Delayed growth and development is a condition in which a person’s patterns of behavior differ from those of their age bracket. Children progress through developmental stages at their own pace, with some moving ahead of others.
Even siblings in the same family can progress at varying speeds. Mild transitory delays are normally unproblematic, but a persistent delay or a series of delays in attaining milestones can indicate that difficulties may come in the future.
Developmental delays can be caused by several reasons, including genetics, prenatal complications, and preterm delivery, the cause of which isn’t always understood. It can sometimes signal an underlying issue that can only be diagnosed by a physician.
A growth delay, on the other hand, occurs when a child does not grow at the normal rate for his or her age. An underlying health condition, such as growth hormone deficiency or hypothyroidism, could also cause the delay.
In certain cases, early diagnosis and treatment can help the children reach a standard or relatively close height.
Theories of Growth and Development
Nurses typically care for patients of all ages during both their nursing education and career. To improve interactions and reduce stress on both sides, it is essential to understand where they are from both a developmental and cognitive standpoint.
Consider giving a vaccination to a two-month-old infant versus a 12-year-old child, prepping a 6-year-old for surgery versus a 19-year-old, or communicating treatment objectives with a 7-year-old versus a 21-year-old versus a 60-year-old.
One thing is certain: applying the same technique to any patient may not be effective or even applicable – the nurse must consider where the individual is at and meet them on their level.
The theories of growth and development listed below can help nurses analyze patients’ behavior and challenges with present developmental stages.
- Erickson’s Psychosocial Theory
Erik Erikson, an ego psychologist, created one of the most famous and dominant developmental theories, focusing on psychosocial development.
He believed that personality developed in stages, from infant to adulthood. Erikson’s theory explains the impact of social experience throughout the lifespan, as well as how social interaction and relationships influenced human development and growth.
Erickson’s psychosocial theory is composed of the following stages:
| Stage | Psychosocial Crisis | Age |
| Stage 1 – Infancy | Trust vs. Mistrust | 0 to 1 ½ |
| Stage 2 – Early Childhood | Autonomy vs. Shame | 1 ½ to 3 |
| Stage 3 – Preschool | Initiative vs. Guilt | 3 to 5 |
| Stage 4 – School Age | Industry vs. Inferiority | 5 to 12 |
| Stage 5 – Adolescence | Identity vs. Role Confusion | 12 to 18 |
| Stage 6 – Young Adulthood | Intimacy vs. Isolation | 18 to 40 |
| Stage 7 – Middle Adulthood | Generativity vs. Stagnation | 40 to 65 |
| Stage 8 – Late Adulthood | Ego Integrity vs. Despair | 65+ |
At every stage, a person goes through a psychosocial crisis, which can have a positive or negative impact on their personality development.
According to Erikson, completing each stage successfully results in a healthy personality and the discovery of basic virtues, which are distinguishing characteristics that the ego can use to survive in the future.
Inability to complete a stage successfully can lead to a reduced capacity to perform subsequent stages and, as a result, a more undesirable personality and sense of self. These stages, on the other hand, can be completed successfully at a later date.
- Piaget’s Four Stages of Cognitive Development
According to the theory of cognitive development developed by Jean Piaget, a renowned Swiss psychologist, children progress through four stages of mental development.
Jean Piaget’s theory tries to recognize not just how children obtain knowledge, but also the nature of intelligence. The intellectual or cognitive development stages developed by Jean Piaget are as follows:
| Stages | Age | Characteristics |
| Stage 1 – Sensorimotor | 0 – 24 months | Starts to distinguish oneself from things Communicates with its surroundings Develops object permanence and separation anxiety |
| Stage 2 – Pre-operational | 2 – 7 years | Learns how to use word or image symbols Egocentric thinking – cannot see the perspectives of others Knows how to pretend |
| Stage 3 – Concrete operational | 7 – 11 years | Possess the ability to think logically concerning objects and events Objects are classified based on various characteristics. Understands the rules |
| Stage 4 – Formal operational | 11 years & up | Can reason logically about abstract arguments and test hypotheses methodically Has become preoccupied with hypothetical, prospective, and intellectual concerns |
As previously stated, each child develops at his or her own speed but possesses a basic comprehension of where he or she is, assists the healthcare provider in strengthening the therapeutic relationship with the patient.
