, hearing as well as the
perception of pain,in the newborn. All cranial nerve are myelinated except the optic and
olfactory nerves.
Sensory Functions:- Are well developed and have a significant effect on growth and
development including the attachment process.
Vision:-at birth the eyes are structurally incomplete. The cornea centralism is not yet
completely differentiated from the macula. The ciliary muscles are immature limiting the
ability of the eyes to accommodate and fixate on an object for any length of time. The pupils
reflect to light, the blink reflex is responsible to a minimal stimulus, and the corneal reflex is
activated by a light touch. Tear glands do not begin to function until 2-4 weeks of age. The
newborn has the ability to momentarily fix on bright or moving objects that is within 20cm
and in midline of the visual field. In fact infant ability to fixate on coordinate movement is
greater during the first hour of life than in succeeding several days. Visual acuity is between
20/100 and 20/400 depending upon the visual preference.:-medium colors (red, orange ,
blue),black, and white contrasting patterns, especially geometric shapes checker-large objects
with medium complexity rather than small complex objects, and reflecting objects over dull
ones.
Hearing:- Ones the amniotic fluid has drained from the ears, the infants probably has
auditory acuity similar to that of adult. The newborn able to detect a loud sound of about 90
decibels, and reacts with a startle reflex. Newborns response too low frequency differs from
that of higher frequency. Former tends to decrease an infants most activities and crying
whereas the later elicits an altering reaction.
Smell:- Newborns react to strong odors by turning their head away. Breast fed newborn are
able to smell breast milk. Also they are able to differentiate the smell between the breast milk
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of their mother from other women. Maternal doctors are believed to influence attachment
process and successful breast feeding.
Tastes:- The newborn can differentiate taste difference between different types of solution
and elicit different facial reflexes. A tasteless solution elicits no facial expression. A sweet
elicits an eager suck and a look of satisfaction sour solution elicits a usual puckering of lips
and bitter produces upset expressions. They prefer glucose water to sterile water.
The newborn perceives tactile sensation in any part of the body although face , hands and
soles of the feet seem to be most sensitive. There is increasing documentation that touches
and motion are essential for normal growth and development. However painful stimuli,
pinprick is upsetting. Most neurologic reflexes are primitive reflexes

Development of the new born:-
Physical growth:- newborn loses some weight shortly after birth. This weight usually
is regained within 10 to 12 days. Most newborns gain about 4 oz (113 g) to 8 oz (227
g) a week and grow about 1 in. (2.5 cm) to1.5 in. (3.5 cm) in the first month.
Cognitive development. Cognition is the ability to think, learn, and remember.
Newborn's brain is developing rapidly. To promote healthy brain growth every time
mother need to interact in a positive way with baby.
Emotional and social development. Newborns quickly learn to communicate. They
seek interaction with you and express how they feel with sounds and facial
expressions. At first, instinctual behaviors, such as crying when uncomfortable, are
the baby's ways to signal his or her needs. Soon newborn starts to subtly communicate
and interact with mother. For example, baby's eyes will track mothers movements.
And his or her face will brighten when mother cuddle and talk soothingly. Even at a
few days old, baby may try to mimic by sticking out tongue.
Language development:- newborn is listening to and absorbing the basic and distinct
sounds of language. This process forms the foundation for speech.
Sensory and motor skills development. Newborns have all five senses. Newborn
quickly learns to recognize face, the sound of voice, and how you smell. Newborn's
sense of touch is especially developed, particularly around the mouth. Baby also has a
strong sense of smell. After a few days, newborn hears fairly well and responds most
noticeably to high-pitched and loud sounds. Baby recognizes and prefers sweet tastes
to those that are sour, bitter, or salty. Vision is developing quickly but is believed to
be the weakest of the senses. Motor skills develop as baby's muscles and nerves work
together. Movements are mostly controlled by reflexes, such as the rooting reflex,
which is when a newborn's head turns and his or her mouth "reaches" toward a touch.
Hands are tightly fisted when the baby is alert.

