2. Learning objectives:
By the end of session the learners will be able to:
Assessing Growth & Development in children of different
age group
Discuss Growth & Development pattern in South Asian
Countries, and influence of Pakistani culture on Growth and
Development of child.
Identify Factors influencing physical and emotional
development of children
Assessing Milestones
Identify Nursing Care aspects for dealing with deviations in
Growth & Development pattern
1/5/2024 2
3. DEFINITION
GROWTH:
The term growth denotes a net increase in the size,
or mass of the tissue. It is largely attributed to multiplication
of cells and increase in the intracellular substance.
ACCORDING TO HURLOCK
GROWTH is change in size, in proportion, disappearance
of old features and acquisition of new ones
According to Crow and Crow (1962)
Growth refers to structural and physiological changes
1/5/2024 3
4. DEVELOPMENT
Development specify maturation of functions. It
is related to the maturation and myelination of
the nervous system and indicates acquisition of a
variety of skills for optimal functioning of the
individual
According to Hurlock(1959)
Development means a progressive series of
changes that occur in an orderly predictable
pattern as a result of maturation and experience.
1/5/2024 4
5. Cont…
According to J.E. Anderson(1950)
Development is concerned with growth as well
as those changes in behavior which results from
environmental situations.
According to Liebert, Poulos and Marmor (1979)
Development refers to a process of change in
growth and capability over time, as function of
both maturation and interaction with the
environment
1/5/2024 5
6. DIFFERENCE BETWEEN GROWTH AND
DEVELOPMENT
GROWTH
The term is used in purely
physical sense. It generally
refers to increase in size,
length.
Changes in the quantitative
aspects come into the domain
of Growth.
DEVELOPMENT
Development implies overall
change in shape, form or
structure resulting in
improved working or
functioning.
Changes in the quality or
character rather than the
quantitative aspects comes in
this domain.
1/5/2024 6
7. Cont.…
GROWTH
It is a part of developmental
process. Development in its
quantitative aspect is termed
as growth.
Growth does not continue
throughout life. It stops when
maturity has been attained.
DEVELOPMENT
It is a comprehensive and
wider term and refers to
overall changes in the
individual.
Development is a wider and
comprehensive term and
refers to overall changes in
the individual. It continues
throughout life and is
progressive.
1/5/2024 7
8. Cont….
GROWTH
Growth involves body changes.
The changes produced by growth
are the subject of measurement.
They may be quantified.
Growth is cellular. It takes place
due to the multiplication of cells.
Growth may or may not bring
development.
DEVELOPMENT
Development involves changes of
an orderly, coherent type tending
towards the goal of maturity.
Development implies improvement
in functioning and behavior and
hence bring qualitative changes
which are difficult to be
Development is organizational. It is
organization of all the parts which
growth and differentiation have
produced.
Development is also possible
without growth.
1/5/2024 8
9. PRINCIPLES OF GROWTH AND
DEVELOPMENT
Development is a continuous process from conception
to maturity
Development depends on the maturation and
myelination of nervous system.
The sequence of the development is same for all
children, but the rate of development varies from child
to child
Each child grows in his/her own unique way.
Each stage of growth and development is affected by the
preceding types of development. 1/5/2024 9
13. DEVELOPMENTAL AGE PERIODS
Infancy
Neonate -Birth to 1 month
Infancy -1 month to 1 year
Early Childhood
Toddler – 1 to 3 years
Preschool – 3 to 6 years
Middle Childhood
School age – 6 to 12 years
Late Childhood
Adolescent – 13 years to approximately 18 years
1/5/2024 13
17. Types of growth and development
Types of growth:
Physical growth (Ht., Wt., head & chest
circumference)
Physiological growth (vital signs …)
Types of development:
Motor development
Cognitive development
Social and Emotional development
Linguistic development 1/5/2024 17
18. NEWBORN:
Newborn stage is the first 4 weeks or first month of
life. It is a transitional period from intrauterine
life to extra uterine environment.
1/5/2024 18
19. NORMAL NEWBORN:
Physical growth
- Weight = 2.500 – 3.5 kg
- Wt. loss 5% -10% by 3-4 days after birth
- Wt. gain by 10th days of life
- Gain ¾ kg by the end of the 1st month
1/5/2024 19
20. WEIGHT:
They loose 5 % to 10 % of weight by 3-4 days
after birth as result of :
Withdrawal of hormones from mother.
Loss of excessive extra cellular fluid.
Passage of meconium (feces) and urine.