The greater the connection, the more honest and transparent the patient will be with the healthcare provider. This will allow the nurse to further evaluate the patient’s worries and concerns, and provide them with the best possible care.
Signs and Symptoms of Delayed Growth and Development
If the child is smaller than other children his or her age, he or she may be experiencing growth problems. It is usually considered a medical concern if they are smaller than 95% of other children their age and grow at a slow rate. A child with a normal height but a slowed rate of growth may also be diagnosed with a growth delay. Other symptoms may occur depending on the underlying cause of their growth delay, as listed below:
- The size of their arms or legs may be out of proportion to their body in conditions related to certain forms of dwarfism.
- If the underlying cause is low thyroxine levels, they may experience fatigue, constipation, dry skin, dry hair, and difficulty staying warm.
- For those with low levels of growth hormone, it can influence the growth of the face, making children appear unusually young.
- They may have blood in their stool, loose bowel movement, constipation, vomiting, or nausea if the delay is caused by stomach or bowel disease.
On the other hand, delays in encompassing speech, thinking, interpersonal, or motor function milestones, are referred to as developmental delay. Similar to growth delay, the symptoms of developmental delay are typically associated with the underlying cause or condition and can be further classified into the following:
- Delay in fine and gross motor skills. Fine motor skills involve small movements such as holding a doll or using a pencil, whereas gross motor skills involve larger movements such as hopping, climbing, or throwing and catching a ball. Some of the following symptoms may indicate that the child is delayed in developing specific fine or gross motor functions:
- trunk and limbs that are wobbly or loose
- arms and legs that are rigid
- movement of the arm and leg is restricted.
- failure to sit without assistance by 9 months of age
- involuntary reflexes are noticeably dominant over voluntary movements
- inability to bear weight on the legs and stand up by the age of one year
- Delay in speech and language. Language delay and speech delay are not the same things. A speech delay occurs when children do not say as many words as would be expected for their age, whereas a language delay occurs when children struggle to comprehend what others say or cannot express themselves. In young children, discerning between speech and language delay can be challenging. A child who understands things and can express their needs, perhaps by pointing or signing, but is not speaking as many words as they should, for example, may have an isolated speech delay. In addition, hearing loss can cause speech and language delays, so a hearing test is usually included in the diagnosis.
- Autism spectrum disorder (ASD). ASD consists of quite a few neurodevelopmental disorders. Autistic people may think, move, interact, and deal with their senses in ways that normal people do not. It is typically diagnosed in early childhood and is characterized by a significant delay in language and social development. ASD symptoms and signs, as listed below, differ and are sometimes clear early on, but may not be realized until a child is 2 or 3 years old.
- not responding to their name
- dislike hugging and playing with other people
- flat affect
- difficulty speaking, conversing, or recalling words or phrases
- do repetitive and exact routines and movements
- trouble with coordination
Causes of Delayed Growth and Development
The causes of developmental and growth delays can be difficult to ascertain, and a lot of factors can play a role, but the following are the most common:
- Genetics or family history
- Constitutional growth delay. Affected children typically have a slow bone age, which means their bones mature at a slower rate than their actual age. This results in a lower-than-average height in early adolescence, but they usually catch up with the pace by adulthood.
- Growth hormone deficiency
- Hypothyroidism
- Turner Syndrome. It is a genetic disorder that affects females who are lacking a fraction or all of one X chromosome.
- Down syndrome, skeletal dysplasia, sickle cell anemia, kidney, heart, digestive, or lung diseases, use of certain drugs by the mother during pregnancy, poor nutrition, and severe stress are all less common causes of delayed growth.
- Autism spectrum disorders (ASDs), cerebral palsy, fetal alcohol spectrum disorders, myopathies, and Landau Kleffner syndrome are all examples of medical conditions that can lead to developmental delay.
