2. Definition of growth
Growth is a physical maturation
resulting an increase in size or numbers of
the body tissues and its various organs.
3. Development
It is the process of functional,
physiological maturation of the body. It is
the progressive increase in skills and
capacity to function.
4. Stages of Growth and Development
Infancy
Neonate: Birth to 1 month
Infancy: 1 month to 1 year
Early Childhood
Toddler: 1-3 years
Preschool: 3-6 years
Middle Childhood
School age: 6 to 12 years
Late Childhood
Adolescent: 13 years to approximately 18 years
5. Principles of Growth and Development
Growth is an orderly process, occurring
continuously and unique to each child everywhere
in the world.
G& D is proceed by stages and its sequence is
predictable.
G& D depends on many factors especially
heriditary and environment.
Society has strong influence on G& D of a children.
6. Development proceeds from the simple to the
complex and from the general to the specific.
Development occurs in a cephalocaudal and a
proximodistal progression.
There are critical periods for growth and
development.
There is a positive correlation between physical,
mental and emotional development of a child.
8. Growth Patterns
The child’s pattern of growth is in a head-
to-toe direction, or cephalocaudal, and
in an inward to outward pattern called
proximodistal.
9. Why developmental assessment?
Early detection of deviation in child’s
pattern of development
Simple and time efficient mechanism to
ensure developmental progress
Domains assessed: cognitive, motor,
language, social / behavioral and adaptive
10. Anthropometric assessment
Weight
Length
BMI (Body mass Index)
Circumference:
Head Circumference
Chest Circumference
Mid upper arm Circumference
Dentition/eruption of teeth
Osseous growth
11. 1. Weight
Weight of full term infant: 2.5-3.8 kg
20% loss of weight in first week of life
25-30gm/day increases till 3 months.
40gm/month increases till 1 yr
Doubled their birth weight in 5 months old.
Tripled by one year of age.
Four times in 2 yrs
Five times in 3 yrs, Six times in 5 yrs
7 times in7yrs, 10 times n 10 yrs
12. 2.Length
Height improvement indicates skeletal
growth.
At birth average length is about 50cm.
Increases to 60cm at 3 months, 70cm at 9
months.
75cm-1 yr
12cm increases in 2nd yr
9cm increases in 3rd yr
7cm increases in 4th yr
13. 6cm increases in 5th yr
Doubles in height 4-5yrs
Height increases in every year after the 5
years of age.
14. 3.Body mass index (BMI)
BMI= weight in Kg
Height in M2
BMI remains constant up to 5 yrs of age.
BMI >30kg/ M2 indicates obesity
BMI <10kg/ M2 indicates malnutrition
15. 4. Head circumference
Average Head circumference at birth is
about 35 cm
At 3 months it is about 40cm
At 6 months it is about 43cm
At 1 Year it is about 45cm
At 2 Years it is about 48cm
At 7 Year it is about 50cm
At 12 Year it is about 52cm
16. Fontannelle closure
Anterior Fontannelle & posterior
Fontannelle present at birth.
Posterior Fontannelle closes early within
6-8 weeks of life
Anterior Fontannelle closes at 12-18
months of life.
Delayed closure results from malnutrition.
Hydrocephalus, con. Heart disease.
18. Chest circumference
Also known as thoracic diameter
At birth 2-8cm less than the head circumference.
6-12 months head circumference becomes equal.
After 1 yr head circumference more than chest
circumference.
During birth chest circumference round in
shape, later becomes transverse diameter
increases.
19. Mid upper arm circumference
It helps to find out the nutritional condition of children.
At birth average MURC is about 12cm in a normal newborn.
At 1 yr of age about 12-16cm
1-5 yrs about 16-17cm
At 12 yrs 17-18cm
At 15 yrs 20-21 cm
Measurement is taken from acromian process to oleocranon
process of ulna. The simple tape measures are used.
21. Types of teeth
Temporary for small face in small size
Permanent teeth Bigger in size for growing
face.
Temporary teeth
Also called as Milk teeth/Deciduous teeth,
which erupt at the rate of one tooth every
month.
By the age of 2.5-3yrs all (20)temporary
teeth erupts.
22. Permanent teeth
all temporary teeth replaced by permanent teeth.
It starts from 6yrs and 12yrs.
Third molar appears at 18 yrs or later in some
children.
Some babies born with teeth, it is called as natal teeth.
Malocclusion of teeth due to thumb sucking
23. 6. Osseous growth
Bony growth is essential for the proper height
of the child.
Full term neonate have five ossification center.
They are;
Distal end of femur
Proximal end of tibia
Talus
Calcaneous
Cuboid
25. Factors affecting growth and development
Genetic
1. Sex
2. Race and nationality
Environmental
1. Prenatal
Maternal
nutrition/Infections
2. Postnatal
26. Genetic factors
Characteristics such as
height, body structure, color
of skin, eyes and hair
depends upon inherited
genes from parents.
