1.
GROWTH & DEVELOPMENT
IN INFANCY
Lt Col Nirmala Roberts
India

2.
INFANCY
Neonate – Birth – 28 days
o Early neonatal period – 0 - 6 days
o Late neonatal period – 7 – 28 days
Infancy - 28 days – 12 months
o Physical adjustment to external environment
o Rapid motor, cognitive, and social development
o Trust develops
o Psychological adjustment of parents

3.
We shall see…
Infancy through -
• Growth and physical maturation
• Motor skill Development
• Psychological development
• Needs and special concerns

4.
GROWTH & PHYSICAL
MATURATION
• Anthropometry (Measurements &
Proportions)
• Maturation of Systems

5.
Anthropometry

6.
WEIGHT
Age Weight
At birth 2.5 – 3.5 Kg
0 – 7 days 10% loss of Birth weight (Physiological losses)
By 10th day Lost wt regained
0 – 6/12 yr > by 30 gms / day OR 150 gms / wk
5 – 6/12 yr Birth weight doubled
7 – 12/12 yr > by 15 gms / day OR 75 gms / wk
1 year Birth weight trebled
Weech’s formula -
3 – 12 Months  X+ 9 (X – Age in months)
2

7.
LENGTH
Age Length
At birth 50 cms (20”) + 2 cms
First 6 months > by 2.5 cms / month
Later 6 months > by 1.25 cms / month
At 1 yr of age – Length at birth x 1.5 = 75 cms

8.
OCCIPITO-FRONTAL
CIRCUMFERENCE (OFC)
Age OFC
At birth 35 cms
 1.25 – 2.5 cms > Chest Circumference (CC)
0 – 3 months > es by 2 cms / month
3 – 12 months > es by 2 cms / 3 months
1 Year OFC = CC
• Dine’s formula for OFC in infants – Length (cm) + 9.5
2
 Neural development, brain growth, and neural
abnormalities, such as hydrocephalus.

9.
Closure of Fontanelles
•Increase of brain weight – By 2½ times in the first year!
Anterior fontanelle - 12-18 months (1½ yrs)
Clinical significance – Hydration & ICP status
Posterior fontanelle –
6 – 8 weeks (1½ months)
Sphenoid
fontanelle
Mastoid
fontanelle

10.
Chest Circumference
• At Birth - 33 cms, barrel shaped
• At 1 yr of age - 45 cms (Equals OFC)
- Transverse diameter > AP diameter by 25 %

11.
MID UPPER ARM CIRCUMFERENCE
(MUAC)
• MUAC – NBB – 9 - 11 cms
• Not recommended for use in < 6/12 yrs (lack of data
on its reliability)
• 1 year – 15 - 17 cms.

12.
BODY PROPORTIONS
Big heads, large trunk, short
extremities upto 2 years
Mid point of body
- In infants - 1.8 cms above umbilicus
Sitting Height
- At Birth – 70% of total length

13.
Dentition
• Begins at 6 – 12 months
Rule – Age (months) - 6 = No of teeth. OR
No. of teeth + 6 = Age in months
(not a reliable parameter)
 teething problems - irritability, tender and
swollen gums

14.
Maturation of Systems

15.
Cardiovascular System
Heart – Transversely placed, Apex beat at IV ICS
HR – 140/mt (NBB)…….. 80 – 120/mt (1 yr)
Sleeping Pulse Rate – 10 – 20 beats lower
BP – 64/40 …. 90/60 mm Hg
Systole >es in the 2nd month
Diastole falls in the first 3 months, then >es

16.
Hematological system
Hb F –Lasts till 5/12 yr
 HbF 
� Suppresses production of erythropoietin
� <ing maternal stores of Fe by 5/12 yr
 Physiological Anemia
�>ed load of bilirubin (due to < ed RBC life span)
 Physiological Jaundice
.... HbA steadily increases in the first 6 months of life

17.
Respiratory System
Resp rate – 35 –50/ mt
Respiration is abdominal & diaphragmatic
Mostly nose breathing - till 6 months of age
Trachea close to bronchi, narrow lumen
 Risk for choking, aspiration, respiratory
obstruction
< IgA in mucosal lining
 Risk for Resp infection
Short straight eustachean tube
 Risk for middle ear infection

18.
• Lymphatic System –
• Hyperplastic in children.
• Maximum increase in growth around 6-7
years of age
• Grows steadily till puberty, then resolves

19.
Gastro-intestinal System
Salivation begins at 3 months
Stomach capacity – 20 ml at birth, 360 ml at 1 yr
Daily intake – 150 – 160 ml/kg
 Enzyme amylase  Poor digestion of complex CHO
Liver immature throughout infancy - ↓ gluconeogenesis,
formation of plasma proteins & ketones, storage of vitamins,
deamination of amino acids
Stools – Higher frequency in exclusively breastfed infants in
the first 2 months of life
By 1 yr – 3 meals + 1 bed time feed
- 1 or 2 bowel movements

20.
• Nervous System –
NBB – Brain wt – 10% of body weight
Infancy – Rapid brain growth... 80% by 4 yrs
Myelination begins after 3 months, completed by
2 years
Primitive reflexes replaced by righting reflexes &
voluntary, purposeful movements

21.
Immunologic System
IgG - Maternal IgG upto 3 months.
Begins self synthesis by 1 year (40% of adult levels)
IgM - Produced at birth. Adult levels by 9 months
IgA - Production gradual. Adult levels by puberty.
Large amounts in colostrum – Protects the gastric mucosa.
IgD and IgE – Gradual formation till early childhood

22.
Integumentary
System
Vernix caseosa is protective
Epidermis matures in 1st month – prevents infection,
thermal losses and water losses
BSA is 3 times more by volume than of the adult
Absent shivering and sweating at birth
- Accumulation of adipose tissue in 6 months
( helps insulation)
Thermoregulation and thermogenesis improves

23.
Fluid & Electrolytes
• NBB – 75% of total body wt is water.
<es to 45 – 60% (Male - 50 – 65%)
- ECF vol - 40%. <es to 20% in adulthood
 Risk for dehydration in fever, diarrhea..