Treatment of Delayed Growth and Development
The treatment plan for delayed growth and development will be determined by the underlying cause of the condition. Physicians usually do not recommend any treatments or interventions for delayed growth and development caused by family history or a constitutional delay. In terms of the other underlying causes, the treatments or interventions listed below may assist them in initiating normal growth.
- Growth hormone (GH) deficiency The physician may advise giving them GH injections, which are usually administered at home by a parent once a day. The treatment will most likely last several years as the child grows and the physician will assess the efficacy of the GH treatment and adjust the dosage as needed.
- Hypothyroidism. The physician may prescribe thyroid hormone replacement drugs to make up for the child’s underperforming thyroid gland, while also regularly monitoring the child’s thyroid hormone levels.
- Turner syndrome. From around the age of four to six, the child’s doctor may advise beginning daily GH injections to increase the child’s likelihood of achieving average adult height. Just like in the treatment for GH deficiency, the injections are usually given to the child at home, and the dosage can be adjusted based on the child’s progress.
Other treatments for the child’s delayed growth and development may be available depending on the cause.
Related Factors to Delayed Growth and Development
- consequences of physical disability
- deficit in the environment and stimulation
- lack of interaction with family and significant others
- inadequate care resulting from apathy, inappropriate responses, and multiple caregivers
- imposed dependence to parents/ guardians
Delayed Growth and Development Nursing Diagnosis
Delayed Growth and Development is the nursing diagnosis and here are the medical diagnoses secondary to the following health disorders.
Nursing Care Plan for Delayed Growth and Development 1
Nursing Diagnosis: Delayed Growth and Development related to activity limitations and environmental deficiencies secondary to cerebral palsy as evidenced by delayed in achieving developmental milestones, weakness in one arm and leg, and lack of muscle coordination.
Desired Outcome: The patient will attain a stimulating environment, and convey interest in people and activities around.
| Nursing Interventions for Delayed Growth and Development | Rationale |
| Continue to assess the patient’s developmental levels at reasonable intervals based on disorder or other difficulties. | Gives supporting evidence to evaluate the care plan for improving any deficiencies in growth and development. |
| Evaluate the family members’ feelings concerning the child’s health condition and necessary treatment options. | Motivates acceptance and adaptation to the child’s abilities and functional capacity. |
| Encourage a child while he or she is involved in his or her activities. | Learning to perform activities on their own can help children develop a sense of self-worth. |
| Promote age-appropriate games as well as other activities that enhance gross and fine motor development, sensory development, and cognitive development, like allowing the child to sort and arrange the different colors of balls. | These activities promote growth and development while also stimulating the child. |
| Select toys that are appropriate for the child’s abilities. | Since some children with cerebral palsy have struggles in gripping, pick a good toy that is easy to grasp. |
| Initiate a referral to occupational therapy as needed. | Occupational therapy helps children with cerebral palsy improve their physical, intellectual, and social abilities, as well as their motor skills and posture. |
| Encourage the parent to register the child in a school program. | A school program that is appropriate for the child’s cognitive aptitudes is necessary to attain desirable exposure from the outside. |
Nursing Care Plan for Delayed Growth and Development 2
Lead Poisoning
Nursing Diagnosis: Delayed Growth and Development related to effects of lead on the brain secondary to lead poisoning as evidenced by disorganized behavior, hyperactivity, irritability, and lethargy.
Desired Outcome: The patient will be able to communicate and interact with the family members.