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Growth and Development Of The infant:-
Babies change more in the first year of life than at any other time. From 1 to 12 months of
age, most babies grow and develop in these main areas:-
Physical growth:- A baby's growth is dramatic during this first year. Babies grow taller, and
their heads get bigger. The first year is characterized by rapid physical growth. A normal
baby doubles its birth weight in six months and triples it in a year. During that time, there is
great expansion of the head and chest, thus permitting development of the brain, heart, and
lungs, the organs most vital to survival. The bones, which are relatively soft at birth, begin to
harden, and the fontanelles, the soft parts of the newborn skull, begin to calcify, the small one
at the back of the head at about 3 months, the larger one in front at varying ages up to 18
months. Brain weight also increases rapidly during infancy: by the end of the second year, the
brain has already reached 75% of its adult weight.
Growth and size depend on environmental conditions as well as genetic endowment. For
example, severe nutritional deficiency during the mother's pregnancy and in infancy are
likely to result in an irreversible impairment of growth and intellectual development, while
overfed, fat infants are predisposed to become obese later in life. Human milk provides the
basic nutritional elements necessary for growth; however, in Western cultures supplemental
foods are generally added to the diet during the first year.
The newborn infant sleeps almost constantly, awakening only for feedings, but the number
and length of waking periods gradually increases. By the age of three months, most infants
have acquired a fairly regular schedule for sleeping, feeding, and bowel movements. By the
end of the first year, sleeping and waking hours are divided about equally.

Cognitive development. Babies make great advances in being able to learn and
remember.
Emotional and social development. Babies start to show their emotions and how they
feel about other people.
Language development. Babies quickly learn language by what is spoken around them.
Sensory and motor development. Babies become strong enough to sit. Some will stand,
and others will begin to take their first steps.
Each baby grows and gains skills at his or her own pace. It is common for a baby to be ahead
in one area, such as language, but a little behind in another.
Babies who were born early or have health problems may grow and develop at a slower pace.

Growth and Development Of The Toddler
Toddler:-
Toddler ranges from the time when children begin to walk independently until they walk and
run with ease which is form 12 to 36 months. The toddler is characterized by increasing
independence bolstered by greater physical mobility and cognitive abilities. Toddlers are
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increasingly aware of their abilities to control and are pleased with the successful effort with
this new skill.
The ages between 2 and 5 are often called the preschool years. During these years, children
change from clumsy toddlers into lively explorers of their world. A child develops in these
main areas
Physical growth of the toddler:-
1) Biological growth:- the rate of biological growth slows down compared with that
during infancy.
2) Weight and height:- the toddler rate of weight gain markedly differ in comparison
with the infant. The toddler gains about 1.8 to 2.7 kg a year. The average weight at 2
years of age is 12 kg. at 2

years of age the childs weight is about four times that at
birth. The gain in height is greater than that of weight during the toddler period.
Height increases about 10 to 12.5 Cms per year and is largely a result of growth in the
length of the legs. The height of 2 years of age is about 85 cms. Boys tend to be
slightly taller than girls, although this difference is slight.
3) Body proportion:- the young toddler has a relatively large head in comparison with
the size of the rest of the body. The head circumference in the second year increases
by 25cm. by 2 years of age the hest circumference exceeds that of the head.
4) Dentition:- at 2 years, the toddler has about 16 teeth, and 2
1/5
years the full set of 20
temporary teeth have erupted
Growth of the preschooler :-
Ages 2 through 6 are the early childhood years, or preschool years. Like infants and
toddlers, preschoolers grow quicklyboth physically and cognitively
Children begin to lose their baby fat, or chubbiness, around age 3. Toddlers soon acquire the
leaner, more athletic look associated with childhood. The child's trunk and limbs grow
longer, and the abdominal muscles form, tightening the appearance of the stomach. Even at
this early stage of life, boys tend to have more muscle mass than girls. The preschoolers'
physical proportions also continue to change, with their heads still being disproportionately
large, but less so than in toddlerhood.
Threeyearold preschoolers may grow to be about 38 inches tall and weigh about 32 pounds.
For the next 3 years, healthy preschoolers grow an additional 2 to 3 inches and gain from 4 to
6 pounds per year. By age 6, children reach a height of about 46 inches and weigh about 46
pounds. Of course, these figures are averages and differ from child to child, depending on
socioeconomic status, nourishment, health, and heredity factors.
Development of the toddler upto preschooler:-
Physical development. In these years, a child becomes stronger and starts to look
longer and leaner.
Cognitive development. A child this age makes great strides in being able to think
and reason. In these years, children learn their letters, counting, and colors.
17

