THis is a growth and development PowerPoint for fulfilment of masters degree in Epidemiology

1. AMU School Of Medicine
By: Ephrem F. (MD)
GROWTH AND DEVELOPMENT

2. OBJECTIVES
 Define growth and development
 To discuss on the normal patterns of growth and development at
different age groups
 To discuss on how to assess growth and development
 To discuss on the factors affecting growth and development
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3. DEFINITIONS
 Growth: is an increase in size of the body and its various organs
from simple to complex, from its earliest stage to maturity.
 Development: implies an increase in skill and complexity of
function.
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4. NORMAL GROWTH PATTERNS
 The rate of growth in the first year of life is the most rapid one,
tripling his birth weight and increasing his length by 50% .
 The increase in the head circumference is also one of the rapid rates
in his entire life which is 12cm
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5. WEIGHT
 Average birth wt is said to be abt 3.25 kg
 New born loses up to 10% of body wt in the first week and regains
the birth wt at the 10’th day of life.
 For the first 3 months the infant gains about 30 gm per day.
 Then gains about 40 gm per month for the rest of the first year.
 The infant doubles his birth wt. at 5 months and triples it at 1 yr.
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6. WEIGHT
 At 1yr is 3 times birth weight
 At 2yrs is 4 times Birth weight
 At 3yrs is 5 times the birth weight
 At 5yrs is 6 times the birth weight
 At 10yrs is 10 times the birth weight
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7. LENGTH / HEIGHT
 The birth length on average is about 50 cm
 75 cm at 1yr
 85 cm at 2yrs
 95 cm at 3yrs
 Then the child increases by 5 cm every year till puberty
 Approximate height for those b/n 2-12yrs is
Ht. =( age in yr. x6)+77cm
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Ht. =( age in yr. x6)+77cm

8. Formulas to approximate wt. and ht. when the age is known
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9. HEAD CIRCUMFERENCE
 Represents the growth of the brain
 Average HC
◦ 35 cm at birth
◦ 47 cm at one yr
◦ 50 cm at 7 yrs
◦ 52 cm at 12yrs
 90% of adult head circumference is achieved by age 2 yr,
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10. DENTITION
 Dental development includes mineralization, eruption, and
exfoliation
 Mineralization begins as early as the 2nd trimester and continues
through 3 yr of age for the primary (deciduous) teeth and 25 yr of
age for the permanent teeth
 Average age for the eruption of the first teeth is at 6-7 months
 Eruption begins with the central incisors and progresses laterally.
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11.  The rest of the milk teeth appear at a rate of one teeth per month
 By 2&half to 3 yrs the child has the 20 milk teeth
 At 6yrs exfoliation of milk teeth begins and continue up to 12 yrs.
 Delayed eruption of tooth as late as 13 months is normal
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12. FACTORS AFFECTING GROWTH AND
DEVELOPMENT
 Genetic/biologic factors
 Neuro hormonal factors
 Nutritional factors
 Psychological factors
 Social factors
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13. GENETIC FACTORS
 The growth of a child is a result of complex interactions of genetic
and environmental factors.
 As a result of multiple genetic differences, certain people are taller
than others.
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14. NEURO HORMONAL FACTORS
 It has been suggested that there may be a growth center in the brain
that keeps the child in his or her genetically determined growth
curve.
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15. HORMONAL INFLUENCE
 Most of the endocrine glands influence growth significantly either
by promoting protein synthesis, regulating substrate supply, or
enhancing the effect of other hormones on specific organs.
 Hormones with a great influence on growth are: growth hormone,
somatomedines, insulin, thyroid hormone, and sex hormones.
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16. NUTRITION
 Adequate food to provide substrate for energy and synthesis of
proteins is essential for normal growth.
 Illnesses which interfere with nutritional intake or compete for it
delays growth and dev’t.
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17. ASSESSMENT OF GROWTH AND
DEVELOPMENT
 Important for early detection of deviation in child’s pattern of
growth and development, and to take appropriate action.
 The most powerful tool in growth assessment is the growth chart
which provides most of the information needed to assess growth.
 The standard charts are based on the data collected from 1963
to1975 by the National Centers for Health Statistics (NCHS).
 The new standard chart prepared by CDC also provides body mass
index (BMI) curves through age 2yrs to 20yrs, facilitating
identification of obesity.
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18.  Separate charts are provided for boys and girls.
 Each chart is composed of seven percentile curves, which indicate
the percentages of children at a given age on the X-axis whose
measured values fall below the corresponding value on the Y-axis.
 The normal values for age are represented between the fifth and
ninety-fifth percentiles, and the fiftieth percentile represents the
median (standard) value.
 In children under 5 years old an additional chart (Harvard standard)
is used to measure weight for age as percentages of the median or
standard value in the NCHS curve.
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19.  The data are presented in 5 standard gender-specific charts:
(1) weight for age;
(2) height/length for age;
(3) head circumference for age;
(4) weight for height/ length; and
(5) BMI for age, for children over 2 yr of age
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20. WEIGHT FOR AGE
 Children falling below the 5th centile of NCHS or below the 80% of
Harvard Standard are labelled as malnourished.
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21. HEIGHT/ LENGTH FOR AGE
 A height for age that is below normal shows stunting and indicates
chronic states of malnutrition.
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22. WEIGHT FOR HEIGHT
 Getting an accurate age may be a problem in countries like
Ethiopia, where the majority of people are from rural areas and
illiterate.
 Weight for height measurements can overcome this problem.
 Those with weight for height falling below the normal are labeled
as wasted (acute malnutrition).
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23. HEAD CIRCUMFERENCE FOR AGE
 Values below the -3 standard deviation (SD) are labelled as
microcephaly and above +3 SD as macrocephaly.
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24. Mid-upper arm circumference (MUAC)
 This indicates acute malnutrition and values less than normal are
labeled as wasting.
 For children 6 month to 5yrs:
<11cm is severe wasting
11-12.5cm is moderate wasting
12.5- 13.5 is mild wasting
>13.5cm is normal
 Not used in children less than 6 months.
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25.  There are four components of developmental Assessment
1. Gross motor development
2. Fine motor development (manipulation)
3. Cognition and social skill development
4. Language development
 Development follows in a predictive manner i.e,central to
peripheral , proximal to distal, and cephal to caudal.
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ASSESSMENT OF DEVELOPMENT