Limited food intake.
1/5/2024 20
21. HEIGHT:
• Boys average Ht. = 50 cm
• Girls average Ht. = 49 cm
• Normal range for both (47.5- 53.75 cm)
HEAD CIRCUMFERENCE
33-35 cm
Head is ¼ total body length
Skull has 2 fontanels (anterior & posterior)
CHEST CIRCUMFERENCE
It is 30.5 to 33cm (usually 2–3cm less than head
circumference).
1/5/2024 21
22. ANTERIOR FONTANELLE:
• Diamond in shape
• The junction of the sagittal, corneal and frontal
sutures forms it
• Between 2 frontal & 2 parietal bones
• 3-4 cm in length and 2-3 cm width
• It closes at 12-18 months of age
1/5/2024 22
27. TOUCH:
• It is the most highly developed sense.
• It is mostly at lips, tongue, ears, and forehead.
• The newborn is usually comfortable with touch.
VISION:
• Pupils react to light
• Bright lights appear to be unpleasant to newborn
infant.
• Follow objects in line of vision
1/5/2024 27
28. HEARING:
• The newborn infant usually makes some
response to sound from birth.
• Ordinary sounds are heard well before 10 days of
life.
• The newborn infant responds to sounds with
either cry or eye movement, cessation of activity
and / or startle reaction.
1/5/2024 28
29. TASTE:
Well developed as bitter and sour fluids are resisted
while sweet fluids are accepted.
SMELL:
Only evidence in newborn infant’s search for the
nipple, as he smell breast milk.
1/5/2024 29
30. GROSS MOTOR DEVELOPMENT:
Motor development:
The newborn's movement are
random, diffuse and uncoordinated. Reflexes
carry out bodily functions and responses to
external stimuli.
FINE MOTOR DEVELOPMENT:
• Holds hand in fist
• When crying, he draws arms and legs to body
1/5/2024 30
32. Cognitive development:
The cognitive development of newborn infant is
difficult to understand or observe it.
Emotional development:
The newborn infant expresses his emotion just
through cry for hunger, pain or discomfort
sensation
1/5/2024 32
33. INFANT:
It is the period which starts at the end of the
first month up to the end of the first year of
age. Infant's growth and development during
this period are rapid.
1/5/2024 33
34. 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
1/5/2024 34
35. CALCULATING INFANT’S WEIGHT:
Infants from 3 to 12 months
Weight = Age in months + 9
2
Wt. of 7 months old infant = 7+9 = 16 = 8 kg
2 2
1/5/2024 35
36. 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
1/5/2024 36
37. HEAD CIRCUMFERENCE:
• It increases about 2 cm /month during the 1st 3
months,
• Then, ½ cm/month during the 2nd 9 months of
age.
• Posterior fontanel closes by 6-8 w of age.
• Anterior fontanel closes by 12-18 months of age.
1/5/2024 37
38. CHEST CIRCUMFERENCE:
By the end of the 1st year, it will be equal to head
circumference.
PHYSIOLOGICAL GROWTH OF INFANTS:
Pulse 110-150 b/min
Resp. 35 ± 10 c/min
Breath through nose.
Blood pressure 80/50 ± 20/10 mmHg
1/5/2024 38
39. MOTOR DEVELOPMENT:
At 2 months
• Hold head erects in mid-position.
• Turn from side back.
At 3 months, the infant can
• Hold head erects and steady.
• Open or close hand loosely.
• Hold object put in hand
1/5/2024 39
NEONATE
6 MONTHS
40. AT 4 MONTHS, THE INFANT CAN:
• Sit with adequate support.
• Roll over from front to back.
• Hold head erect and steady while in sitting
position.
• Bring hands together in midline and plays with
fingers.
• Grasp objects with both hands.
1/5/2024 40
41. AT 5 MONTHS, THE INFANT CAN:
• Balance head well when sitting.
• Site with slight support.
• Pull feet up to mouth when supine.
• Grasp objects with whole hand (Rt. or Lt.).
• Hold one object while looking at another
1/5/2024 41
42. AT 6 MONTHS, THE INFANT CAN:
• Sit alone briefly.
• Turn completely over ( abdomen to abdomen ).
• Lift chest and upper abdomen when prone.
• Hold own bottle.
AT 7 MONTHS, THE INFANT CAN:
• Sit alone.
• Hold cup.
• Imitate simple acts of others.
1/5/2024 42
43. AT 8 MONTHS, THE INFANT CAN:
• Site alone steadily.