Emotional and social development. Between the ages of 2 and 5, children gradually
learn how to manage their feelings. By age 5, friends become important.
Language. By age 2, most children can say at least 50 words. By age 5, a child may
know thousands of words and be able to carry on conversations and tell stories.
Sensory and motor development. By age 2, most children can walk up stairs one at
a time, kick a ball, and draw simple strokes with a pencil. By age 5, most can dress
and undress themselves and write some lowercase and capital letters.
Each child grows and gains skills at his or her own pace. It is common for a child to
be ahead in one area, such as language, but a little behind in another.
Learning what is normal for children this age can help you spot problems early or feel
better about how your child is doing.
Growth and development of school age children:-
School-age period is between the age of 6 to 12 years. The child's growth and development is
characterized by gradual growth.
Biological changes:-
Growth in height and weight assumes a slower but steady pace as compared with the earlier
years. Between ages 6 to 12, children will grow an average of 5cm per year to gain 30-60 cm
in height and will almost double their weight, increasing 2 to 3 per year.
Age 6: Male/female
Weight:- 16-23.5 kg
Height:- 106.6-123.5 cm
Age 7: Male/female
Weight:- 17.7-30 kg
Height:- 111.8-129.7 cm
Age 8-9: Male/female
Weight:- 19.6-39.6 kg
Height:- 117-141.8 cm
Age 10-12: Male/female
Weight:- 24.3-58 kg
Height:- 127.5-162.3 cm
Physiological changes:-
Mature of the gastro-intestinal system is reflected in fewer stomach upset, better maintenance
of blood glucose and an increased stomach capacity, which permits retention of food for
longer period. The school age child does not need to be fed carefully.
Physical maturation is evidenced by other body tissues and organs.
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Bladder capacity, greater in girls than boys.
Heart grows slowly in the middle years and small in size when compared with the size
in the other age period. Heart rate and respiratory rates steadily decreases and blood
pressure increases during this age period
Immune system becomes more competent in its ability to localize infection and
produce an antibody-antigen response.
Bones continue to grow and musculoskeletal system continues to mature, in size and
coordination.
Sensory and motor changes:-
At the age of 6 year
Aware of hand as a tool
Returns to finger feedings
Likes to draw and print
Color vision reaches maturity
Uses knife to spread butter or jam on bread.
At the age of 7 years
Repeats the performance to master them
More caution in performing new things
Uses brush and combs the hair
At the age of 8-9 years
Often graceful
Always on the go; jumps skip.
Increased smoothness and speed in fine motor control
At the age of 10-12 years
Mostly children will have the normal characteristics similar to adults.
Developmental tasks of school age children
Develop the concepts of number
Counts 13 pennies/coins
Knows the time as morning and afternoon.
Knows right from left hand
Does simple calculation
Perform bed time activities
Takes bath alone
More independent in doing things
Occasional temper tantrum can be seen.
Cognitive development:-

At 7-11 years, the child now is in the concrete operational stage
of cognitive development. He is able to function on a higher level in his mental ability.
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Greater ability to concentrate and participate in self-initiating quiet activities that challenge
cognitive skills, such as reading, playing computer and board games.
Emotional development:-