| Nursing Interventions for Delayed Growth and Development | Rationale |
| Instruct the family to throw out old painted toys, avoid canned goods from other countries, and cover the walls with paneling or Masonite. | To decrease the child’s exposure to lead by eliminating materials that contain lead. |
| Administer medications, as prescribed by the physician while closely monitoring for possible side effects. | All chelating substances may have toxic side effects, and children receiving treatment must be closely monitored with urinalysis, blood cell counts, and renal function tests regularly. |
| Educate the patient’s parents about lead sources, common behavior attributed to lead exposure, such as pica, and the risks associated with lead exposure on children’s development. | Nutritional assessment is especially important since lead absorption is augmented by inadequate dietary intake, particularly in the presence of high fat intake and/or lack of certain essentials, such as calcium and iron. |
| Ensure that the patient is having an adequate nutritional intake. | The meal plan should be high in energy or caloric intake and rich in calcium, zinc, and iron, as well as vitamin C and D because low dietary intake of said vitamins increases lead accumulation in bones and may increase lead levels in the blood. |
| Watch out for seizures and respiratory depression. Ensures child safety and administers oxygen as necessary. | Shortness of breath as a sign of respiratory depression or even seizures may occur in a child who has been exposed to lead. |
Nursing Care Plan for Delayed Growth and Development 3
Down Syndrome / Trisomy 21
Nursing Diagnosis: Delayed Growth and Development related to diminished ability to attain developmental tasks secondary to Down syndrome / Trisomy 21 as evidenced by stunted growth, delayed milestone of talking and walking, poor attention span, verbal memory, and inability to sit or stay for a long time.
Desired Outcome: The patient will be able to perform motor, social, and/or expressive skills typical of the age group within the scope of present capabilities.
| Nursing Interventions for Delayed Growth and Development | Rationale |
| Assess the child’s swallowing ability, provide information on proper food administration, as well as provide proper nutritional counseling. | This is done to provide and ensure that the patient receives adequate nutrition. |
| Encourage parents to have their child’s hearing and vision tested regularly. | Hearing problems are frequently associated with developmental delay; therefore, frequent consultations are required to ensure that appropriate treatment is provided and the underlying cause is dealt with. |
| Evaluate the parents’ knowledge of Down syndrome. | It is beneficial to educate parents about Down syndrome and how to care for a child with the disorder to promote continuity of care at home. |
| Give emotional and motivational support to the patient’s family. | The family requires assistance during these difficult times; they require strong support and guidance from the time the child is born. |
Nursing Care Plan for Delayed Growth and Development 4
Nursing Diagnosis: Delayed Growth and Development related to impaired ability to achieve developmental tasks secondary to hydrocephalus as evidenced by the slow development of hand-eye coordination and difficulty learning to walk.
Desired Outcome: The patient will be able to maintain growth and development appropriate to his or her age.
| Nursing Interventions for Delayed Growth and Development | Rationale |
| Monitor the patient’s vital signs, neurological status, and pupil reaction. | The purpose of monitoring is to detect changes in mental status, reflexes, and motor function. Changes in the patient’s pupil reaction may reveal that the brain stem is not functioning properly. |
| Communicate effectively and establish a good working relationship with the patient’s caregiver. | Establishing a good working relationship helps the nurse in gaining trust and cooperation. |
| Encourage growth and development by constantly interacting with the patient and providing age-appropriate activities and toys. | The child requires social interaction and should be talked to, played with, and provided with the opportunity for activity, as well as toys that are appropriate for his physical and psychological capability. |
| Keep the enlarged head constantly supported and elevated when holding an infant | To encourage the integration of brain function that affects the patient’s behavior, learning capacity, and emotions |
| Regularly monitor the patient’s weight. | Making sure that the patient receives adequate nutrition allows the nurse to evaluate whether the feeding pattern is sufficient to enhance growth and development. |
| Always ensure the patient’s safety to avoid head and neck injuries, | Additional injuries to the patient must be avoided at all costs as they may aggravate the development and growth delay of the patient. |
Nursing Care Plan for Delayed Growth and Development 5
Congenital Hypothyroidism
Nursing Diagnosis: Delayed Growth and Development related to related to insufficient production of thyroid hormone secondary to congenital hypothyroidism as evidenced by lethargy, poor growth, short limbs, and slow developmental capacity.
Desired Outcome: The patient will be able to maintain growth and development appropriate to his or her age.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
Disclaimer:
Please follow your facility’s guidelines, policies, and procedures.
The medical information on this site is provided as an information resource only and should not be used or relied on for diagnostic or treatment purposes.
This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