26. Gross motor development
 Denotes a neuromuscular development including posture,
independent mobilities, progresses from head control when the
child is sitting alone to standing, walking and running.
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27. Fine motor development
 Fine motor development denotes the ability of the child to reach
for, grasp and manipulate objects.
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28. Cognition and social skill
 These include social smile, watching a mirror, waving goodbye,
general alertness, and curiosity about the surrounding.
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29. Language
 Development of speech.
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30. Infancy
 Gross motor: lift their heads with good control at 3 months, sit
independently at 6 months without support , crawl at 8 months,
stand and start to walk at 1 year.
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31.  Fine motor: at 3-4 months babies can grasp objects, at 5-6 months
they can transfer objects from hand to hand, at 9 months they can
achieve a thumb-finger grasp, and at around 12 months they start to
scribble.
 Cognition and social skills: at 6-8 weeks babies start to smile in
response to faces or voices, at 4 months they laugh, at 6-8 months
they develop stranger anxiety.
 Language: during their first 6 months babies pronounce vowels; at
7 months they start to voice consonants, at age 12 months they start
saying ‘mama’ & ‘dada .
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32. Toddlerhood
 In this period the growth rate slows down compared to infancy.
 Gross motor: toddlers start to walk independently between the age
of 12 to 15 months; at 18 months, they can run stiffly and walk
upstairs with one hand held, at 24 months they can run well.
 Fine motor: at 15 month toddlers can make a line with crayon and
insert pellet in a bottle; at 18 month they can imitate a vertical
stroke, and at 24 months they can imitate a horizontal stroke.
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33.  Cognition and social skills: at 15 month toddlers can indicate
some desires by pointing; at 18 month they can feed themself and
they may complain when wet or soiled; at 24 months they can listen
to stories with pictures.
 Language: at 15 month toddlers start to speak in jargon; at 18
months they can say 10 to 15 words; at the end of 24 months they
can say two word sentences (e.g. mama shoe)
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34. Pre school years
 Gross and fine motor: at two and half years children can go
upstairs alternating feet, at 4 years they can hop on one foot, and at
5 years they can skip.
 Handedness is usually established by the 3rd yr.
 Bowel and bladder control emerge during this period.
 Bed-wetting is normal up to age 4yrs in girls, 5yrs in boys.
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35.  Cognition and Language: language development occurs most
rapidly between the ages of 2 - 5 years.
 At two and half years most children know their full name and at 3
years they know their age and sex, count three objects correctly.
 At 4 years children can tell a story and play with several children;
at five years they can name 4 colors, count 10 objects correctly, and
dress and undress.
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36. School age
 Motor: able to perform complex movements such as dancing.
 Cognition and language: children start thinking in concrete logical
operations.
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37. Adolescence
 Children undergo rapid changes in body size, shape, physiology,
and psychology and social functioning.
 It proceeds in three phases; early, middle,& late adolescence.
 Each phase has its own characteristics
 The common changes that occur during each phase are described in
the following table.
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39. Sexual maturity rating for adolescence assessment,
males
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40. Sexual maturity rating for adolescence
assessment,females
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41. Sexual changes in boys and girls during adolescence
Fig. A – Sex maturity ratings of pubic hair changes in adolescent boys and girls
Fig. B – Sex maturity ratings of breast changes in adolescent girls
A B
2 3
4 5
2 3
4 5
1
2
3
4
5
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42.  In the girls, the first visible sign of puberty is the appearance of
breast buds, between 8 and 12 yr of age.
 Menses typically begins at median age of 12 yr; (9–16 yr.)
 In boys, the first visible sign of puberty is testicular enlargement,
beginning as early as 9½ yr. followed by penile growth.
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43. THANK YOU!
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