The schoolage child:
Fears injury to body and fear of dark.
Jealous of siblings (especially 68 years old child).
Curious about everything.
Has short bursts of anger by age of 10 years but able to control anger by 12 years.
Social development:- The schoolage child is :
Continues to be egocentric.
Wants other children to play with him.
Insists on being first in every thing
Becomes peer oriented.
Improves relationship with siblings.
Has greater selfcontrol, confident, sincere.
Respects parents and their role.
Joints group (formal and informal).
Engage in tasks in the real world.
Growth Development Of Adolescence:-
Adolescence is a transition period from childhood to adulthood. Its is based on childhood
experiences and accomplishments.
It begins with the appearance of secondary sex characteristics and ends when somatic growth
is completed and the individual is psychological mature.
Stages of adolescence:-
Early adolescence- (9-13 years):- this is characterized by growth and development of
secondary sexual characteristics.
Mid adolescence- (14-15 years):- this stage is distinguished by the development of a separate
identity from parents, of new relationship with peer groups, and the opposite sex and
experimentation.
Late adolescence- (16-19 years):- at this stage adolescents have fully developed physical
characteristics, and form a distinct identity and have well formed option and ideas.
Physical growth:
Weight:
Growth spurt begins earlier in girls (1014 years, while it is 1216 in boys).
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Males gains 7 to 30kg, while female gains 7 to 25kg.
Height:
By the age of 13, the adolescent triples his birth length.
Males gains 10 to 30cm in height.
Females gains less height than males as they gain 5 to 20cm.
Growth in height ceases at 16 or 17 years in females and 18 to 20in males
1- Secondary sex characteristics in girls:
Increase in transverse diameter of the pelvis.
Development of the breasts.
Change in the vaginal secretions.
Growth of pubic and axillary hair.
Menstruation (first menstruation is called menarche, which occurs between 12 to 13
years).
2- Secondary sex characteristics in boys:
Increase in size of genitalia.
Swelling of the breast.
Growth of pubic, axillary, facial and chest hair.
Change in voice.
Rapid growth of shoulder breadth.
Production of spermatozoa (which is sign of puberty).
Cognitive development: Through formal operational thinking, adolescent can deal with a
problem.
Emotional development: This period is accompanied usually by changes in emotional
control. Adolescent exhibits alternating and recurrent episodes of disturbed behavior with
periods of quite one. He may become hostile or ready to fight, complain or resist everything.
Social development: He needs to know "who he is" in relation to family and society, i.e., he
develops a sense of identity. If the adolescent is unable to formulate a satisfactory identity
from the multi-identifications, sense of self-confusion will be developed according to
Erikson:-
Adolescent shows interest in other sex.
He looks for close friendships.


21

Early adulthood growth and developmental
Age frame is from about late teens to thirty (20-40 years)
Peak of physical health and fitness (occurs on average at approximately age 30)
Height of cognitive abilities
Healthy, vigorous, energetic
Physical growth:-
In 20 years
May still gain height
Gain in muscle, fat
Brain still increasing in size and weight (although no new neurons are being formed)
Senses optimal
Developmental task:-
Establish personal and economic independence
Forming a support group of friends and others
Developing work skills/career
Making a commitment in a relationship
Establishing a family
Managing optimal healthy lifestyles
Middle Adulthood development:-
Age frame from about the thirties to the mid sixties
Expand personal and social involvement and responsibility
Adjusting to physiological and emotion changes
Reaching and maintaining job satisfaction/ preparing for retirement
Observing maturation of children
Managing chronic health conditions
Late Adulthood development:-
Age time frame from mid sixties to death. Aging is influenced by heredity, nutrition,
exercise, lifestyle choices such as smoking, and lifelong adjustments to change.
Young-Old development task:-
Age frame 65-74 years
If healthy may not experience ages from middle years
Beginning social and emotional adjustments to decreasing physical strengths and
changes in body such as vision and hearing limitations
Adjusting to retirement with loss of job related activities
Adjusting to changing family roles with children, spouse and grandchildren.
22