• Drink from cup with assistance.
• Eat finger food that can be held in one hand.
AT 9 MONTHS, THE INFANT CAN:
• Rise to sitting position alone.
• Crawl (i.e., pull body while in prone position).
• Hold one bottle with good hand-mouth
coordination
1/5/2024 43
44. AT 10 MONTHS, THE INFANT CAN:
• Creep well (use hands and legs).
• Walk but with help.
• Bring the hands together.
AT 11 MONTHS , THE INFANT CAN:
• Walk holding on furniture.
• Stand erect with minimal support
1/5/2024 44
45. AT 12 MONTHS, THE INFANT CAN:
• Stand-alone for variable length of time.
• Site down from standing position alone.
• Walk in few steps with help or alone (hands held
at shoulder height for balance).
• Pick up small bits of food and transfers them to
his mouth
1/5/2024 45
46. AMBULATION(MOTOR GROWTH)
• 9 month old: crawl
• 10 month old: creep
• 1 year: stand independently from a crawl & creep
position
• 13 month old: walk and toddle quickly
• 15 month old: can run
1/5/2024 46
47. 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.
1/5/2024 47
48. SOCIAL DEVELOPMENT:
• He learns that crying brings attention.
• The infant smiles in response to smile of others.
• The infant shows fear of stranger (stranger
anxiety).
• He responds socially to his name.
1/5/2024 48
49. CONT…
• According to Erikson, the infant develops
sense of trust. Through the infant's interaction
with caregiver (mainly the mother), especially
during feeding, he learns to trust others through
the relief of basic needs.
1/5/2024 49
50. 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 1/5/2024 50
51. TODDLERS:
Toddler stage is between 1 to 3 years of age.
During this period, growth slows
considerably.
1/5/2024 51
52. 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
1/5/2024 52
53. HEIGHT:
• During 1–2 years, the child's height increases by
1cm/month.
• The toddler's height increases about 10 to
12.5cm/year.
HEAD AND CHEST CIRCUMFERENCE:
• The head increases 10 cm only from the age of 1
year to adult age.
• During toddler years, chest circumference continues
to increase in size and exceeds head circumference.
1/5/2024 53
54. TEETHNING:
• 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
1/5/2024 54
55. 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.
1/5/2024 55
56. FINE MOTOR - TODDLER
• 1 year old: transfer objects from hand to hand
• 2 year old: can hold a crayon and color vertical
strokes
o Turn the page of a book
o Build a tower of six blocks
• 3 year old: copy a circle and a cross – build
using small blocks
1/5/2024 56
57. GROSS - MOTOR OF TODDLER:
At 15 months, the toddler can:
• Walk alone.
• Creep upstairs.
• Assume standing position without falling.
• Hold a cup with all fingers grasped around it.
At 18 months:
• Hold cup with both hands.
• Transfer objects hand-to hand at will.
1/5/2024 57
58. CONT…
At 24 months:
• Go up and down stairs alone with two feet on
each step.
• Hold a cup with one hand.
• Remove most of own clothes.
• Drink well from a small glass held in one hand.
1/5/2024 58
59. CONT…
At 30 months: the toddler can:
• Jump with both feet.
• Jump from chair or step.
• Walk up and downstairs, one foot on a step.
• Drink without assistance.
1/5/2024 59
60. ISSUES IN PARENTING – TODDLER
(EMOTIONAL DEVELOPMENT)
• Stranger anxiety – should dissipate 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
1/5/2024 60
61. COGNITIVE DEVELOPMENT:
• Up to 2 years, the toddler uses his senses and
motor development to different self from objects.
• The toddler from 2 to 3 years will be in the pre-
conceptual phase of cognitive development (2-4
years), where he is still egocentric and can not
take the point of view of other people.
1/5/2024 61
62. SOCIAL DEVELOPMENT:
• The toddler is very social being but still egocentric.
• He imitates parents.
• Notice sex differences and know own sex.
• According to Erikson,
• The development of autonomy during this period is
centered around toddlers increasing abilities to
control their bodies, themselves and their
environment i.e., "I can do it myself".
1/5/2024 62
63. PRE-SCHOOL CHILD
It is the stage where child is 3 to 6 years of age. The
growth during this period is relatively slow.
1/5/2024 63
64. PHYSICAL GROWTH:-
Weight: The preschooler gains approximately
1.8kg/year.
Height: He doubles birth length by 4–5 years of age.