Some familial diseases also
affected the growth of
children
27. Environmental factors
1. Prenatal factors
Intrauterine environment is an important
predominant factor of growth and development.
Maternal malnutrition
Maternal infections
Maternal substance abuse
Maternal illness
Hormones- Thyroxine es the skeleton growth
Uterine malformations
28. 2. Postnatal environmental factors
Growth pattern
Nutrition
Childhood illness
Acute illness
Physical environment
Psychological environment
Cultural influences
Socio economic status
Climate and season
Play and exercises
30. Physical growth of normal infant
Weight : the infant gains :
- Birth to 4 months → ¾ kg /month
- 5 to 8 months → ½ kg / month
- 9 to 12 months → ¼ kg /month
The infant will double his birth wt by 4-5
months and triple it by 10-12 months of
age
32. Height
• Length increases about 3 cm /month
during the 1st 3 months of age,
• then it increases 2 cm /month at age of 4-
6 months,
• Then, at 7 – 12 months, it increases 1 ½ cm
per month
34. Gross Motor Skills
The acquisition of gross motor skill precedes
the development of fine motor skills.
Both processes occur in a cephalocaudal
fashion
Head control preceding arm and hand control
Followed by leg and foot control.
35. Gross Motor Development
Newborn: hardly able
to lift head
6 months: easily lifts
head, chest and
upper abdomen and
can bear weight on
arms
37. Sitting up
2months old: needs assistance
6 months old: can sit alone in the tripod
position
8 months old: can sit without support and
engage in play
39. Ambulation
9 month old: crawl
1 year: stand independently from a crawl
position
13 month old: walk and toddle quickly
15 month old: can run
41. Fine Motor - Infant
Newborn has very little control. Objects will
be involuntarily grasped and dropped
without notice.
6 month old: palmer grasp – uses entire hand
to pick up an object
9 month old: pincer grasp – can grasp small
objects using thumb and forefinger
43. Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as sounds
10-12 months: “mama/dada specific
18-20 months: 20 to 30 words – 50% understood by
strangers
22-24 months: two word sentences, >50 words, 75%
understood by strangers
30-36 months: almost all speech understood by strangers
44. Hearing
Hearing test done at birth
Ability to hear correlates with ability enunciate
words properly
Always ask about history of otitis media – ear
infection, placement of PET – tubes in ear
Early referral to pediatrician to assess for possible
fluid in ears (effusion)
Repeat hearing screening test
Speech therapist as needed
45. Personal and social development
2 months……..social smile
3 months …….. Recognizing the mother
6months………. He responds socially to his name
9 months……….waves bye bye
12 months…….. The infant shows fear of stranger
(stranger anxiety).
He learns that crying brings attention.
The infant smiles in response to smile of others.
46. Emotional development:
• His emotions are instable, where it is rapidly changes
from crying to laughter.
• His affection for or love family members appears.
• By 10 months, he expresses several beginning recognizable
emotions, such as anger, sadness, pleasure, jealousy, anxiety and
affection.
• By 12 months of age, these emotions are clearly
distinguishable.
47. Red Flags in infant development
Unable to sit alone by age 9 months
Unable to transfer objects from hand to hand by
age 1 year
Abnormal pincer grip or grasp by age 15 months
Unable to walk alone by 18 months
Failure to speak recognizable words by 2 years.
49. Physical growth
Weight:
The toddler's average weight gain is 1.8 to 2.7
kg/year.
Formula to calculate normal weight of children
over 1 year of age is
Age in years X 2+8 = ….. kg.
e.g., The weight of a child aging 4 years
= 4 X 2 + 8 = 16 kg
50. Height:
• During 1–2 years, the child's height
increases by 1cm/month.
• The toddler's height increases about
10 to 12.5cm/year.
51. Formula to calculate normal height
Age in years X 5 + 80 =
cm.
e.g., the length of 2 years old child
= 2 X 5 + 80 = 90cm
52. Teething:
• By 2 years of age, the
toddler has 16
temporary teeth.
• By the age of 30
months (2.5 years),
the toddler has 20
teeth
53. Physiological growth:
Pulse: 80–130 beats/min (average
110/min).
Respiration: 20–30C/min.
Bowel and bladder control:
Daytime control of bladder and bowel
control by 24–30 months.
54. Gross motor development
15 month- stands and walk without support.
Creeps upstairs
Throw small objects and pick them up
repeatedly.
18 months- walk sideways and backward
Runs and often falls
Climbs on furniture
55. 24 months- runs more quikly
Walk backward
Kicks large balls with out falling.
30 months- stands on one feet alone
Jumps with both legs
Ride a walker or pedal car.
56. Fine Motor - toddler
15 month- build a tower of 2-3 cubes.
Open boxes
Makes a line with crayon.