Middle Old and Old- Old development task:-
Middle old, 75-84
Adjusting to more chronic conditions, such as arthritis
Adjusting to losses of abilities to drive car
Losses of friends and siblings
Need to accept lifes experiences
Old-Old, 85 and older
Accept physical limitations and dependence on others
Acceptance of losses (deaths and activities).
Acceptance to alternate living conditions, such as assisted living or long term care

Freud theory (sexual development)
Infancy stage Oral sensory stage
Toddler stage Anal stage
Preschool stage Genital stage
School-age stage Latency stage
Adolescence stage Pubertal stage

Piaget theory (cognitive development)
Infancy stage up to2 years sensory -motor
Toddler stage 2-3 years pre-conceptual phase
Preschool stage Up to 4years pre-conceptual phase
School-age stage 7-12 years concrete-operational
Adolescence stage 12-15 years preoperational formal operations
15 years - through life formal operations




23

Eriksons Theory

Eriksons (1963) psychosocial theory states that an individuals development proceeds
throughout life. Each of his eight developmental stages includes psychosocial tasks that need
to be mastered .

1.Trust vs Mistrust :- The first stage of Erikson's theory of psychosocial development
occurs between birth and one year of age and is the most fundamental stage in life. Because
an infant is utterly dependent, the development of trust is based on the dependability and
quality of the child's caregivers. If a child successfully develops trust, he or she will feel safe
and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or
rejecting contribute to feelings of mistrust in the children they care for. Failure to develop
trust will result in fear and a belief that the world is inconsistent and unpredictable.
Psychosocial Conflict: Trust vs Mistrust
Major Question: "Can I trust the people around me?"
Basic Virtue: Hope
2. Autonomy vs Shame & doubt :- This stage occurs between the ages of 18 months
to approximately age two to three years. According to Erikson, children at this stage are
focused on developing a greater sense of self-control. Gaining a sense of personal control
over the world is important at this stage of development. Toilet training plays a major role;
learning to control ones body functions leads to a feeling of control and a sense of
independence. Other important events include gaining more control over food choices, toy
preferences and clothing selection. Children who successfully complete this stage feel secure
and confident, while those who do not are left with a sense of inadequacy and self-doubt.
Psychosocial Conflict: Autonomy versus Shame and Doubt
Major Question: "Can I do things myself or am I reliant on the help of others?"
Basic Virtue: Will
3. I nitiative vs. Guilt:- This stage occurs during the preschool years, between the ages of
three and five. During the initiative versus guilt stage, children begin to assert their power
and control over the world through directing play and other social interactions. Children who
are successful at this stage feel capable and able to lead others. Those who fail to acquire
these skills are left with a sense of guilt, self-doubt, and lack of initiative. Play and
imagination takes on an important role at this stage. Children have their sense of initiative
reinforced by being given the freedom and encouragement to play. When efforts to engage in
physical and imaginative play are stifled by caregivers, children begin to feel that their self-
initiated efforts are a source of embarrassment. Success in this stage leads to a sense of
purpose, while failure results in a sense of guilt.
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Psychosocial Conflict: Initiative versus Guilt
Major Question: Am I good or bad?
Basic Virtue: Purpose
4. Industry vs .Inferiority:- This stage covers the early school years from
approximately age 5 to 11. Through social interactions, children begin to develop a sense of
pride in their accomplishments and abilities. During the industry versus inferiority stage,
children become capable of performing increasingly complex tasks. As a result, they strive to
master new skills. Children who are encouraged and commended by parents and teachers
develop a feeling of competence and belief in their skills. Those who receive little or no
encouragement from parents, teachers, or peers will doubt their ability to be successful.
According to Erikson, this stage is vital in the development of self-confidence. During school
and other social activities, children receive praise and attention for performing various tasks
such as reading, writing, drawing and solving problems. Children need to cope with new
social and academic demands. Success leads to a sense of competence, while failure results in
feelings of inferiority.
Psychosocial Conflict: Industry versus Inferiority
Major Question: "How can I be good?"
Basic Virtue: Competence
5. Identity vs. Role Confusion:- This stage occurs during adolescence between the ages
of approximately 12 to 18.In the adolescent years, youths develop a desire for independence
from parents, achieve physical maturity and are concerned with the question of Who am I?
Achievement of the task result in a sense of confidence, emotional stability, and a view of the
self as a unique individual. Commitments are made to the choice of career and to relationship
with members of other genders. Parents are available to Offer support when needed and to
encourage the development of an independent sense of self. Non achievement results in sense
of self consciousness, doubt, and confusion about once role in life.
Psychosocial Conflict: Identity Versus Confusion
Major Question: "Who am I?
Basic Virtue: Fidelity
6. Intimacy vs. Isolation:- This stage takes place during young adulthood between the
ages of approximately 19 and 40. During this period of time, the major conflict centers on
forming intimate, loving relationships with other people. Erikson believed it was vital that
people develop close, committed relationships with other people. Success leads to strong
relationships, while failure results in loneliness and isolation.
Psychosocial Conflict: Intimacy Versus Isolation
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Major Question: "Will I be loved or will I be alone?
Basic Virtue: Love
7. Generativity vs. Stagnation:- This stage takes place during middle adulthood
between the ages of approximately 40 and 65.During adulthood, we continue to build our
lives, focusing on our career and family. Those who are successful during this phase will feel
that they are contributing to the world by being active in their home and community. Those
who fail to attain this skill will feel unproductive and uninvolved in the world.
Psychosocial Conflict: Generatively Versus Stagnation
Major Question: "How can I contribute to the world?"
Basic Virtue: Care
8. Integrity vs. Despair:- This stage occurs during late adulthood from age 65 through
the end of life. During this period of time, people reflect back on the life they have lived and
come away with either a sense of fulfillment from a life well lived or a sense of regret and
despair over a life misspent. Those who feel proud of their accomplishments will feel a sense
of integrity. Successfully completing this phase means looking back with few regrets and a
general feeling of satisfaction. These individuals will attain wisdom, even when confronting
death. Those who are unsuccessful during this phase will feel that their life has been wasted
and will experience many regrets. The individual will be left with feelings of bitterness and
despair.
Psychosocial Conflict: Integrity versus despair
Major Question: "Did I live a meaningful life?
Basic Virtue: Wisdom


