PHYSIOLOGICAL GROWTH:
• Pulse: 80–120 beat/min. (average 100/min).
• Respiration: 20–30C/min.
• Blood Pressure: 100/67+24/25.
1/5/2024 64
65. FINE MOTOR:
• 3 year old: copy a circle and a cross – build using
small blocks
• 4 year old: use scissors, color within the borders
• 5 year old: write some letters and draw a person
with body parts
1/5/2024 65
66. FINE MOTOR AND COGNITIVE ABILITIES
PRE-SCHOOL
• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself
1/5/2024 66
67. COGNITIVE DEVELOPMENT:
Preschooler up to 4 years of age is in the pre-
conceptual phase. He begins to be able to give
reasons for his belief and actions, but not true
cause-effect relationship.
1/5/2024 67
68. EMOTIONAL DEVELOPMENT OF
PRESCHOOLER
• Fears the dark
• Tends to be impatient and selfish
• Expresses agression through physical and
verbal behaviours.
• Shows signs of jealousy of siblings.
1/5/2024 68
69. SOCIAL DEVELOPMNT OF
PRESCHOOLER
• Egocentric
• Tolerates short separation
• Less dependent on parents
• May have dreams & night-mares
• Attachment to opposite sex parent
• More cooperative in play
1/5/2024 69
70. 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.
1/5/2024 70
71. 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
1/5/2024 71
72. CONT…
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. 1/5/2024 72
74. SCHOOL YEARS: FINE MOTOR
• Writing skills improve
• Fine motor is refined
• Fine motor with more focus
• Building: models –
• Musical instrument
• Painting
• Typing skills
• Technology: computers
1/5/2024 74
75. MOTOR DEVELOPMENT
At 6–8 years, the school–age child:
• Rides a bicycle.
• Runs Jumps, climbs and hops.
• Has improved eye-hand coordination.
• Prints word and learn cursive writing.
• Can brush and comb hair.
1/5/2024 75
76. CONT…
At 8–10 years, the school–age child:
• Throws balls skillfully.
• Uses to participate in organized sports.
• Uses both hands independently.
• Handles eating utensils (spoon, fork, knife)
skillfully.
At 10–12 years, the school–age child:
• Enjoy all physical activities.
• Continues to improve his motor coordination.
1/5/2024 76
77. 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.
1/5/2024 77
78. SOCIAL DEVELOPMENT
The school–age 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 self–control, confident, sincere.
• Respects parents and their role
• Engage in tasks in the real world.
1/5/2024 78
79. NURSING INTERVENTIONS IN
GROWTH AND DEVELOPMENT
Infant:
Encourage parents to hold and stay with infant
Provide infant with toys that give comfort or
stimulate interest
Toddler:
Maintain toilet training procedures
Encourage appropriate independent behavior
Give short explanations
Provide awards for appropriate behaviors 1/5/2024 79
80. CONT…
Pre-schooler:
Encourage parents to be involved in care of child
Provide safe versions of medical equipment's for play
time
Give clear explanations about procedures and illness
School-age child:
Provide for privacy and modesty
Explain treatments and procedures clearly
Encourage continuation of school work
1/5/2024 80
81. CONT…
Adolescent:
Provide privacy
Interview and examine adolescent without parents
presence, if possible
Encourage adolescent participation in treatment and
decision making
Encourage visitation of peers
1/5/2024 81
82. CHILDREN'S IN SOUTH ASIA:
South Asia is home to about 627 million children under 18 years
of age - approximately 36 percent of the total population of 1.82
billion.
Countries in South Asia have made remarkable progress in human
development. Most are now classified middle-income countries,
with rapid economic growth and improving social indicators. In
the last five years alone over 150 million people have climbed out
of income poverty.
Bangladesh, India, and Pakistan are among the ten most populous
countries in the world while Bhutan and Maldives are among
those with the smallest population.
1/5/2024 82
83. CONT…
Urbanization is also shaping South Asia’s development trajectory.
Nearly 130 million South Asians currently live in informal urban
settlements, but with rapid and uncontrolled urbanization this
may increase to 42 percent by 2035.
The region faces continuing challenges from weak urban
governance, poor provision of public services, lack of effective
social protection systems and mounting urban poverty to the
impact of climate change, natural hazards, political turmoil,
gender inequality, etc.
1/5/2024 83
84. CONT..
newborn deaths now account for 44 percent of under-5 deaths
globally and almost 60 percent of the deaths in South Asia.