Pokes finger in holes
18 months- build a tower of 3-4 cubes
Scripple vigorously
Turns a page in book two to three at a time
Transfers object hand to hand
57. Fine Motor – Older Toddler
24 months- build a tower of 6-7 cubes
Scrippled in more controlled way
Imitates a circle stroke.
Able to fold the paper
30 months- build a tower of 8 cubes
Hold crayons with finger instead of entire
hand.
Make vertical and horizontal stroke.
58. Feeding skills- toddler
15 month- hold a cup with all fingers.
Cause spilling
Enjoys finger feeding than spoon feeding.
Cannot fill the spoon it goes up and down
18 months- Eat with spoon
Play with food
Drop the food in the floor
Spills while eating
59. Feeding skills – Older Toddler
24 months- drink well from a single glass
Plays with food
Can use straw to drink.
Imitate eating habit of others
30 months- self feeding with occasional
spilling
Uses fork and spoon.
Distinguishes from finger and spoon feed.
62. Issues in parenting - toddlers
Stranger anxiety – avoid strangers by age 2 ½ to 3 years
Temper tantrums: occur weekly in 50 to 80% of children –
peak incidence 18 months – most disappear by age 3
Sibling rivalry: aggressive behavior towards new infant:
peak between 1 to 2 years but may be prolonged
indefinitely
Thumb sucking
Toilet Training
66. Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself .
67. Emotional Development of Preschooler
• Fears the dark
• Tends to be impatient and selfish
• Expresses aggression through physical
and verbal behaviors.
• Shows signs of jealousy of siblings.
68. Social development in preschoolers
• Egocentric (Selfish)
• Tolerates short separation
• Less dependant on parents
• May have dreams & night-mares
• Attachment to opposite sex parent
• More cooperative in play
69. Red flags: preschool
Inability to perform self-care tasks, hand washing
simple dressing, daytime toileting
Lack of socialization
Unable to play with other children
Able to follow directions during exam
Performance evaluation of pre-school teacher for
kindergarten readiness
72. Normal school-age child
School-age period is between the age
of 6 to 12 years. The child's growth and
development is characterized by
gradual growth.
73. Physical growth
Weight:
• School–age child gains about 3.8kg/year.
• Boys tend to gain slightly more weight through
12 years.
• Weight Formula for 7 - 12 yrs
= (age in yrs x 7 )– 5
2
74. Height
• The child gains about 5cm/year.
• Body proportion during this period: Both boys and girls
are long-legged.
Dentition
• Permanent teeth erupt during school-age period,
starting from 6 years, usually in the same order in
which primary teeth are lost.
• The child acquires permanent molars, medial and lateral
incisors.
76. Fine motor development
Writing skills improve
Fine motor is refined
Fine motor with more focus
Building blocks
Sewing
Musical instrument
Painting
Typing skills
Technology: computers
77. Motor development
At 6–8 years :
• Rides a bicycle.
• Runs Jumps, climbs and hops.
• Has improved eye-hand coordination.
• Prints word and learn cursive writing.
• Can brush and comb hair.
78. At 8–10 years:
• Throws balls skillfully.
• Uses to participate in organized sports.
• Uses both hands independently.
• Handles eating utensils (spoon, fork, knife) skillfully.
At 10–12 years:
• Enjoy all physical activities.
• Continues to improve his motor coordination.
79. School performance
• Ask about favorite subject
• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
80. Emotional development
The school–age child:
• Fears injury to body and fear of dark.
• Jealous of siblings (especially 6–8 years
old child).
• Curious about everything.
• Has short bursts of anger by age of
10 years but able to control anger by
12 years.
81. Social development
The school–age child is :
• Wants other children to play with him.
• Insists on being first in every thing
• Becomes peer oriented.
• Improves relationship with siblings.
• Has greater self–control, confident, sincere.
• Respects parents and their role.
• Joints group (formal and informal).
• Engage in tasks in the real world.
82. Cognitive development
Greater ability to concentrate and
participate in self-initiating quiet activities
that challenge cognitive skills, such as
reading, playing computer and board
games.
83. Red flags: school age
School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting,
animal abuse
85. Definition of adolescent:
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.
86. Adolescent
As teenagers gain independence they
begin to challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early
adolescents
87. Physical growth:
Weight:
• Growth spurt begins earlier in girls (10–14 years, while it is 12–16 in
boys).
• 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
88. Physiological growth:
Pulse: Reaches adult value 60–80 beats/min.
Respiration: 16–20C/minute.
NB: The sebaceous glands of face, neck and chest
become more active. When their secretion
accumulates under the skin in face,
acne/pimples will appear.
89. Appearance of secondary sex characteristics
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).
90. 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).
91. 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 every thing.
92. Social development:
He needs to know "who he is" in relation to
family and society, i.e., he develops a sense of
identity.
Adolescent shows interest in other sex.
He looks for close friendships.