Theories Related to Growth and Development

Core Concepts

Why Development Needs Theories

Without a framework, a nurse collects observations without knowing which matter. Theories organize facts into patterns, generate predictions ("what should this child be able to do next?"), and highlight what to assess. They also carry a caution: every theory was built in a particular time and culture, and each has limitations. Use them as lenses, not as rules that define a child.

Freud's Psychosexual Theory

Freud proposed that personality develops through stages centered on pleasure-seeking energy focused in different body areas: oral (birth–1 year: sucking, mouthing), anal (1–3 years: toilet training and control), phallic (3–6 years: awareness of gender differences), latency (6–12 years: relatively quiet period), and genital (adolescence onward: mature intimacy). Freud's theory is historically important and widely criticized — much of it lacks empirical support, and its claims about early childhood sexuality are contested. Nurses today rarely apply it directly, but it introduced the idea that early experiences shape later personality.

Erikson's Psychosocial Theory

Erikson described eight lifelong stages, each built around a psychosocial crisis that must be resolved. The first five span the ages in this chapter:

The remaining three (intimacy, generativity, ego integrity) belong to adulthood, covered in Chapter 40. Unlike Freud, Erikson emphasized social relationships and culture, and his framework remains a staple of nursing assessment: "Is this child developing trust through consistent, responsive care?"

Piaget's Cognitive Theory

Piaget described how thinking develops in four stages:

• Sensorimotor (birth–2 years): infants learn through senses and movement; the hallmark achievement is object permanence — knowing a hidden toy still exists.
• Preoperational (2–7 years): symbolic thinking and language explode, but thinking is egocentric (seeing the world from one's own viewpoint), and children use magical thinking and centration (focusing on one feature at a time).
• Concrete operational (7–11 years): logical thinking about real, tangible things; children master conservation — recognizing that amount stays the same despite changes in shape or container.
• Formal operational (12 years and up): abstract, hypothetical, and systematic reasoning becomes possible.

Piaget's stages explain everyday nursing observations: why a preschooler fears a "shot" more than the illness it prevents, and why an adolescent can weigh options the way a younger child cannot.

Kohlberg's Moral Development

Kohlberg described moral reasoning in three levels: preconventional (young children: rules obeyed to avoid punishment or gain reward), conventional (older children and many adults: rules followed to maintain approval, relationships, and social order), and postconventional (principled reasoning based on universal ethical principles). Critiques matter here: Kohlberg's original research used mostly male participants, and the stages describe reasoning about right and wrong, not behavior. Moral reasoning and moral action are not the same thing.

Maslow's Hierarchy of Needs

Maslow ranked human needs from most to least basic: physiological (food, water, sleep, oxygen), safety, love and belonging, esteem, and self-actualization. The hierarchy is a useful nursing triage tool — a hungry, frightened child is unlikely to learn, and safety needs come before teaching. Maslow himself did not intend it as a rigid ladder; people move between levels, and the ordering varies across cultures and situations.

Havighurst's Developmental Tasks

Havighurst defined developmental tasks as skills that arise at certain periods of life — tasks whose mastery leads to happiness and success with later tasks, and whose failure leads to difficulty ahead. Examples in childhood include learning to walk and talk (infancy), learning to get along with age-mates (early childhood), and achieving personal independence (adolescence). Havighurst's tasks pair naturally with anticipatory guidance: teach families what task is next, and they know what to support.

Using Theories in Practice

In practice, nurses take an eclectic approach: match the theory to the question. Use Erikson for psychosocial assessment, Piaget for how to explain things, Maslow to prioritize, and Havighurst to plan anticipatory guidance. Remember the limits: stages describe typical patterns, not every child; cultural and individual variation is normal; and a theory-based "label" must never replace a full assessment of the actual child and family.

How It Works / Step-by-Step Process: Applying a Theory to a Clinical Question

1. Name the question. Example: "Why is 4-year-old Jayden refusing to hold still for the dressing change, and how do I explain it to him?"
2. Pick the fitting lens. The question is about thinking and communication → Piaget (preoperational); about feelings and control → Erikson (initiative vs. guilt).
3. Predict behavior from the theory. Preoperational thinking means Jayden interprets the procedure through imagination and his own viewpoint — he may fear it as punishment or magic.
4. Design the approach. Use concrete, simple language; let him "help" (respecting initiative); use play or a doll; keep explanations immediate rather than abstract.
5. Evaluate and document. Note what worked and the child's response; share the strategy with the family and team. Flag any behavior outside expected patterns for provider review.

Common Confusions