Globally, there are 23 million children who are not fully
immunized and 8 million of them live in South Asia6.
South Asia is home to more than half the world’s wasted children,
a key driver of the high stunting prevalence.
only two-thirds of children between the ages of 36 to 59 months
are developmentally on track in South Asia.
only half the children in South Asia attend early learning
programmes.
1/5/2024 84
85. Cont…
South Asia is the third highest region for violence against children
There are still 610 million people practicing open defecation (over
60% of the global burden) and over 119 million people do not have
access to even a basic level of drinking water.
South Asia is home to the largest numbers of out-of-school
children and youths at 31.8 million with 8.2 million at primary level
(6 to 9 years) and 23.6 million at the secondary level (10 to 14
years
Nowhere else in the world is the incidence of child marriage as
high as it is in South Asia.
1/5/2024 85
86. CONT…
Adolescents in South Asia today remain largely invisible and
voiceless. Girls get married and have children before they reach
adulthood, many adolescents are out-of-school and those that are
in school are poorly educated and lack skills. When adolescents
reach the working age, they face unstable labour markets, poor
wages and evolving
South Asia is highly prone to disasters including flooding,
droughts, earthquakes, refugee flows and climate change which
has led to human suffering.
1/5/2024 86
87. CHILDREN’S IN PAKISTAN:
Newborn rituals: In Muslim families, it is common for the father
or the grandfather of the child to recite the Azan (Call to Prayer) in
the child’s right ear and the Iqama (Avowal of faith) in the child’s
left ear just after birth to confirm that the child is Muslim.
All boys are circumcised.
The child is usually named within forty days after birth and thus is
generally known by a nickname until then.
A newborn baby's hair is shaved off and food is distributed to the
poor in a ritual called “Aqiqa”. The tradition dictates that shorn
hair is weighed and balanced against silver, and that silver is then
given to the poor.
1/5/2024 87
88. CONT…
Parenting: Pakistan is an extremely pronatalistic society
(encourages having children), and the desire to have a male child
is greatly stressed.
Male children are raised to be assertive, less tolerant,
independent, self-reliant, demanding, and domineering.
Females, in contrast, are socialized from an early age to be self-
sacrificing, docile, accommodating, nurturing, altruistic, adaptive,
tolerant, and religious and to value family above all.
1/5/2024 88
89. CONT…
Childrearing practices in Pakistan tend to be permissive, and
children are not encouraged to be independent and self-sufficient.
In Pakistani culture, the whole family is involved in the care of
the children.
Respect is highly valued and children are taught to be respectful
of all elders, whether it is grandparents, siblings, teachers, or
family friends.
In the traditional family, communication between parents and
children tends to be one-sided. Children are expected to listen,
respect, and obey their parents.
1/5/2024 89
90. CONT…
Food: Because at least 95 percent of the Pakistani population is
Muslim, there are two food customs that are followed almost
universally.
First, Muslims do not eat pork (therefore beef, chicken, lamb, and fish
are the basic foods), and second, alcohol is forbidden.
The Mughal and Persian styles of cooking, which is rich and extremely
spicy heavily, influences Pakistani cuisine.
The diet is heavily meat based. Both Wheat and rice are the main stays
of the daily diet. Green and black tea is the typical drink served at all
meals.
1/5/2024 90
91. CONT…
Pakistan has over 80 million children and is suffering to fulfil
their needs. Children in Pakistan are vulnerable to several
development challenges impacting their safeguarding including:
quality of education, prevention of sexual exploitation of
children, child trafficking, marriage, and labour.
23 million children unable to go to school, only 71% of children
attend primary school in Pakistan. The government allocates
1.8% of its national budget to education, which is undoubtedly
insufficient considering the urgent need.
1/5/2024 91
92. CONT…
In Pakistan, a child’s right to health is endangered from their
youngest age. Approximately one child out of six dies before the
age of five.
These deaths are ordinarily caused by malnutrition or the lack of
access to clean water and supplies. Every day, around 1,100
Pakistani children die from diarrhea and illnesses related to water,
sanitation, and hygiene.
In Pakistan, there are many “invisible” children, children who are
not recognized by the Pakistani law because their births are not
recorded.
1/5/2024 92
93. CONT…
Around 70% of deliveries are not officially reported to the
Pakistani public authorities.
There is a great necessity to inform the general public about the
problems that this could cause, such as the absence of official
identity, nationality, or even the failure to respect the rights and
practical needs of children.
1/5/2024 93