26

Summary
Basic human needs are the indispensable need of our body. For living a healthy and
meaningful life we have to fulfill all the needs. Nurses have a great role in achieving the
needs of the individual, family community. Nurses must have thorough knowledge regarding
the needs of an individual and should know how to plan and give care to the patient
according to the priority of need. In this seminar I have covered basic human needs, Maslow
Hierarchy of need, growth and development, its principles and its occurrence in different
stages of life, and theories related to development like, Freud theory and Erikson theory.
Conclusion
Through this seminar I learned more about the growth and developmental needs of human
being. Milestones and developmental task of each stage of life. The role of cognitive,
emotional and social development in different stage of life.

Bibliography
Dutta parul ,Child Health Nursing,3
rd
edition, jaypee publishers, page no. 76-80.
Kozier, Fundamental Of Nursing 5
th
Edition, page no. 18-21, 40-41.
Lois While Fudamental of Nursing Mosby Publication, Page No.85, 224.
Patricia A. Potter, fundamental Of Nursing 3
rd
edition, Mosby Publication, Page
no.- 29-31
Potter and Perry, fundamental Of Nursing, 5
th
edition Mosby publication.
Shabeer P. Basheer, A Concise Book of Advanced Nursing Practice 1
st
edition,
2012, Emmss medical publishers, page no. 648-675.

Internet:-
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www.ACN.org.com