24.
Renal System
• Immature at birth
Complete maturity (>ed GFR) achieved in 18 to 24
months
Urine Sp.Gr – 1.000 – 1.010
Predisposition to dehydration & elect imbalance

25.
Special Senses
Hearing – Adult levels of acuity
• 6 months – can differentiate familiar voices
• 7 months – vestibular function begins
• Short external auditory meatus & Eustachian canal
Visual – Low acuity. Hypermetropic
• 6 wks – 4 months – Binocularity well estd.
• 7 - 9 months – Stereopsis ( depth perception) begins to
develop. Fully mature by 2 - 3 yrs of age
 Risk of falling

26.
MOTOR DEVELOPMENT

27.
GROSS MOTOR
(Devt.al maturation in posture & locomotion)
General movements
Head balance (3/12)
Rolling over (5/12)
Sitting without
support (6/12)
Walking (12 months)
Sitting with support (4/12)
Standing (10/12)
Crawling & Creeping (8/12)

28.
FINE MOTOR
• Use of hands and fingers in prehension
Grasp reflex at 0 – 3months
Palmar grasp
Crude pincer grasp – 8-9 months
Neat pincer grasp – 11 months
Builds a tower of 2 blocks by 1 year
• eye coordination, hand- eye coordination,
hand to mouth coordination

29.
PSYCHOLOGICAL DEVELOPMENT

30.
Psychosocial Development
Reflex behaviour – Response to parent, others
1 month – Social smile, 4 months – laughs aloud.
Play helps socialize
Attachment- Indiscriminate response. cry, smile
Vocalize more to mother, distinct preferences
6 months – ‘peekaboo’, asks to be carried
- Stranger anxiety & separation anxiety
Eric Erickson- Trust Vs Mistrust
- 3-4 months – Oral phase (pri narcissism)
- 5-12 months – Social phase

31.
Language
Cry – for displeasure and pleasure
2 months – ah, eh, uh….
3 months – coos, gurgles, laughs (n,k p, g)
8 months – Imitates sounds t,d,w
9-10 months – Understands ‘NO’, obeys simple commands
1 yr – 3-5 words with meaning

32.
Play and sleep
Play – Sensorimotor, narcissistic, dependant, solitary
- Laughs, peekaboo, pat-a-cake, repetition,
imitation
- Selective after 6-8 months (No strangers!)
Sleep – 0-6 months – 18-20 hrs /day
- 6-12 months – 16-18 hrs/day
IMPORTANT – Not only ‘to play’, but to be ‘played with’.

33.
• Psycho- sexual development
Sigmund Freud – Oral phase
• Cognitive ( Intellectual) development
Jean Piaget – Sensorimotor Phase ( 0-2 yrs)
- Use of reflexes, deliberate acts, repetitive acts (4-8
months), object permanence (10 months), develops
self image by 1 yr of age

34.
SUMMARY OF MILESTONES OF
DEVELOPMENT
• 1 Month - Social Smile
• 2 Months - ah, eh, uh sounds
• 3 months - Head holding
• 4 Months - Grasps objects, sits with support
• 5 Months - Rolls over
• 6 months - Sits without support
• 7 Months - Crawls & creeps
• 8 Months - Thumb- finger prehension
• 9 months - Pulls up to sit, stands with support
• 10 Months - Walks with support
• 11 Months - Stands with support
• 12 months - Takes a few steps by self

35.
Language
Cry – for displeasure and pleasure
2 months – ah, eh, uh….
3 months – coos, gurg;es, laughs (n,k p, g)
8 months – Imitates sounds t,d,w
9-10 months – Understands ‘NO’, obeys simple commands
1 yr – 3-5 words with meaning
Play – Sensorimotor, narcissistic, dependant, solitary
- Laughs, peekaboo, pat-a-cake, repetition, imitation
- Selective after 6-8 months ( No strangers!)
Sleep – 0-6 months – 18-20 hrs /day
- 6-12 months – 16-18 hrs/day
- 2-4 yrs - 12-16 hrs/ day
- 5-10 yrs - 10-12 hrs/ day
IMPORTANT – Not only ‘to play’, but to be ‘played with’.

36.
NEEDS & SPECIAL CONCERNS IN
INFANCY

37.
Love & security
Nutritional needs –
o Cals - 0 – 6 months - 100 – 120 Cal/Kg
6 – 12 months - 95 - 100 Cal/Kg
o Protein - 1-1.5 gms/Kg.
o Exclusive breast feeding upto 6 months
o Timely & quality weaning
 Malnutrition and nutritional deficiency

38.
General hygiene
Promotion of growth & development
Promotion of play
Sleep & activity, infant shoes
Care in teething, thumb sucking
Protection from accidents
Immunization & Vit A prophylaxis

39.
Protection from infection (skin, eye,
ear, oral, GIT, Resp, umbilical)…and
from Covid infection
Regular medical check up
Dental health

40.
• Psychological needs – Help develop ‘Trust’
- Play ‘with’ the child
- Care to prevent separation anxiety
- Prevent stranger fear & anxiety
- Encourage inquisitive behaviour
- Develop sensory perception
- Avoid unpleasant tastes
- Avoid painful experiences

41.
Questions any???